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Tips to power profitability in surgery centers

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More high-acuity, high-reimbursing procedures are moving to outpatient settings, presenting a major financial opportunity for surgery centers.

One of the major growth areas is in orthopedics, as 68 percent of orthopedic surgeries can be performed in ASCs today, according to National Medical Billing Services. 

However, when adding these complex procedures to an ASC it is critical to get contracting, coding, AR and analytics correct, four industry experts explained in a March 31 webinar. 

In the webinar, sponsored by National Medical Billing Services and hosted by Becker's Hospital Review,the four experts discussed how ASCs can capitalize on the anticipated growth of orthopedics, avoid reimbursement pitfalls and learn about unlisted CPT codes. 

The presenters were:

  • Nader Samii, CEO, National Medical Billing Services
  • Lisa Rock, president, National Medical Billing Services
  • Scott Allen, vice president of managed care, National Medical Billing Services
  • Alison Kuley, senior spine coder, National Medical Billing Services

Here are four key takeaways from the webinar:

1. Adding complex procedures to an ASC can dramatically improve finances. Mr. Samii described how a 300-case per month multispecialty surgery center could increase high-acuity procedure volume by 30 cases per month to significantly improve top line, bottom line and equity value of the center. For example, if a $7.2 million surgery center added a complex procedure and saw 30 cases per month at $11,000 cash per case, the center would add $4 million in revenue per year and increase its annual EBITDA by $2 million.

"Moving these high-acuity cases to surgery centers and capitalizing on this trend and getting in at the relatively still early stages of it will create incredible financial improvement for your center," Mr. Samii said. 

2. Accurate documentation is key to driving and keeping revenue. Payer audits are always ongoing, but National Medical is seeing an uptick of commercial payers hiring rack auditors to review documentation and assess accuracy of the code assigned to the procedure, Ms. Rock said. This makes documenting medical necessity of a procedure and ensuring the right CPT code is selected critical to keeping revenue.

 "The integrity of the code selected ... is critical not only to maximize revenue but also to keep it," Ms. Rock said. "Once it hits your bank, you don't want it going back out due to these audits."

3. Before using an unlisted CPT code, conduct research. Many surgery centers use unlisted CPT codes because physicians perform novel procedures or use new technology, Ms. Kuley said. However, prior to using an unlisted CPT code it is vital to conduct research and make sure there isn't a specific code that would accurately describe the procedure. Category III codes, temporary codes that describe emerging and experimental services, get created each year, Ms. Kuley said. "Take the time to do a little bit of research before you just apply an unlisted code," Ms. Kuley said. 

4. Managed care contracting should be a top priority. Managed care contracts allow ASCs to negotiate appropriate reimbursement for complex procedures, including newly added orthopedic ones, Mr. Allen explained. To ensure managed care contracts are set up and utilized appropriately, ASCs should first ensure they gather complete contracts, including crosswalks, fee schedules and amendments. After the full contract is on file, ASCs should work to understand how payers in the area are communicating with patients and directing care, analyze your case costing and case reimbursement, Mr. Allen said.

To learn more tips to tackle unlisted codes, ensure proper managed care contracts and capitalize on the growth in orthopedics, listen to the full webinar here

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