CASE STUDY:

Situation

A multi-specialty ambulatory surgery center in the Northeast was not meeting its financial goals. Though the center was flourishing from a clinical perspective, with a high volume of satisfied patients, it struggled to pay its monthly bills on time.

The ASC owners and administrator suspected that part of the cash flow problem was caused by their outsourced revenue cycle vendor’s performance. Upon the recommendation of the ASC’s management company, the administrator sought PhyBus’ help to identify and correct the revenue cycle problems.

---

Solution

Upon engagement, PhyBus took over the ASC’s billing operations to get the cash flowing quickly.

Simultaneously, the PhyBus team audited a year’s worth of the surgery center’s operations logs and claims. This review uncovered numerous revenue cycle issues that were negatively impacting the ASC’s bottom line:

• More than 75 claims had not even been billed
• Very few of the anesthesia claims had been billed either
• Numerous claims were billed incorrectly
• A/R activities were not being pursued in order to collect unpaid claims or dispute denied or rejected claims
• Accurate financial reports were not provided to the ASC

Next, PhyBus rebilled as many of the problematic claims found as feasible. Additionally, the company followed up on all outstanding claims to recoup money owed from both payors and patients. This task included pursuing a large number of out-of-network claims where the payor had sent the reimbursement directly to the patient, but the patient had not yet paid the ASC.

To ensure the surgery center was fully optimizing reimbursement, PhyBus reviewed the ASC’s managed care contracts. During this process, PhyBus discovered that many previous claims were not reimbursed at the maximum-allowed rate due to billing errors.

What’s more, PhyBus worked with the ASC staff to integrate revenue cycle workflow procedures throughout the entire facility. These procedures, such as benefit verification and implant tracking, helped improve the accuracy and timeliness of claims submissions. To further improve cash flow, PhyBus set the ASC up to submit claims to payors electronically.

PhyBus guaranteed that 100% of the ASC’s claims would be submitted within 72 hours of receiving all necessary information. However, most claims were submitted within 48 hours or less, thanks to PhyBus’ methodical approach to obtaining proper documentation. PhyBus’ knowledge of ASC coding helped improve billing accuracy, resulting in optimized reimbursement. Additionally, the company’s tenacious A/R team ensured denials, rejections, and past-due accounts were quickly resolved.

PhyBus provided revenue cycle data analytics reports to the ASC’s new management company. The management company integrated those reports with additional analytics reports to get a complete picture of the ASC’s performance. This data allowed the ASC owners and administrator to track key performance indicators and make better-informed business decisions.

---

Results

By working together with PhyBus, the ASC was able to significantly improve its financial situation. The enhanced revenue cycle performance helped improve cash flow and increase the collection rate.

This allowed the ASC to invest in advanced surgical technology and equipment, such as a LensX® Laser System. As a result, the ASC’s surgical volume increased, further boosting profitability. Plus, for the first time in several years, the ASC was profitable enough to pay a distribution to its owners.

Since engaging with PhyBus, the ASC’s owners and administrator are confident that their billing and collections are optimized. This allows them to focus on other priorities that can help ensure the ASC is positioned to thrive financially.

Back to Case Studies