- EMR Software, ASC Software, Practice Management Systems, ASC Technology, ASC Operations, Digital Patient Chart (EHR), ASC Billing, ASC Reporting, Revenue Cycle Management
- BY: DeeDee Dalke, CPC, CPPM, LMT, NCBTMB
- May 20, 2021
Ugh! It always seems like there is some workaround that we do to get through our day. Ambulatory Surgery Center operations are no exception. At first, we complain about the extra work because we absolutely hate it. Then, over time we accept and learn to live with it, sometimes even taking pride in the fact that we survive in spite of it (change management is no easy task). Like some twisted version of Stockholm Syndrome, we bond to the software, hardware and processes that we initially despised. But as we go about our day-to-day existence, in the universe outside our bubble, things change. Improvements occur. Ideas take shape. Progress happens. And one day an opportunity presents itself that is seemingly almost too good to be true.
Here are some of the most annoying manual tasks encountered while operating an ASC (and the innovations that exist today to rectify them).
1. Storing Charts (Dealing with Paper)
It probably comes as no surprise that struggling with binders, paper clips, post-it notes and paper cuts would be on the list. It is estimated that up to 50% of all outpatient surgery centers are still charting on paper. As the physician population continues to trend younger and digital charting becomes more widely adopted, this complaint will be a thing of the past. But for now, centers still on paper must deal with the hard (and soft) costs of physical charts. For example, at the ASC where I worked, when you entered the front door, we had a little front desk for our reception area with little cubicles around the corner, and then the whole back half of the office was a huge rolodex file of charts. But as soon as we went paperless, we all received new L-shaped desks and were able to spread out. It was nice because for the first time we could actually breathe. We could hire more people. So, we put in a counter space area and installed better staff mailboxes. Although we still kept a small storage area for some of the old files, we eventually we got rid of that too because we were able to shred the paperwork. Going paperless was one of the best decisions we ever made.
2. Reconciling Case Costing Inconsistencies
Let’s face it, physicians are very interested in case costing because they want to know that they're getting paid what they should on a case and that they aren't costing the center too much money. So, if you aren’t taking advantage of a software system to generate your case costing reports, then chances are you are manually doing this to some degree and it takes a lot of time and effort. I mean a lot of time. Even if you are using software that handles some of this (but not all of it), then it is still likely too much time… and effort. Back in the day, at my center I would update an Excel spreadsheet to input each patient's account, what we got paid, and the cost of the case from the legacy software system we were using, which was not always reliable. And it was super manual. Especially when you're trying to figure out whether our standard fees look okay? Are we getting paid enough for this case? Are we wasting supplies? Are we picking supplies that are too expensive? Are we getting paid on the implants? And if we're not getting paid on the implants, why are we doing this case here versus at the hospital because we are hospital owned? These are the kind of questions that an integrated software platform with a digital patient chart (EMR/EHR) will be able to solve more efficiently. For example, the chart automatically populates the times in the case, the supplies used and the staff involved. The Practice Management software (PM) controls your supply costs. So, if you’ve entered your supply costs, overhead expenses and staff salaries correctly, you'll be able to accurately see where you've gone over in expenses, time or supplies. It is possible that those overages are justifiable, especially in cases that are more difficult. So yes, it would make sense that our time was in the red versus our normal flow of things, our average. Having the right software in place will flag the exceptions in order to investigate. Your time shifts from playing detective and piecing the puzzle together to interpreting the results and taking action, which is particularly helpful when evaluating new procedures or specialties.
3. Coping with Systems Forcing You to Schedule Single Procedures When You Know More Will be Performed
If you can only put one procedure into your system, then you're kind of going in a little bit blind, right? For example, if we're going to schedule a shoulder, and all I can put in the system is “shoulder arthroscopy,” that doesn't tell me much when I know that there's a good chance that there is going to be a rotator cuff repair, a subacromial decompression, and a distal clavicle excision. All of those procedures have certain supplies, instruments, room time, and positioning specifications. If you can only put one procedure in the system, then you're probably not getting all the information clinically that you need. Now, on the business side of things, it's going to bite you on the pre-estimate letter if you can only put in one procedure. And if that's all that's written on the paper, because that's how the system works, then you're not going to fully give that patient a good picture of what their bill might look like. On the on the back end of billing, you're still going to code to what the operative note says. You're never going to go by what was entered at scheduling. So, it doesn't really affect that piece. But it’s still a clunky process. The newer generation systems (Simplify included) allow you to schedule and plan more easily for multiple procedures. And the cool thing about ours, specifically, is it organizes the procedures into families. Therefore, if we always know that these five shoulder procedures are probably going to happen together, then we can plan for that with OR block times, supplies, and pre-estimates. We also streamline our preference cards into one whereby other old systems make you put in maybe five CPT codes resulting in five preference cards, leaving nurses with the daunting task of adding or deleting multiple supplies from several preference cards. It makes your case details rather messy and prone for error. For example, the system shows that we had a very expensive procedure using all those supplies when we actually didn't. And it causes inventory problems as well.
