COVID-19 Shines Light on ASC Revenue Cycle Fragility
By Chuck Meisel, Vice President of Sales
For over a year, ASC administrators have needed to confront challenges unlike any they ever encountered before — or even envisioned facing in their careers. For most administrators, these new responsibilities, layered on top of an already densely packed schedule, are making a difficult job that much more challenging.
The ASCs and their administrators that often struggled most to navigate disruptions associated with the pandemic were those that lost one or more members of their business office staff for a lengthy period. Contributing factors included a COVID-19 diagnosis or exposure; long-haul symptoms; personal challenges brought on by the pandemic; and professional challenges (e.g., burnout, fear of coming to the facility).
ASCs that experienced a loss of a clinical team member(s) also found the disruption challenging. However, such disruptions tended to have reduced short- and long-term impacts compared to centers that lost a business office team member.
Why? First, consider that most ASC administrators possess a clinical background. When a clinical staff member was unavailable, such an administrator could put on scrubs and fill a patient care role or other job in the back of the ASC. In addition, many ASCs use pro re nata (PRN) staffing and operate a flexible clinical staffing schedule. When faced with a temporary loss of a clinical staff member, this individual's role was often filled, at least in part, by PRN staff, with other clinical staff moving around responsibilities to ensure there were no gaps in care. For those longer-term or permanent absences, replacing the clinical team member may have taken some time, but ASCs could usually weather the storm by leaning more on existing clinical staff and PRN employees until the position was filled.
Unfortunately, as the pandemic has revealed to many ASCs and administrators, the loss of a business office team member is usually more difficult to manage and often wreaks havoc on revenue cycle performance. An administrator with clinical experience is likely to lack the experience and knowledge to fill an open coding or billing position. Even an administrator with a financial background may struggle to adequately perform the responsibilities required of these positions.
Unless there is an existing business office team member with the skills and bandwidth to tackle the responsibilities associated with the open position, the ASC's revenue cycle will immediately start to suffer. Billing and collections will go south — and fast.
Even if the administrator can find an available coding or billing professional to fill the position, revenue cycle roles are rarely "plug and play." This person will likely need ample time to learn about and become accustomed with a center's systems, processes, and payer contracts — everything from specific payers' rules and guidelines to where those contacts are stored to the steps required to validate payments and ensure their accuracy. If the individual lacks ambulatory surgery center experience, that will be another barrier that prolongs the time it will take to get the new hire comfortable in their position and working at full capacity. With every day that passes where the business office is operating at reduced performance, revenue inevitably suffers and problems such as billing delays and denials surface and begin to build up.
It is for these reasons and others that many administrators are reevaluating whether revenue cycle management (RCM) should be a core competency of their ASCs. What they are increasingly finding is that it should not. Administrators have enough work on their plate with managing and leading their center’s staff and other critical responsibilities, such as optimizing the surgical schedule, board meetings, physician and staff recruitment, managed care contracting, accreditation, and inventory management. Managing the revenue cycle does not need to be on this list when there are companies like Surgical Notes, capable of delivering a complete, end-to-end revenue cycle management solution to ASCs.
By outsourcing RCM, surgery centers get ASC revenue cycle experts at their fingertips. In addition, administrators can eliminate the work, stress, and concern that come with managing an in-house revenue cycle team that may be a COVID-19 diagnosis away from experiencing a rapid decline in performance.To learn more about how outsourcing can benefit an ASC like yours, check out our newest e-book, “Outsourcing Your ASC’s Revenue Cycle: How to Know When It’s Time.” Request your copy here.