Revenue Cycle Management For Ambulatory Surgery Centers

Revenue Cycle Management For Ambulatory Surgery Centers

Typically, when ASC (Ambulatory Surgery Center) practice started 40 years back in 1970, it was majorly the individual-owned single specialty structure with very limited outpatient procedures. But as the healthcare industry evolved over time with technological advancements, it became possible to perform several other procedures safely at ASC without a need to stay overnight at the hospital. Legislative and CMS rules supported the growth of ASCs during the Covid-19 pandemic period as it probes less risk of transmission of the virus, making it grow from 5,717 in 2018 to 7000 in numbers at the end of 2022. Now, an increasing number of individuals are turning to ASC for their surgeries as it provides specialized care with lesser drain from the pocket.

ASC Billing

ASC billing is altogether different from a hospital or provider billing, as it involves two separate bills – one from the provider physician, and the other from the ASC facility. CMS has established an Outpatient Perspective Payment System (OPPS) for covered surgical and ancillary services like – drugs, biologicals, anesthesia, radiology, brachytherapy sources and excluding the non-implantable DME.

Tips to Maximize Revenue

Although setting up an ASC is itself a huge and costly endeavor, running it efficiently to generate maximum profitable revenue necessitates a significant amount of administrative work too. The establishment of the No Surprise Act (NSA) in 2022 has placed another nail into the coffin. As ASC seems a lucrative option for providers it’s crucial to understand its revenue and practice model heuristics to make the best of available resources. Here are some tips to scale up revenue from your ASC business:-

1. C-Code

CMS has issued a new C-code to indicate the complexity and expenditure incurred in the procedure performance. Applying the correct C-codes can generate better payment adjustments rather than using the combination codes. For instance,

For a complete list effective from January 2023, you can visit CMS Manual System

2. Multispecialty Model

More than 65% of ASC are single specialties concentrating a very less percentage of each specialty type with the highest of 25% in ophthalmology. The trend of multispecialty ASC is in boom where all specialty types are in a good deal with the highest of 69% in orthopedic. Opting for a multispecialty model gives ASC the leverage to deal against specialty-centric downfall due to economic and constitutional changes. The loss from one can be offset by the other.

3. Financial Statement Knowledge

Understanding business financial statements will give you an edge to better plan your resources and funds. A little insight into asset depreciation, account receivables turnover period, and cash flow statement can help in decisions pertaining to investment in equipment and analyzing ROI. Cash Flow statement analysis enables you to meet everyday operating expenses efficiently and also to maintain a contingency amount for accidental glitches in the plan.

4. Negotiate with Suppliers

ASC reimbursement rates are based on the consumer price index which doesn’t harbor medical inflation properly. To minimize the effect, it’s better to negotiate when purchasing implants and equipment. It will make the business operation cost-effective and maximize your margin in the total bill claim. A Penny saved is a penny earned – it will result in more revenue and more availability of funds for fixed and large investments. Buying specialized or customized packages for ASC can prove to be a deal and reduce maintenance burden.

5. OR Management

To increase your operating room turnover, prioritize cases as per specialty requirements. Keep the OR manager in sync with the physicians’ office for advance scheduling and documentation completion. This will give you ample time to order implants and other requirements. Scheduling similar surgeries consecutively in the same room will save preparation time and reduce staff hassle.

6. Recruitment

Grand View Research exhibited the expected growth in the ASC market from USD 34.8 Billion in 2021 to USD 58.6 Billion in 2030. The upsurge in numbers is elevating the demand curve for competent physicians. Recruiting top-notch physicians from the limited pool is a target to achieve for successful ASC establishments. They will not only promote the ASC’s reputation but also bring in their already established patient volume to the ASC. Recruiting multi-specialized staff will snip staffing costs and OR placement juggle between surgeries.

7. Outgrow Procedures

CMS has expanded the list of covered surgical procedures and ancillary services. ASC should also follow suit by adding those technically advanced procedures and physician investors to the list as ASC surgical procedures are protected against Stark self-referral law allowing them to perform the procedure at ASC. This will increase the overall patient volume and revenue size. Migrating OBL (office-based procedure room or lab) and VAC (vascular access centers) procedures into ASC brings better reimbursement rates. For instance, OBL Angiogram with Angioplasty (CPT 36902) rate is $1,338 while the same is reimbursed at $3,119 in the ASC setting. Plan the expansion by analyzing case mix and reimbursement rates considering geographical adjustments and competitive market.

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