Q: What issues do you see in ASC back office functions?
JF: We consistently find issues during our evaluations of surgery center business practices that relate directly to a lack of rules, processes, and procedures being in place. When there is not on-going education and compliance throughout the entire continuum of back office services — from coding to billing to collections — that every area is impacts. We see coding issues that directly impact both compliance and revenue, we see billing departments consistently fail to bill correctly for implants, we find there is no process in place to collect patient time-of-service co-pays, a general lack of understanding on effective write-off policies and much more. You need to truly take an objective look at how well you are performing and take the necessary steps to improve all aspects of your practice. There needs to be an adoption of procedures and processes, an understanding of best practices along these service lines and an adoption from the entire team to make this work.
The impact on revenue and compliance is significant. There are a number of ways that ASCs can improve these functions — the most important of which is to truly access how well they are performing all functions along the continuum of service — from patient registration and verification and pre-registration through transcription and coding and onto billing, claim follow-up, patient statement, collections, payment posting and finally the reporting and data analytics. What we have done is create a best practices metrics in each one of the practice areas using our industry leading benchmarking data gathered from over 500 ASCs. What we have found is that when best practices aren’t achieved in even one area, never mind three or four, that the entire business is impacted. We see not only the impact on revenue, but on costs, quality and compliance. I can’t tell you how many times over the years someone has told me there billing office does a good job — only to find out that they are losing 100s of thousands of dollars or more every year because they simply don’t know that they could be and should be doing things differently.
Q: What can ASCs do to improve efficiency?
JF: There needs to be an understanding of how well you are performing against industry accepted best practices. Compare these to how well you are performing in each specific business office function — from transcription and coding and feed through the billing, claim follow-up, patient statements, collections, payment processing and reporting. This will enable you to focus on areas that need improvement and then create a plan that will address this. This can include staff training, on-going education, implement the appropriate rules and processes along service lines, and continually track your performance. The challenge for any ASC, whether independent or managed, is to truly understand their business and make the appropriate changes.
Q: What financial changes have you seen in the market over time?
JF: My first 20 years in the ASC space were marked by unprecedented growth and financial success — surgery centers were making money and thriving for the most part — often time in spite of themselves. That has all significantly changed over the past few years — as a result of the economy, increased government regulation, reimbursement pressure, decreasing case volume for elective surgeries and more — we have seen almost zero growth in the ASC market. What it means is that surgery centers, whether independent or in partnership, have had to step back and take a hard look at their business. We have seen that most centers continue to do business as they had just a few years ago and that for many, by the time they realize they have a problem they are in serious trouble. More than ever ASCs need to have someone looking at their business with a magnifying glass and finding ways to help them survive and thrive in this climate.
Q: What is important for ASC leaders to know about the future of the market?
JF: While all of the aforementioned challenges will continue to exist — the ASC business will continue to offer opportunity for those who embrace change. We continue to see technological changes that positively impact the way procedures are performed and patients are cared for in this setting. An example is what we are doing for business offices. We have been able to leverage technology, expertise and processes to significantly impact both compliance and the financial success of surgery centers. By creating a seamless and transparent solution for ASCs we have been able to effectively improve all of their billing processes, give them real-time insight into their business and provide them with the data analytics necessary to make informed decisions. Now is the time to evaluate your entire business and implement changes that will enable you to survive and thrive moving forward.
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