Ophthalmology Business

OCT 2013

Ophthalmology Business is focused on business topics relevant to the entrepreneurial ophthalmologist. It offers editorial, opinion, and practical tips for physicians running an ophthalmic practice. It is a companion publication of EyeWorld.

Issue link: http://digital.ophthalmologybusiness.org/i/197424

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Page 21 of 27

continued from page 21 income can be. This important responsibility should not be left up to an ASC's coder or insurance clerk. The agreements are typically lengthy and include terms that may be difficult to comprehend. These agreements MUST be read in full and broken down in a way that ensures that you understand what you are signing. The administrative tasks involved in the contracting process can be very onerous and time consuming. The process often involves repeated attempts to get the paperwork needed to negotiate terms and come to agreement. Even contact information for the appropriate provider representatives can prove elusive. If an ASC cannot allocate resources toward this function, a contract can very easily fall through the cracks. • Many billing agencies employ staff that are quite competent in the area of contract review and negotiation and perform these services for their clients. Often the agency has already worked—and established a good relationship—with the commercial payer's representative on behalf of other clients. Government regulations Keeping abreast of evolving government regulations has always been a headache and source of anxiety. Many ASCs are gearing up for ICD10 and expansions to quality reporting. Owners and staff know all too well how overwhelming these changing regulations can be. • For the most part, dealing with these issues can be outsourced to a 22 billing agency, which will free management to direct its attention to patient care issues. How much does outsourcing cost? Depending on the agreed-to contract terms between the agency and ASC, the agency will be compensated based on a percentage of collections, a flat fee, or a combination of the two. The percentage of collections method often proves most advantageous to both parties because it motivates the agency to collect as much—and as efficiently—as possible. Most ASCs pay between 4 and 8%, depending on the facility's size and specialties. The cost of outsourcing to an agency most often looks quite competitive when compared to the cost of keeping these functions in-house, particularly if the agency's services improve the effectiveness of the revenue cycle management. The more important question may be how much does it cost to keep billing and collections inhouse? Consider staffing needs. Many ASCs find it difficult to find candidates with the expertise and personal traits needed to excel in billing and collections positions, more so if the facility is located in a rural area. The work is detail oriented and requires a strong work ethic, knowledge of medical terminology, and the ability to work assertively when dealing with insurance companies and patients. Even if you are fortunate to fill these positions with experienced, proficient staff able to get the job done, sooner or later that person will go on vacation, take a leave of Ophthalmology Business • October 2013 absence, or accept a position elsewhere, causing significant disruption of the process. An agency minimizes the risk inherent to employee turnover by having multiple trained individuals on staff who can cover for a vacancy. When it comes to managing your revenue cycle, don't make an impulsive decision. First, decide what services and results you want an agency to provide, then interview several agencies and select one that is tailored to meet the needs of your ASC. Coordinate with them to keep your ASC performing in the top third of facilities, then enjoy the perks that made owning an ASC an attractive proposition. OB References 1. Hethcock, Bill. Ambulatory surgery centers catching up to hospitals. Dallas Business Journal, Jan. 19, 2013. www.bizjournals.com/ dallas/news/2013/01/29/ambulatory-surgerycenters-catching-up.html. 2. Bussewitz, Bradly. Can Ambulatory Surgical Centers Still Be a Good Investment? Podiatry Today, January 17, 2013. www.podiatrytoday. com/blogged/can-ambulatory-surgical-centers-still-be-good-investment. Consultant Erin Malloy monitors the financial health and efficiency of ASCs and oversees Medical Consulting Group's accounting, billing, and management coordination teams that enhance their profitability. She can be contacted at emalloy@medcgroup.com.

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