8 Top Reasons Orthopedic ASCs Are Outsourcing Their Billing
It's a great time to be an ASC with an orthopedics service line. According to Sg2, a recognized expert in healthcare trends, insights, and market analytics, orthopedic procedures will be one of the specialties fueling growth in ASC volume in the coming years. The consulting firm made this prediction before the Centers for Medicare & Medicaid Services (CMS) announced in its 2024 final payment rule that the agency was adding total shoulder arthroplasty to the ASC Covered Procedures List (ASC-CPL) — a decision that should further accelerate migration of orthopedics into surgery centers.
To capitalize on this growth potential, orthopedic ASCs are increasingly outsourcing their revenue cycle management. Here are eight of the reasons why.
1. More easily accommodate growth. By outsourcing their billing, adding more orthopedic procedures is simplified. The responsibility for ensuring completion of the revenue cycle tasks associated with the increase in procedures — and sometimes new procedures, like total shoulder arthroplasty or the other orthopedic procedures added to the ASC-CPL for 2024 — is largely the responsibility of the ASC billing company.
Growing clinical operations is also easier, less expensive, and more successful with outsourced billing. As orthopedic ASCs grow, they do not need to worry about or allocate time to finding, hiring, and training new business office staff.
2. Enhanced use of physical space. With outsourced ASC billing, surgery centers free up valuable square footage that can be turned into clinical space. As orthopedic ASCs grow, the decision to outsource can eliminate a need for physical expansion or complement such expansion. If physical expansion helps capture more orthopedic case volume, outsourcing reduces or potentially eliminates the space, furnishings, technology, and supplies needed to support additional business office operations.
3. Getting paid for implants. Since orthopedic procedures often involve expensive implants, getting paid for these devices is critical as missed billing opportunities can significantly reduce the profitability of these procedures. Outsourcing billing helps ensure an ASC is paid appropriately and in a timely manner for its implants.
In addition, an ASC billing company can provide an ASC with managed care contracting negotiation support that helps ensure payments at least cover the costs of the implants.
4. More efficient use of leadership time. By eliminating in-house business office positions, ASC leadership can allocate more time and resources to recruiting orthopedic surgeons, recruiting clinical and operational staff, and performing due diligence on the equipment and technology needed to support growth.
With less time spent on internal revenue cycle processes and management, administrative leadership can also allocate more time toward executing a marketing plan that assists with physician and staff recruitment and building greater awareness of the ASC's orthopedic program.
5. Staff recruitment and retention. Through the savings achieved on business office salaries and benefits that come with outsourcing ASC billing, orthopedic surgery centers are offering more competitive salaries and benefits to the staff members they need to recruit and retain.
6. Improved managed care contracting. An ASC billing company can help its clients determine managed care contracting negotiation goals, including where payment increases would contribute most to growth and what reimbursement figures should be targeted for coverage of new orthopedic procedures and implants.
Once a new managed care contract is negotiated and loaded, the ASC billing company ensures the surgery center remains compliant with the contract terms, gets bills out in a timely manner, and gets paid what it deserves.
7. Case volume shifts. For orthopedic ASCs that experience substantial case volume changes (e.g., seasonal volume), outsourcing reduces the costs associated with shifting levels of staff.
8. Better growth decision-making. While orthopedic ASCs have opportunities to grow their case volume, sometimes it doesn't make sense to do so.An experienced ASC billing partner can help a surgery center determine whether and when it is financially practical to proceed with the addition of new procedures through analysis of existing managed care contracts.
Achieving Greater Orthopedic Success With Outsourced ASC Billing
The reasons cited above highlight some of the most significant ways outsourcing ASC billing is making it easier for orthopedic surgery centers to take advantage of their tremendous growth opportunities. In today's highly competitive surgical environment, ASCs must identify sound opportunities to strengthen their operations and bottom lines. With outsourced ASC billing, orthopedic surgery centers are putting themselves in an even stronger position to achieve long-term success.