The number of specialty ASCs owned by physician practice groups or investors has grown in recent years — and this trend is only expected to continue. Unfortunately, many of these organizations are struggling with declining reimbursements from government and commercial payers.
One way that specialty ASCs can improve their financial health is by serving personal injury patients. To learn more about opportunities related to litigated claims, Becker's ASC Review spoke with Reid Zeising, founder and CEO of Gain.
Litigated claims can help ASCs with utilization and revenue optimization
The Gain platform helps a variety of specialty ASCs with utilization and revenue optimization. A large percentage of the company's customer base is orthopedic and pain management practices.
"In terms of the payer sources that ASC surgeons see, we've experienced a tremendous pickup in litigated claims," Mr. Zeising said. "There's been a significant increase in activity among orthopedists seeing personal injury patients or litigated claims. In these cases, reimbursements come from third-party liability carriers."
Historically, third-party liability carrier reimbursements have been higher than those from commercial or government payers. When orthopedists treat personal injury patients in specialty ASCs, it's a win for patients and physicians alike. Access to care is increased and ASC margins are enhanced.
Generating revenue from litigated claims, however, requires specialized knowledge. Every state has medical lien statutes. Gain understands this legislation and knows how to secure reimbursements on those receivables. As an independent third party, Gain significantly reduces judicial, legislative and insurance defense risks for ASCs.
Gain enables specialty ASCs to achieve their financial objectives
Based on an ASC's financial condition and projected financial needs over the next 24 to 36 months, ASC owners can determine which of Gain's offerings aligns with their unique needs.
"ASCs must understand what percentage of their business is in the litigated claims space," Mr. Zeising said. "Key questions are whether you can wait to maximize your reimbursements and what cash you will need in the interim, if you're growing."
The most profitable option for ASCs is simply to have Gain service their receivables. It's important to keep in mind, however, that the average duration for reimbursement can be long. In orthopedics, reimbursements can take about 18 months. For pain management, 13 months is the norm and for imaging and physical therapy, reimbursements can take 10 months.
"If you can wait for reimbursement, we can service your receivables and pay Gain a percentage of the collections," Mr. Zeising said. "We collect almost 900 basis points more than healthcare providers that service receivables themselves."
For growing ASCs that have capital or cashflow needs, Gain can provide a partial advance of future collections.
"We keep a return on that capital, and we are paid a percentage of the collections. The reimbursement is slightly less than Gain's pure service model, but it's still more than commercial and government payers," Mr. Zeising said.
If cashflow is very tight, ASCs should evaluate their operating efficiencies. One short-term solution is for Gain to advance reimbursement for all receivables up front. This is a lower level of payment than the other two options. However, it's still more favorable than commercial and government payer reimbursement rates.
"Gain is an expert in utilization and optimization," Mr. Zeising said. "We are here to help ASCs maximize their reimbursements and see patients that they wouldn't otherwise see."