ASC Billing & Coding

Dispelling ASC Myths: The Transition from Internal Billing and Collections to Outsourced RCM is Challenging

The Myth: It is challenging for an ambulatory surgery center (ASC) to transition from an internal billing and collections team to an outsourced revenue cycle management (RCM) team.

The Truth: ASCs can actually increase the productivity of a center quickly and efficiently if they select to partner with an outsourced RCM team that is proactive and has an orchestrated transition process in place.

The Evidence: Dispelling this ASC myth comes down to the ASC selecting the right outsourced RCM provider. When going through the selection process, ASCs should consider three key qualities to ensure a smooth, efficient transition process:

  1. ASC Policies and Procedures:
    A proactive RCM providers will spend one to three weeks on-site with a transition team to understand the center’s current RCM policies and procedures. Common questions asked at this stage may include: “How does the center handle patients who pay at the time of service?” “How are insurance payments received (via lockbox or sent directly to the facility)?” and “What daily, weekly and month-end reports are necessary to operate your business?” When developing the transition strategy, certain changes to current policies may be recommended to increase efficiency. Since there isn’t a cookie-cutter approach to transitioning to an outsourced RCM provider, this is an essential step that must occur prior to conversion to ensure there is minimal business disruption.
  1. IT Systems:
    The preconceived notion that RCM partners require centers to switch to a specific IT system often fuels this myth. This is not the case with all RCM providers. A good RCM provider will be able to work with any management information system (MIS) in use, while potentially offering recommendations that could increase efficiency for the center. Prior to the transition, an IT assessment should be performed to determine how the RCM provider would connect to the center’s existing MIS. Newer systems can be accessed via the cloud, allowing the RCM provider to make adjustments as quickly as if they were physically in the center. VPN tunnels can be used to access older systems. It’s important that HIPPA/HIGHTECH compliant software should be utilized to always keep data secure.
  1. Contracts:
    Becoming intimate with a center’s contracts prior to transitioning is also essential for a smooth transition. The RCM provider should request updated copies of each contract for extensive review and loading into the system well before conversion. While the transition team is still on-site, a good RCM provider will meet with the managed care team to fully understand the content and avoid any hidden language that could affect bundling, payment methods, or limit the increase of charges. Contracts are an essential part of the billing and collections process and as a result, oversights could cause a center to be operating at only 60 to 80 percent.