Specialized procedures are migrating to the outpatient setting, including complex orthopedic, spinal, and cardiology surgeries, among others. The health care trends driving specialized surgeries to ambulatory surgery centers include cost savings, technological advancements, convenience, safety and outcomes. Patients, providers, and payers are all benefiting from this shift from hospital to outpatient surgery facilities.
If you’re focusing on ways to maximize reimbursement in your surgery center, you want to first maximize the value of these complex procedures by adopting policies that reduce claim denials and improve front desk staffing.
Here are five strategic considerations to measure ROI for complex procedures and provide a roadmap for maximizing the reimbursement in your surgery center.
Most Ambulatory Surgery Centers perform a combination of simple and complex surgeries. For a simple procedure, managed care contracts may seem straightforward; however, when you’re performing more complex procedures there’s an increased probability of additional expenses. It’s also likely that your managed care contracts will be ineffective in terms of the language as it relates to cardio, ortho, and spine procedures or the contract might have dated reimbursement rates. It is important to review your contracts and negotiate more effective terms. For ambulatory surgery centers to increase revenue on complex surgery procedures, it’s critical for managed care contracts to work to your advantage—and that means knowing what you earn on every procedure.
One of the first interactions with patients happens at the front desk. This is where patient information is captured, and where patients develop an impression of what their experience might entail. That’s why it’s essential for front end processes to be thoughtful and well-executed. This may mean investing in better training for front desk staff or implementing new technology. When front desk processes accurately capture patient demographics and insurance information, claim denials are reduced, and the overall revenue of your center increases.
The No Surprises Act went into effect January 1, 2022; providers are now required to have the ability to produce good faith estimates when asked. While it is common for patients to have to pay some portion of their procedure, not all patients understand their insurance plan, what is covered, what their portion will be and when that payment is due. Having someone available to talk with patients and educate them from a financial perspective will improve the patient’s experience and help to ensure the surgery center is getting paid on time.
After investing a considerable amount of time, effort, and money into your surgery center, make sure you reap the rewards of your efforts. One of the best ways to do this is to make sure you have strong coders that understand your surgery specialties, specifically the new procedures you want to add. Coding incorrectly will lead to denials, underpayments, or overpayments which becomes a compliance issue. Coding errors related to complex procedures can lead to denial of insurance claims or patients left with unexpected bills. Even when errors are corrected, you may experience a significant delay of payment as a result. Having a tight process for accounts receivable is necessary to ensure you maintain good cash flow.
Since cardio, orthopedic, and spinal surgeries have complex CPT codes, surgery centers can find it challenging to measure case costing and ROI. Modern analytics software can help you create tangible benchmarks and make sense of the data. Data is an important way to determine what is working for your surgery center and, more importantly, what is not. This can help you measure growth and give you data that makes it clear whether your complex procedures are helping your revenue stream. The right revenue cycle analytics will allow you to track the performance of your surgery specialties in detailed daily, weekly, and monthly reports. Analytics help you to determine what your cash per case is, your denial rate, even how many implants are sitting out there that have not been paid.
This is an exciting time of growth for surgery centers. High growth and high margin procedures will increase revenue opportunities for your ASC. By implementing strategies to effectively manage your revenue cycle, you’ll maximize your surgery center’s revenue potential.
National Medical Billing Services can help you establish the processes, systems, and software you need to capitalize on the value of complex surgery procedures.
Read our case study on how our client gained 640% revenue growth by adding total joint procedures to their surgery facility.
This post was first published June 30, 2022 and was updated August 1, 2022.