The Center for Specialized Surgery

Case Study: A/R Follow-Up Increases Collections in Ft. Myers

SITUATION

The Center for Specialized Surgery in Ft. Myers (TCSSFM), Florida is a state-of-the-art outpatient surgical center designed with a focus on quality orthopedic surgical care for patients. The 9,102-square-foot surgery center features three operating rooms, step-down recovery, recovery, nurse station, consultation room, reception, staff lounge and administrative offices.

Growing rapidly, TCSSFM leverages benchmarks defined by Regent RCM to gauge center performance across all functions of the revenue cycle.  TCSSFM has had especially positive experience with the benchmark for Accounts Receivable Follow-Up, a metric that goes deeper than overall center performance to provide a true measure of individual biller/collector performance. The A/R follow-up benchmark tracks how many of the cases a center has with an open balance are being followed up on each month. The gold standard expectation is that biller/collectors follow up with the payer for at least 95% of all the open claims every month.

“The Ft. Myers surgery center is a very high-volume facility and they generate a lot of revenue, so having the goal of 95% follow up on open claims every month definitely impacts the cash flow,” says Gina Tolbert, Regent RCM’s specialist serving TCSSFM. “We need to ensure that we collect on the revenue that’s been generated.”

Erin Petrie, Regent RCM’s Director of Revenue Cycle Management says: “We’ve started using this metric because it allows us to drill down into the actual biller’s performance or collector’s performance, versus just the center’s performance. A center might have a great month and collections are up through the roof, but that’s not necessarily a reflection of the efforts of that collector. Whereas your follow up, how many claims you’re touching every month, reflects your work.”

SOLUTION

Tolbert says tracking the A/R follow-up benchmark helps her identify problems to proactively solve. For example, she identified a key challenge at TCSSFM among the center’s workers comp payers.

“I feel like every time I think I have them figured out, they switch up something on me. But they are our largest payers, so I tend to handle them a little bit more aggressively,” she says. “What helps me most – and it really is about paying attention to the full revenue cycle – but getting a clean claim out the door is critical. If that means I may have to wait a day or two before I get all the necessary information that I think will be helpful in getting that processed correctly in the first place, I’ll do that.”

Exceeding the gold standard, Tolbert tries to follow up with 100% of claims every month, or in some cases even more often. “If I call and they say they have it, I set a calendar alert for 10 days later and follow up again, because I believe the squeaky wheel gets the oil,” she explains. “If they get tired of me calling, they’re going to try to get that claim through.”

When she first started working toward this benchmark, 95% follow up was difficult, due to the center’s high volume. But Tolbert says once she got arms around where the money was outstanding, it became easier.

“I began to identify trends as to why claims aren’t being processed,” she explains. “For instance, right now for work comp I’m keeping a log because it seems like we’re getting more denials or underpayments for our implants and some of our pain blocks. If I can see a trend ahead of time, maybe there’s additional information I can send, like a page from our reimbursement manual for Florida workers comp that proves they need to pay this amount. Those are the kinds of things I’m looking for right now. It really helps if we can make the claims even cleaner than clean, because although the appeals are difficult, they’re time consuming and that’s time I could be spending on another claim that might be a little more complicated or might require a little more attention.”

RESULTS

Collections at TCSSFM have increased an amazing $125,000 per month in the past year. While center growth and the addition of high reimbursement procedures have contributed as well, Tolbert’s efforts to follow up with payers on at least 95% of claims every month have been a big part of that success.

“I think setting the bar high definitely helps,” Tolbert says. “I’m trying to be a little more aggressive to meet the benchmark and with the volume of my clinic it gets a little hectic each month, but once you have kind of a system, and know your facility, I think it’s attainable.”

Regent RCM’s Petrie agrees.  “We’ve found that by following up with every claim every month, we see improved collections and a decrease in our percentage of A/R over 90 days.”

diagnostic results

“I believe the squeaky wheel gets the oil. If they get tired of me calling, they’re going to try to get that claim through.”

— Gina Tolbert, Regent RCM Revenue Cycle Specialist