No one understands the importance of regular check-ups better than a health care provider. That’s why more and more ASCs are turning to external facility reviews in order to evaluate their overall health, identify key areas where performance could be improved, and develop strategies for operational and financial stability.
A recent article in Becker’s ASC Review outlines 10 major areas that facility reviews typically focus on in order to provide a complete picture of an ASC’s performance. These include:
Patient information gathering.
Accurate patient demographics are an essential step in ensuring clean claims and timely reimbursement; inaccurate demographic information inevitably leads to processing delays and other challenges down the road. An ASC facility review will therefore assess how patient information intake is handled by front desk staff and systems, paying particular attention to special aspects like pre-authorizations, verifications, and eligibility.
A formal billing compliance program that meets standards recommended by the Office of the Inspector General is a must for ASCs that want to follow collections best practices and optimize their revenue cycle management. However, just because the ASC’s policies exist in theory does not necessarily mean that they are carried out in practice. In examining an ASC’s billing compliance procedures, therefore, a facility review will also take into account how effectively staff are adhering to these procedures.
Separation of duties.
At smaller or newer ASCs, where staff must often fill multiple roles in order to ensure that the ASC is operating smoothly, appropriate separation of duties can be an issue. This is a particular cause for concern when it comes to cash or financial transactions, as overlapping duties handled by the same person can increase the risk of fraud or embezzlement. In such cases, a facility review can help an ASC identify ways to make checks and balances a fundamental part of its processes.
Payor contract review.
ASCs that do not make a practice of regularly renegotiating their payor contracts are unlikely to be getting the best possible returns, and may be suffering financially because older contracts are no longer meeting reimbursement standards or even adequately covering the cost of services. A facility review can help ASCs look at their top payor contracts, assess potential opportunities for improvement, and implement steps to open the renegotiation process.
Fee schedule reviews.
ASCs should regularly evaluate their fee schedules in order to ensure that their pricing is current with the market and that they are taking full advantage of the maximum reimbursement that their payor contracts allow. However, the day-to-day pressures of keeping an ASC running smoothly can make it hard to prioritize these types of tasks. But as reimbursement continues to decline, ASCs must make every dollar count. A facility review is therefore a good opportunity to get an outside perspective on fee schedules and possibly find opportunities that the ASC may have overlooked.
Without an external perspective, it can sometimes be difficult for an ASC to know whether their operations and financials are in line with similar providers operating in the same region. A facility review can delve into the details of an ASC’s financial reports —including key benchmarks like net revenue per case, and salaries, wages, benefits, and supplies expressed on both a per-case basis and as a percentage of revenue. The review can also help ASC owners and operators be clear about the center’s position and identify any necessary changes.
Facility policies and procedures.
Taking a close look at an ASC’s policies and procedures, with an eye to both content and appropriate adherence to accreditation standards, provides a facility reviewer with an accurate overview of the center as a whole. In addition, one of the great benefits of a facility review of policies and procedures is that reviewers can directly observe and evaluate how closely ASC personnel are following these policies.
Quality assessment and performance improvement.
In order to foster a culture of patient, physician, and staff satisfaction, it’s important that quality assessment activities and outcomes be carefully documented, analyzed, and appropriately communicated at all levels of the ASC. Facility reviews will check for key documentation like hospital transfer rates, infection rates, safety checklists, case cancellations, and peer reviews.
All physician credentialing information must be up-to-date and credentialing requirements must be followed in order to avoid violating state and federal laws. Facility reviews help ensure that current files on physician credentialing are maintained at all times.
Protected information management.
In today’s digital age, patient health information must be managed more carefully than ever. Standards outlined in HIPAA specify appropriate handling of patient information, but, whether consciously or unknowingly, these are not always followed in daily practice by ASC personnel. Facility reviews can help identify serious gaps in the way sensitive information is treated at an ASC, and can generate recommendations for ongoing education and training to keep personnel fully compliant with HIPAA.