Increasing Productivity in a Complex, High-Volume Environment A case study of a large multi-specialty ASC leveraging technology to increase revenue BY TINA ELLIOTT

Many recent studies dem- onstrate that ASCs pro- vide cost savings for Medicare, insurers and patients alike. A few of

the most noteworthy include one released by the US Department of Health and Human Services (HHS) Office of the Inspector General (OIG) in April 2014, one by researchers at the University of California-Berke- ley released in late 2013 and another by two health economists published in Health Affairs in May 2014. The OIG study demonstrates that ASCs have saved Medicare more than $1 billion a year for many years, while the Berkeley study shows that ASCs have the potential to save Medicare and its beneficiaries up to $57.6 bil- lion over the next decade. The study released by Health Affairs concludes that ASCs are a “high-quality, lower cost substitute for hospitals as venues for surgery.” With many patients and insur- ers seeking ASC options over hospi- tals, ASCs are in an enviable position to grow, expand and meet market needs. This high demand can lead to operational challenges within the fast-paced, high-volume ASC envi- ronment. In particular, ASCs must optimize claims management pro- cesses so that

their revenue cycle

management (RCM) teams can cope more effectively with high volume and optimize productivity. The lead- ership at Little Rock Diagnostic Clinic recognized these challenges and wanted to make improvements that would set up its claims manage- ment team for success.

High Volume Plus High Diversity Equals Additional RCM Challenges Due to the high volume of claims that ASCs handle, most ASC leaders and staff are used to managing a challeng- ing revenue cycle. When you add a broad array of specialties to the mix, the already challenging environment becomes even more difficult. At Little Rock Diagnostic Clinic (LRDC), the RCM team not only addresses a daily claims volume of 1,600, but also must manage diversity within claims includ- ing UB-04, 1500 and ASC X23 837. The multi-specialty clinic and ASC has 50 providers with diverse specialties such as endocrinology, rheumatology, internal medicine, neurology, gastroen- terology and pulmonary care. When it comes to claims manage- ment, one of the greatest challenges has always been keeping the UB and 1500 claims straight while manag- ing the high volume. Each week, the

team submits hundreds of claims that require careful review and editing. Many are high-dollar claims, so it is important to stay on top of their sta- tus and take care of denials and rejec- tions as fast as possible. UB-04s are a classic example; they are especially complex, but they also are tied to sig- nificant revenue. They require close monitoring and fast editing.

Going High-Tech, Getting Rid of Paper

LRDC has always placed a high prior- ity on improving patient care through advanced technology, yet it has not tra- ditionally prioritized RCM technol- ogy. The ASC had a completely paper- based process, which was not ideal for complex UB-04 claims. The team worked hard to try to overcome the problems inherent in manual claims management, but it had an uphill bat- tle. The team members did not know

The advice and opinions expressed in this column are those of the author’s and do not represent official Ambulatory Surgery Center Association policy or opinion. 18 ASC FOCUS FEBRUARY 2016

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