Simple Steps for Surgery Centers That Can Improve Your Efficiency and Profit Margin

by on 07/05/11 at 7:27 pm

Simple Steps for Surgery Centers That Can Improve Your Efficiency and Profit Margin

Here are some insights on a few of the most commonly overlooked areas that directly affect the profitability and efficiency of most surgical sites…

Certain areas usually hindered with challenges are :

  1. Billing / collections, the “part-of” network.,
  2. The automated denial letter,
  3. One member with many caps,
  4. Inaccurate dictation leading to under or over-billing.

Within a surgery centers daily operations, only certain factors can become so mundane that the processes set up to initially help us keep those areas running smoothly, can become antiquated and eventually lead to a hole in your over all profits (cheese)  Add enough holes to any cheese and it begins to look somewhat like Swiss, when you originally started off with Mozzarella!

Out of Network Surgery Centers fail to see the benefits of treating there out of network patients as though they were in network.  To coin a phrase, my “part-of” the network.

Those of us whom have a background in Managed care will tell you that the impact that an out of network pre approval system, or “part-of”, approval system, can cut your wait time for payment from the insurance carries.  In certain cases by half, maybe even eliminate the need to wait for an approval.

Once ASC centers adopt within their scope of improvement plans, the  “in-network” comfort, zone, profitability will cease and platform, creating an in-effective channel By making insurance buyers your ally instead of foe, you not stand to bridge a communication barrier but you lend the benefits of any buy-in strategic pricing from certain Insurance companies that are willing to negotiate the cost of an otherwise not approved service.

Both ASC and Insurance providers can benefit from compromised rates for services usually lost due to denials, delayed submission, appealed and contested.

 There is no automated denial management system:

Receiving denials from payers are one of the aspects affecting the billing and collections process, Surgery centers deal with these situations on a daily basis. Many ASC’s fail to implement a system of tracking and trending denials based on compensating or non-compensating factors.  Information generated and gathered specifically to compile a report letting you know what you were paid for, why and why not.

Reports which will eventually mother a trend strong enough to have a check and balance system that not only points out weaknesses in your process, but people aswell.  Reports, which can be used in physician and peer review, is it a common

Never the less, whether it be physician, office employee or a newer piece of office equipment, once a business identifies a hole: filling it back up correctly would be advised and recommended

One staff member is responsible for the duties of many:

“A Jack of all trades is a master of none.”  Management fails to identify the time necessary to perform a process in your assembly line, making time management a big sinking hole that usually calls its self Over-time.  We’ve all seen it, budget cuts, time management, production reports: Many ASC’s will downsize their office employees to the ridiculous sometimes even questionable number of employees vs. no of patients.  While some centers can benefit from having one employee do many tasks, most ASC’s that are busy with just enough people, should take appropriate note and care to ensure everyone is able to and available to carry on the necessary task.  Outsourcing and hiring temporary or per diem employees can be a huge benefit to in some companies.

 Inaccurate dictation can lead to under billing and over billing:

Coders rely on accurate dictation procedures rom surgeons so they can bill accurately and appropriately.  Surgeons performing their dictation immediately post operatively not only impact the quality of care but the consistency of timely payments.  Timely payments for procedures being at the top of list of unaddressed concerns an ASC should address.

For Example, in a recent case one ASC chose to adopts a simple remedy to fit both the space or lack of, and process for quality improvement.  This was a quick fix, and just may be the answer your ASC is looking for.  The fix?  Was the installation of ceiling mounted surgical light which housed the adjustable Dictaphone microphone so surgeons could dictate while performing the surgery or in the event of complications and un foreseeable add-ons.  This brilliant piece of equipment specially designed to use the space already used by the overhead lights gives tandem functionality without compromising the effectiveness of each.  This tool allowed the transcriber to catch all the added modifiers, co-morbidities, complications, etc.  A technique, which could generate an more detailed, processes enabling them to bill accurately and accordingly.

Mr. Lair states that many times coders will bill correctly for the main procedures but will miss add-ons if the report is not clear and concise.  This ensures the check and balance system to ensure any inconsistencies in reporting from either surgeon, transcriber and biller.  Such information could and should be used in peer reviews and in assessing the need for additional tools and labor, previously not incorporated.  In a better effort to listen to the rhythms of your business, let this serve as a bloodline to the inner workings of the ASC.  Taking the appropriate steps to correct the palpitations within your business.  Analysis which addresses deficiencies in documentation, not supportive to “pile on the charges” philosophy which is not in the best interest of the patient.

 

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