Everything You Need to Know About ASC Revenue Cycle Management (RCM)

Understanding RCM for Ambulatory Surgery Centers

When a patient is admitted to a hospital for surgery, they should be treated regardless of insurance or the ability to pay upfront. This is not the case for ASCs since these patients have already been recommended for the procedure by a physician and treatment is designed for them to return home same-day. Because of this, patients are typically billed before treatment begins.‏ ‏

Of course, this doesn’t mean the patient must pay the entire cost upfront, but it does mean that if they have insurance, the claims process can begin. This means the patient handles the co-pay beforehand and ensures the billing process is moving even before the procedure takes place.‏ Billing practices like these set ASCs up for success and gives them a better opportunity to shorten their AR compared to other providers.

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What Is Revenue Cycle Management?

Revenue cycle management (RCM) includes all operations that work to ensure an ASC receives the correct and full payment for services rendered. While some ASCs prefer to keep their RCM in-house, others choose to work with an ASC revenue cycle management company so they can minimize claims rejections, speed up revenue cycles, and maximize profit at their center.

How RCM Works: 5 Phases of the Revenue Cycle

The revenue cycle works in five basic phases that start the day a patient’s procedure is scheduled and end when their account is paid in full.

The authorization phase is where it all starts, and it’s basically housekeeping. During this time, patient insurance and billing information is collected in order to determine eligibility for services. The information is typically entered into an automated verification system, and the results let the provider know how they’ll be paid. This is also the time when patients find out what is covered by insurance, if they have it, and how much they’ll owe to the provider afterward.

The capture phase, or the charge capture chase, is where the money starts moving. Payment should be collected, or captured, as soon as services are rendered. At this point, a billing code is assigned to the patient’s insurance claim. To avoid any confusion, slowdowns, or denied claims, the billing code should be verified as accurate and error-free.

The submission phase quickly follows, where the claim is submitted to the insurance payer. Proper submission of a claim ensures timely payment, which is why many facilities choose to rely on medical billing and coding software.

In this phase, the provider gets paid. Once the insurance payer reviews the claim, they’ll pay their portion of the patient’s medical bill directly to the provider. The provider will then tell the patient of any remaining balance that they’re responsible for paying. Online payment portals make it easy for providers to get paid by their patients.

When everything goes as it should, the final phase is payment from the patient. However, medical billing and coding can be a tricky process, and it doesn’t always go smoothly. Without the right tools, denied claims, delayed payment, and other problems are bound to happen. If it does, then staff need to do a deep dive on the account, figure out what went wrong, and start the claims process all over again. Because of this, many providers choose to work with a professional medical and billing service that will ensure their revenue cycle is managed with excellence. 

These phases are a short and simple way to explain the basics of the revenue cycle, but RCM is actually incredibly complicated. In order for a provider to run a successful and profitable facility, they need to outsource it to an RCM medical billing company or ensure they have trained staff in-house who understand the ins and outs of billing and coding.

How RCM Affects Ambulatory Surgery Centers

Restrictions are up and reimbursements are down — not just in ASCs, but pretty much in every healthcare facility. If you want to combat these challenges and maintain a successful and profitable center, then you have to take action and focus on what’s really going on with your RCM.

An efficient RCM is the difference between your center barely scraping by or somehow still functioning and actually thriving. A steady stream of revenue is almost always the result of a streamlined RCM process. As long as you have skilled medical billing and coding professionals working on your RCM, you should be seeing good numbers. Whether you choose to have your RCM handled by a qualified in-house team or place your ASC in the hands of a professional revenue management company, you should expect accurate, timely, and maximum reimbursement for your center.

Numbers and Profits: Outsourcing vs. Keeping It In-House

Your ASC is a healthcare facility, and healthcare facilities are designed to help patients however they can. Still, the reality is that your ASC is a business, and businesses need to make money. If you’re not profitable, you can’t pay your staff and your bills, and you won’t have an ASC to run anymore that can help people. That’s why getting your billing and coding department in tip-top shape is so important. You have to know that your RCM is being taken care of by someone who knows what they’re doing — whether that’s in-house or outsourced, however, is up to you.

Outsourcing RCM for Your ASC

Healthcare revenue cycle management is a complex, labor-intensive, operational process that’s directly responsible for the success of your center, so there’s a lot of pressure to get it right.

Working with an ASC revenue management company means all of the headaches that come with RCM will be left in the hands of industry experts whose sole job is to support your center. When professional medical and billing professionals are taking care of your RCM, you’ll have less billing errors, better cash flow, lower claim denial rates, and increased revenue that doesn’t affect your workflow.

Keeping RCM In-House at Your ASC

Because your RCM is such a big deal and determines the future of your center, it’s nice to know when and how it’s being taken care of, and by whom.

An in-house team means you have a good amount of control over the entire process, which is a big responsibility, but ideal if you like to know what’s going on at all times.

With an in-house medical billing and coding department, you get to decide who’s managing your revenue because you pick who’s on your staff. You also get to choose how they’re trained, so your staff gets as much or as little training as you deem necessary. Not to mention, when you have an in-house billing and coding team, finding out the status of an account can be as easy as swinging by a desk or sending an email to ask questions (though keep in mind, this will slow down your staff and take time away from other tasks, both of which will affect your revenue).

Increase Your Profit & Productivity with Help from a Professional ASC Revenue Management Company

When it comes to billing and coding, your ASC should be up-to-date on industry standards and methods, and use them to achieve maximum revenue for your center. Sometimes, it’s really as easy as making one simple change, like investing in an ASC revenue management company. 

By outsourcing your medical billing and coding, you’ll get more money, less stress, and better processes that allow you to focus fully on your patients while your center thrives. If you’re ready to maximize collections and revenue for your ASC, reach out to our team today. Our ASC revenue cycle management company will help you turn your numbers around in no time!