Ambulatory Surgery Centers & Hospitals — An RCM Opportunity

Predating the introduction of the Affordable Care Act (ACA), Ambulatory Surgery Centers (ASC), launched in 1970, have delivered same-day outpatient surgeries that have proved more efficient and cost effective than many traditional hospitals. There are now over 5,500 ASC’s across the United States.

Unfortunately, ASC’s have two major RCM challenges:

• They are reimbursed at roughly 60 percent of the rate of hospitals for a similar procedure, which was a primary motivating factor for hospitals in acquiring off-campus ASCs.
• They use a different reimbursement methodology. Procedures performed at hospitals and ASCs are classified under different coding groups. These codes are less straightforward and create difficulties when claims are underpaid for ASCs.

Addressing this RCM challenge can be done both strategically and tactically according to an article at Becker’s ASC Review:

Strategic Hospital/ASC alliances and acquisitions: Existing physician owners benefit by gaining more referrals from the hospital and often improve reimbursement rates due to this new found affiliation. Health systems gain the opportunity to participate in the growing ASC market while still providing sufficient incentives to their physician partners. This leads to increased profitability, physician morale, patient satisfaction and clinical outcomes.

Tactical improvements in RCM can be realized by applying best practices with analysis of key performance indicators. For example, improved coding processes with feedback from denial analytics take into consideration previously denied claims, thus reducing revenue leakage and AR. Efficiencies like a consolidated research portal and payment automation help speed research and claim re-submissions.

Yet another example of how continual evolution in healthcare is an opportunity for providers as well as solution companies to address specific market needs.