Here are six best practices for successful orthopedic and spine surgery centers.
1. Payor contracts. Find out what is important to the payor, either during the previous negotiations or through ongoing dialogue, and focus on those areas to show improvement. "When we did that back in 2003, we learned a payor was very interested in pay-for-performance," says Tom Faith of The C/N Group. "We offered a pay-for-performance component. One of our contracts boosted our reimbursement rate by 2 percent." The surgery continued to set quality goals and changed the criteria depending on what the payor was focused on at the time. They have been successful in keeping the rate increase for the past several years.
2. Implant billing. Most arthrodesis procedures require the use of an implant, so it is important to note the CPT code for such procedures usually exclude the cost of the implant, says Mona Kaul, chief coding and compliance officer of Genascis. Payors may require implants to be coded using separately identifiable HCPC level II codes.
Note: Some payors may require a copy of implant invoices to be sent with the claim. ASCs should identify which payors require such invoices to help ensure payors do not delay claims processing due to the lack of complete information.
3. Hiring office staff. Knowing what kind of personnel you will need and how each person contributes to the success of the office is crucial for building a thriving practice. "There are some physicians who end up having their wives or nurses running the office without proper qualification," says Pedro Vergne-Marini, MD, managing member of Physicians Capital Investments. "In this environment you need qualified and trained personnel knowledgeable and fully trained in complex billing issues, regulations, HIPAA, etc. If they bill incorrectly, the commitment of 'fraud' could be assumed and you as the 'Captain of the Ship' can be held responsible." A compensation package offered to employees should include health insurance and workers' compensation. It's important to offer a competitive package to attract the best personnel to your facility.
4. Managing clinical and business responsibilities. Designate specific roles and don't over burden any one person, says Tom Jacobs, CEO and co-founder of MedHQ. Designate specific roles to each staff member or leader within the ASC with the help of an accounting professional/CPA, and make sure there is proper oversight of the decisions made at the center. An administrator shouldn't decide alone to make raises for the staff without approval from anyone else. Similarly, there should be some controls over purchasing and allowing new vendors into the ASC to avoid the chance of theft or inaccurate records. Clearly designate a staff member to approve check writing, record invoices and deal with other aspects of the surgery center's finances. However, Mr. Jacobs cautions against giving all these responsibilities to the same person. "You don't want to have over burdensome types of processes and you don't want to go too far," he says.
5. Mergers and acquisitions. Surgeons are often interested in the details of an acquisition or a merger while administrators feel threatened because they fear they could lose their jobs, says Jon Vick, president of ASCs Inc., has helped more than 200 ASCs through the process by representing the seller and bringing the surgery centers purchase proposals from ASC management companies. However, Mr. Vick says that after an acquisition or a merger, the new company wants to keep good administrators on board and will often offer better salaries and benefits for all personnel. "Good companies look for solid, well-trained staff who are oriented toward patient satisfaction," he says. "They want to make sure there is a good pre- and post-operative process and the staff can answer questions for the patient during that process." As long as the administrators and staff members are doing well before the merger or acquisition, the new company will want them to continue their job afterward.
2. Implant billing. Most arthrodesis procedures require the use of an implant, so it is important to note the CPT code for such procedures usually exclude the cost of the implant, says Mona Kaul, chief coding and compliance officer of Genascis. Payors may require implants to be coded using separately identifiable HCPC level II codes.
Note: Some payors may require a copy of implant invoices to be sent with the claim. ASCs should identify which payors require such invoices to help ensure payors do not delay claims processing due to the lack of complete information.
3. Hiring office staff. Knowing what kind of personnel you will need and how each person contributes to the success of the office is crucial for building a thriving practice. "There are some physicians who end up having their wives or nurses running the office without proper qualification," says Pedro Vergne-Marini, MD, managing member of Physicians Capital Investments. "In this environment you need qualified and trained personnel knowledgeable and fully trained in complex billing issues, regulations, HIPAA, etc. If they bill incorrectly, the commitment of 'fraud' could be assumed and you as the 'Captain of the Ship' can be held responsible." A compensation package offered to employees should include health insurance and workers' compensation. It's important to offer a competitive package to attract the best personnel to your facility.
4. Managing clinical and business responsibilities. Designate specific roles and don't over burden any one person, says Tom Jacobs, CEO and co-founder of MedHQ. Designate specific roles to each staff member or leader within the ASC with the help of an accounting professional/CPA, and make sure there is proper oversight of the decisions made at the center. An administrator shouldn't decide alone to make raises for the staff without approval from anyone else. Similarly, there should be some controls over purchasing and allowing new vendors into the ASC to avoid the chance of theft or inaccurate records. Clearly designate a staff member to approve check writing, record invoices and deal with other aspects of the surgery center's finances. However, Mr. Jacobs cautions against giving all these responsibilities to the same person. "You don't want to have over burdensome types of processes and you don't want to go too far," he says.
5. Mergers and acquisitions. Surgeons are often interested in the details of an acquisition or a merger while administrators feel threatened because they fear they could lose their jobs, says Jon Vick, president of ASCs Inc., has helped more than 200 ASCs through the process by representing the seller and bringing the surgery centers purchase proposals from ASC management companies. However, Mr. Vick says that after an acquisition or a merger, the new company wants to keep good administrators on board and will often offer better salaries and benefits for all personnel. "Good companies look for solid, well-trained staff who are oriented toward patient satisfaction," he says. "They want to make sure there is a good pre- and post-operative process and the staff can answer questions for the patient during that process." As long as the administrators and staff members are doing well before the merger or acquisition, the new company will want them to continue their job afterward.
6. Infection control. EPA requirements are very specific as to the manner in which a disinfectant is to be used and applied, says Jack Wagner, president of Micro-Scientific. Furthermore, EPA requirements are very specific as to the minimum amount of time, in minutes, a particular disinfectant must remain visibly wet in order to allow the solution enough time to penetrate microbial cell walls and kill all target microorganisms listed on the label.
Infection control experts know that some microorganisms, such as the hepatitis b virus and staphylococcus aureus bacteria are able to survive for long periods of time on dry surfaces and both have long been identified as causes of serious outbreaks from cross-contamination.
Related Articles for Orthopedic ASCs:
4 Best Practices for Expanding Your Orthopedics Driven ASC
6 Ways to Increase Profitability at Orthopedics Driven ASCs
8 Best Practices for Building a Successful Orthopedics Driven ASC