In-House ASC Billing: How Performance Goes Awry

Revenue cycle outsourcing is surging in popularity among ASCs. Two of the main reasons why: It's become more difficult to run a successful ASC business office, and it's become much easier for a business office's performance to fall off and then struggle to recover.

Here are five of the top factors that can contribute to declines with in-house ASC revenue cycle performance and are motivating more centers to outsource their billing.

1. Staff turnover

Running a lean operation is essential to keeping ASC costs low. This approach also means that any staff turnover has the potential to significantly disrupt operations and workflows. Unfortunately, staff turnover has become an all-too-common challenge for surgery centers, as has recruiting staff to fill openings. Open positions can lead to a backlog of uncompleted business office tasks that stall claims submission, appeals, and collections. Unfilled positions can also strain the remaining staff who must take on additional responsibilities until the position is filled, which can increase the likelihood of errors and more staff turnover. An extended staff member absence for reasons like illness, parental leave, or vacation can bring the same negative effects as an open position.

Even if an ASC is fortunate to find someone to fill an open position, this will not serve as an instant cure-all for the revenue cycle problems associated with the turnover. In fact, achieving long- and even some short-term improvements are not likely to come easy. Initial training on the ASC's procedures, payers, workflows, and processes will typically take a long time, and ongoing oversight and the continuous training required are often exhaustive work. If the position is filled by someone not as competent or experienced in ASCs as their predecessor, this will cause further revenue cycle disruptions.

2. Staff burnout

Even before the COVID-19 pandemic, burnout among the health workforce was a concern. The pandemic further magnified this challenge. Burnout is not just associated with a heavy workload. It can be caused by personal challenges, leadership and staff changes, a perceived lack of appreciation for job performance and success, unrealistic job expectations, and changes to a workload and responsibilities, among others.

Burnout can harm day-to-day staff productivity, lead to distractions that increase errors and oversights, cause a rise in absences, and weigh on an ASC's culture. All these effects can strain revenue cycle performance, with the potential for the effects to magnify if burnout is not identified and addressed quickly.

3. Growth

Growth is generally good news for an ASC. Adding new specialties, procedures, and physicians, or even just increasing the number of performed procedures, should all help improve a center's financial performance.

But growth brings with it many potential challenges for a business office. Current staff may not have the skills and experience to effectively code and bill for the new specialties and procedures. This will require the ASC to either educate and train staff in these areas or recruit new staff with applicable knowledge — both of which can prove difficult and potentially lead to declines in performance. Current staff may not have the bandwidth to take on the additional work. If recruiting staff proves difficult, existing staff may start to feel burned out if they need to shoulder more responsibilities.

4. Changes to payer rules

Payers regularly change the rules providers are expected to follow — and sometimes do so with little or clear notice. If business office staff struggle to remain current on rules changes, this can lead to a flood of claims rejections and denials. If staff then struggle to keep up with or properly respond to rejections and denials, an ASC's cash flow and bottom line will suffer.

5. Adding payers

Requirements can greatly differ between payers. The addition of a payer requires staff to learn and follow new coding and billing rules while ensuring they do not mix up requirements between payers. Misunderstandings and mistakes can lead to payment delays, rising accounts receivable, and even payment losses if timely filing requirements are missed.

Powering Better Revenue Cycle Performance With Outsourced ASC Billing

Operating a competitive ASC these days is far from easy. Surgery centers must take advantage of opportunities to navigate obstacles to viability and pursue improvement initiatives that strengthen operations and financial results.

Moving from in-house to outsourced ASC billing is a time-tested strategy. Outsourced billing keeps revenue cycle performance and an ASC's bottom line on track while alleviating administrative and leadership workloads, freeing up time that can be allocated toward clinical and operational needs.