Choosing an ASC Billing Company: 10 Questions to Ask
Selecting the right ASC billing company as your business partner can be a difficult decision. Revenue cycle management (RCM) is complicated, but it's vital to the financial health of a surgery center. In this time of increasing costs coupled with tightening reimbursement, anything short of a high-functioning revenue cycle will negatively affect the financial viability of a center. Even small issues with ASC billing efficiency and performance can drive up case costs and leave money on the table, potentially turning profitable procedures into money losers.
An RCM company well-versed in ASC business operations helps to ensure a center is paid promptly and correctly while minimizing claims denials and eliminating revenue leakage and bad debt write-offs. An ASC billing company partner can provide a surgery center with many other significant financial and operational benefits.
How do you find the company that's going to be the right partner for your ASC? As part of your due diligence, you will want to interview the companies under consideration. To help you conduct a more effective interview, here are 10 questions you will want to ask of prospective ASC billing companies along with the answers you should expect to receive.
1. Will my ASC receive an assigned, dedicated team?
Answer you are looking for: "Yes." If this is not the case, ask about how your work will be assigned. When team members move in and out of accounts, this can introduce inefficiencies and increase the likelihood of errors. Team members should know each client's key details, including contracts, payment structures, billing rules, and primary and secondary points of contact. Learning and remembering this critical information is easier when staff are assigned to an account.
2. Will the team have specific experience with ASCs?
Answer you are looking for: "Yes." It is critical to have a team with ASC experience, and preferably experience with your specialty(s). ASC revenue cycle management has its own set of rules and best practices concerning coding, billing, and collections — rules and best practices that differ from those of other healthcare organizations (e.g., hospitals, medical groups). An experienced team will know the industry challenges and have experience navigating those obstacles to success.
3. Do all team members have experience working with my ASC's practice management system?
Answer you are looking for: "Yes." You want a team with experience with your specific practice management system as well as with other software systems, including those used by your clearinghouse, online payer websites, and Medicare.
4. Will my team be capable of working my ASC's specialties and payers?
Answer you are looking for: "Yes." To effectively work different specialties requires specific knowledge on their types of procedures and billing rules, which may extend to billing for the likes of implants and biologics. Such knowledge enables a team to recognize issues immediately, know how to resolve those issues, and provide information to the ASC on how to avoid those issues in the future.
As for payers, Medicare, commercial insurance companies, workers' compensation, and Medicaid have specific and sometimes challenging requirements. Payer rules and regulations can differ depending on if you are in-network or out-of-network and/or which state your facility resides. Your assigned ASC billing team must understand how to properly bill your payers. Shortcomings in knowledge will likely lead to increases in denials and delayed payments.
5. Are all coders certified, and do they receive ongoing education to stay current with all industry, state, and federal regulations/changes?
Answer you are looking for: "Yes." It is critical that coders are fully compliant and experienced with coding for ASCs. Without proper ASC coding knowledge — knowledge that's current and comprehensive — the likelihood of code capture errors rises.
6. What is the timeframe for claims submission, initial follow-up, and each subsequent follow-up?
Answer you are looking for: "Charges will be submitted within 24-48 hours of receiving complete documentation. Initial follow-up is completed within 14–21 days to ensure the claim is on file and in processing. Subsequent follow-up is based on the specifics of the case and could be daily or weekly; however, each case is worked within 30 days." This answer reveals that the ASC billing company has a defined, well-established process for claims submission and follow-up.
7. Does your team have the knowledge to analyze current managed care contracts and support us with negotiating better contracts?
Answer you are looking for: "Yes." The right ASC billing company partner can play a key role in helping surgery centers negotiate and renegotiate their managed care contracts. A billing company should help its clients determine negotiating and renegotiating goals, including what reimbursement figures should be targeted for coverage of new procedures and where payment increases would contribute most to growth. The company can provide clients with the billing data to help determine these goals.
The company should also help produce the data — key performance indicators (KPIs) and financial information — that can strengthen an ASC's negotiating position and hold a payer accountable to the terms of a modified managed care contract.
8. What analytics and reporting will my ASC receive?
Answer you are looking for: "You will receive detailed reporting of your monthly production as well as a dashboard to evaluate your key performance metrics." The ASC billing company should leverage next-generation analytics. This technology empowers a surgery center to take an even deeper dive into its revenue cycle data, unearthing insights that can be difficult to impossible to find using legacy platforms.
The ASC billing company should also help its clients analyze and organize its revenue cycle data to put together detailed presentations that can assist in benchmarking efforts.
9. Do you help with preparing board reports and developing customized reports specific to our ASC?
Answer you are looking for: "Yes to both." The ASC billing company should know how and be willing to put together detailed presentations that will assist in your board meetings. The company should also be able to customize reports based on your ASC's specific needs and wants.
10. What do you do to protect our ASC's data?
Answer you are looking for: "A lot." An ASC billing company should treat security as a top priority, and surgery centers researching their vendor options will want to make security a top area of focus and evaluation. The right vendor partner will have achieved SOC 2 Type II compliance; be able to share clearly defined security practices and methodologies, including how staff are trained on security; leverage controls and solutions that help defend against the latest security threats; and make ongoing investments in security. These are some of the key components of an ASC billing company that maintains best-in-class security.
Choosing the Right ASC Billing Company
Surgery centers must do their due diligence before choosing an ASC billing partner. Revenue cycle management companies vary greatly in the types and quality of services provided. ASCs will want to ensure the company they select as their partner is well-equipped with the ASC expertise and experience to provide significant, sustainable improvements in the revenue cycle. While partnering with an ASC billing company requires an investment, the right partner will bring financial and efficiency improvements that deliver a positive and meaningful return on investment.