4. Chasing Down Signatures and Details for Incomplete Paper Charts
Just imagine never having a wayward chart ever again. If you’re still relying on paper charts, then in order to get the charts signed you're probably going to put those files on the physician’s desk with a note, that says, “Please sign your charts.” These charts are most likely displaying the red, yellow, or blue “Please sign” stickers. And I bet you often find these stickers sprinkled throughout your center like confetti as they lose their stickiness. Let’s face it, physicians are busy and therefore try their best to multitask where they can. We’ve heard a few horror stories where physicians take the pile of charts with them as they go to lunch or off to their clinic hours. And while their intentions may be innocent, this act has consequences. Who knows when the charts will be returned or who will have eyes on them outside the center? With an electronic system, that's not an option. Right? The charts are always on site. The physician can sign in the surgery center, or remotely from their office or wherever. With Simplify’s digital charting system, you can even send them the exact page or pages that need to be signed, so they don't have to flip through the entire chart and it puts an end to those loose flags. The system also archives the completed tasks, so if your physician has to head back into surgery, they will know where they left off when they come back to sign the rest of their charts.
5. Meeting Impossible Reporting Demands While Hacking Your Way Through Quirky Software
I don’t know how many times I have heard during my career how difficult and challenging reporting can be, especially for centers that are understaffed. Preparing and generating reports can take a ton of time if you don’t have accurate or easily accessible data, for example pulling several reports of financial information like aging, A/R, case volumes, etc. gathered monthly that you then tally up and place in excel, create graphs, and add to your EOM or board packet. You should expect to have a system that allows you to easily create reports, customize and save them so that they can be run weekly/quarterly/annually as needed. This goes for your quality reporting as well. An integrated ASC platform is one that connects your charting and scheduling/billing/inventory systems together to make this task simple and effortless. It shouldn’t take you longer to prepare the reports than it takes to derive insights and take action. Board prep shouldn’t be an all hands-on deck effort every time. With ASC reporting it can be all too easy to get tangled in the weeds and not be able to see the forest from the trees.
6. Dealing with Multiple Payers with Multiple Requirements, Denials, Rejections, etc.
Ever get a remit back only to see that the claim was denied for something silly like a missing date of birth or patient gender? Frustrating, right? The denials, while small, cost centers several days in receiving payment. Simplify has a solution for that. We have created validation areas and alerts throughout the system that notify users of the errors on the front end so that these errors can be corrected prior to sending claims out to the clearinghouse. These tools are meant to not only facilitate clean claims, but also to save you some time that could have been spent on resubmitting or writing an appeal letter.
When it comes to payers and payer plans, it can be daunting to try to memorize the different billing rules and fee schedules. Again, we made this easy. We have the ability to group these into families adding a fee schedule at the payer level that can be utilized by all payer plans underneath it. This model allows for better maintenance of your contracts and fee schedules with the ability to copy, end date, add new, and indicate specific billing rules as needed. You can also group, sort, and filter the information you are looking for if let’s say you are looking for an expected fee in the Medicare fee schedule for a procedure your physician would like to start performing in the center.
Have you ever considered outsourcing your billing? Maybe your billing staff has retired, has left on family leave, or you are opening a new center. Or, maybe your financials are just not as healthy as they could be. Our Revenue Cycle Management (RCM) services can provide some relief. With an imbedded clearinghouse, benefits verification, and staff with several years of ASC coding and billing experience, we can get you back on track financially and give you back time. Having an all-in-one platform allows you to focus on patient care and successful management of your ASC without giving up control.
7. Keeping Track of Staff’s Credentialing
Many ASCs today are still tracking all their staff’s credentialing information in a binder, which is such an archaic and manual way to do this given the software tools available. For example, in Simplify’s system you can track by specialty and enter all the proper ID numbers that are needed, per staff member and per provider. There is also a place to upload these documents for quick reference and ability to verify that a license is on file, the NPI or malpractice insurance. For your staff members, you can also upload important information such as CPR certification or other clinical licenses and certifications. You now have a central repository or system of record for that information that is easily searchable and accessible. System alerts and reports notify the credentialing staff when a staff member or provider is coming due for renewal. We’ve created these tools in our system so you are not missing information and therefore remain compliant.
Wait! There Is a Silver Lining
Although this list represents some of the top recurring complaints we hear from ASC administrators and center leaders about the manual processes and workarounds they are experiencing every day, there is good news – there exists a remedy for all this pain. With Simplify you get the insight and the control you need to run a more profitable center, provide great care, and actually love the way you work. We know you have better things to do, and our job is to help you do everything better. If any of these challenges sound familiar, we’d like help.