Here are five tips for creating a thriving orthopedic surgery center.
1. Encourage surgeons to report simultaneously. Physicians should document each procedure immediately after the procedure. When a physician waits until the end of the week to document their procedures, they risk forgetting the details of the procedure or writing an insufficient report for the coders to create a claim. Detailed reporting is crucial for the coders to accurately bill for correct reimbursement. "Coding is an art, it's not an exact science," says Jay Nussbaum, CEO of Healthcare Watchdog, a medical billing and advocacy group with offices in New Jersey and California. "A lot of times, what you're going to code depends on what the doctors write in the documentation"
Additionally, if a claim is denied because the payor found a procedure unnecessary, detailed notes help physicians defend their choice to follow through with the procedure. "If the physician has taken good notes, they can make a good claim as to why the procedure was necessary to the insurance companies. Making that strong case really can turn a lot of denials into approvals," says Mr. Nussbaum.
2. Hire and train staff to excel in orthopedics. In a multispecialty center like NorthStar, training OR staff to specialize in orthopedics improves efficiency in the OR and in providing supplies, says John Brock, administrator of NorthStar Surgical Center in Lubbock, Texas, a Symbion facility. When staff is well trained, "the room turnover is better and physicians are satisfied," Mr. Brock says. At NorthStar, staff members are still cross-trained in other specialties but there are crews whose primary focus in orthopedics. "This is not so much for clinical competency as for process competency," he says. "They understand the nuances of certain products."
3. Develop a regular collections process and establish a performance baseline. It is critical for an ASC to have a solid set of protocols everyone on the staff understands and follows month after month, says Brice Voithofer, vice president of ASC and anesthesia services, for AdvantEdge Healthcare Solutions. "If you're starting, stopping, trying different things and not having a standard that you follow each month, then you never know what's actually working."
Once your ASC finds a certain process that is effective at producing desired results, make it a policy and a requirement for everyone to follow. "This provides consistency that gives the ability to benchmark, to monitor performance and manage it," he says. "Trying new [approaches] is perfect if you have a positive attitude about continual process improvement, but you need a baseline to compare improvements against."
4. Strategically negotiate contracts with insurance companies. Supply costs are arguably one of an ASC's highest expenses. Given the high cost of procedures and especially implants, ASCs must work diligently and regularly with payors to ensure they are committing to financially sound contracts with reasonable coverage. For implant reimbursement specifically, Caryl A. Serbin, RN, BSN, LHRM, president and founder of Serbin Surgery Center Billing, urges orthopedic-driven ASCs to ensure they receive a low threshold for each implant; at least cost plus shipping and handling, and no limitations on the number of implants.
5. Make sure your disinfectants are legal. There are products out there which are sold but do not comply with the state and national requirements of regulatory agencies. You need to look at the label and if it's legal, it will give you an EPA registration number, says Jack Wagner, president of Micro-Scientific. That number is like a driver's license. It lets regulatory people and you know the product has been tested, evaluated and it has been approved by the U.S. EPA. If there's no registration number on the label, it's not a legal product to use, he says.
1. Encourage surgeons to report simultaneously. Physicians should document each procedure immediately after the procedure. When a physician waits until the end of the week to document their procedures, they risk forgetting the details of the procedure or writing an insufficient report for the coders to create a claim. Detailed reporting is crucial for the coders to accurately bill for correct reimbursement. "Coding is an art, it's not an exact science," says Jay Nussbaum, CEO of Healthcare Watchdog, a medical billing and advocacy group with offices in New Jersey and California. "A lot of times, what you're going to code depends on what the doctors write in the documentation"
Additionally, if a claim is denied because the payor found a procedure unnecessary, detailed notes help physicians defend their choice to follow through with the procedure. "If the physician has taken good notes, they can make a good claim as to why the procedure was necessary to the insurance companies. Making that strong case really can turn a lot of denials into approvals," says Mr. Nussbaum.
2. Hire and train staff to excel in orthopedics. In a multispecialty center like NorthStar, training OR staff to specialize in orthopedics improves efficiency in the OR and in providing supplies, says John Brock, administrator of NorthStar Surgical Center in Lubbock, Texas, a Symbion facility. When staff is well trained, "the room turnover is better and physicians are satisfied," Mr. Brock says. At NorthStar, staff members are still cross-trained in other specialties but there are crews whose primary focus in orthopedics. "This is not so much for clinical competency as for process competency," he says. "They understand the nuances of certain products."
3. Develop a regular collections process and establish a performance baseline. It is critical for an ASC to have a solid set of protocols everyone on the staff understands and follows month after month, says Brice Voithofer, vice president of ASC and anesthesia services, for AdvantEdge Healthcare Solutions. "If you're starting, stopping, trying different things and not having a standard that you follow each month, then you never know what's actually working."
Once your ASC finds a certain process that is effective at producing desired results, make it a policy and a requirement for everyone to follow. "This provides consistency that gives the ability to benchmark, to monitor performance and manage it," he says. "Trying new [approaches] is perfect if you have a positive attitude about continual process improvement, but you need a baseline to compare improvements against."
4. Strategically negotiate contracts with insurance companies. Supply costs are arguably one of an ASC's highest expenses. Given the high cost of procedures and especially implants, ASCs must work diligently and regularly with payors to ensure they are committing to financially sound contracts with reasonable coverage. For implant reimbursement specifically, Caryl A. Serbin, RN, BSN, LHRM, president and founder of Serbin Surgery Center Billing, urges orthopedic-driven ASCs to ensure they receive a low threshold for each implant; at least cost plus shipping and handling, and no limitations on the number of implants.
5. Make sure your disinfectants are legal. There are products out there which are sold but do not comply with the state and national requirements of regulatory agencies. You need to look at the label and if it's legal, it will give you an EPA registration number, says Jack Wagner, president of Micro-Scientific. That number is like a driver's license. It lets regulatory people and you know the product has been tested, evaluated and it has been approved by the U.S. EPA. If there's no registration number on the label, it's not a legal product to use, he says.