How Do You Measure ASC Revenue Cycle Health? HINT: Use ASC-Specific Benchmarks

Prior to Regent RCM’s development of revenue cycle management benchmarks specifically for ambulatory surgery centers (ASCs) in 2017, leadership leaned on hospital or physician practice metrics. But those “borrowed” metrics caused confusion and failed to provide the assessment tools ASCs needed to compete successfully in the healthcare marketplace.

A new white paper updates the nine ASC-specific benchmarks based on two years of learning, adding an essential new metric to help surgery centers accurately measure their revenue cycle health. The new benchmark tracks Net Collections Rate: the percentage of eligible money that was actually collected. The Regent RCM gold standard is to collect greater than 97% from contracted payers.

According to Erin Petrie, Regent RCM’s Director of Revenue Cycle Management, while striving for an efficient revenue cycle if a center’s net collections percentage is low, it may be a sign that the business office is accepting whatever the third-party pays and not fighting for what is contractually owed.

With reimbursement dollars continuing to be stretched, Regent RCM’s gold standard benchmarks assist ASCs around the country in receiving the most revenue possible for the care they provide. In addition to Net Collections Rate, the white paper provides insights on the advantages of tracking:

  • Claim and Charge Lag: The Regent RCM gold standard for both the number of days from date of service until the billing date, and from the date of service until charge entry, is 48 hours.
  • Statement Lag: According to the Regent RCM benchmarks, the lag between the date a balance becomes a patient’s responsibility to the time the statement is sent should be less than 5 days.
  • Clean Claims %: Proper coding, a knowledgeable billing staff, and the use of a robust clearinghouse to scrub claims prior to submission are paramount for achieving the Regent RCM gold standard of a 98% clean claims rate.
  • Denials: The Regent RCM gold standard for denied claims is less than 10% denials.

Click here to download the full white paper on using Regent RCM’s benchmarks to assess the health of your revenue cycle.

KPIs That Can Transform ASC Revenue Cycle Management

One of the toughest challenges for surgery center leadership is determining the health of their revenue cycle. To help, Regent RCM developed ASC-specific revenue cycle management benchmarks to give ambulatory surgery centers (ASCs) a much better handle on financial issues. A new white paper available here outlines how ASCs can use the benchmarks.

“Centers needed visibility into revenue cycle performance,” said Regent RCM Director of Revenue Cycle Management Erin Petrie. “Until now, ASC-specific measurement tools did not exist. We addressed that head-on and by doing so, armed center leadership with tools they can customize and deploy to gauge their center’s financial health.”

While the white paper features nine ASC benchmarks, this blog looks at the first three:

Staffing/1000 cases

Since more business office staff does not mean more efficiency, the first benchmark helps ASCs optimize staffing based on the number of cases served. The Regent RCM gold standard, based on data mined from ASCs over several years, is 1.5 full-time employee equivalents (FTEs) per 1,000 cases. “Centers that have more than 1.5 FTEs may want to examine their business office practices,” said Petrie.

Days Outstanding

Depending on outside forces, such as case mix, payer mix and whether the center is in-network, the most effective number of accounts receivable days outstanding can fluctuate from the high teens up to 30 days. So, while Regent RCM’s gold standard is less than 30 days, Petrie says this metric should be customized for each facility.

A/R Over 90 Days

Tracking aging accounts receivable (A/R) can highlight issues with patient collections processes and/or insurance denials. The Regent RCM gold standard for A/R over 90 days is 20% or less. In general, Petrie says that if a center’s percentage is very low it could mean revenue cycle staff are writing off balances prior to receiving the full contractual amount, while too high may indicate a lack of follow up.

To learn more about benchmarks for revenue cycle management, download the full white paper.

See You at ASCA in Nashville!

The Regent RCM team will be at the ASCA 2019 Conference and Expo, the largest and most diverse conference of the ambulatory surgery industry. Scheduled for May 15-18 in Nashville, TN, at the Gaylord Opryland Resort & Convention Center, the conference is presented by the Ambulatory Surgery Center Association (ASCA.)

ASCA 2019 offers top notch educational programming and networking opportunities, along with the ASC industry’s largest exhibit hall featuring hundreds of new products, services and technologies representing nearly 200 vendors.

In addition to more than 50 ASC-specific educational sessions, two keynote speakers promise to be motivational highlights of the conference: Alex Sheen, CEO and founder of the international social movement and nonprofit because I said I would, dedicated to bettering humanity through promises made and kept; and Scott Hamilton, Olympic gold medalist in figure skating, best-selling author of “Finish First: Winning Changes Everything,” and cancer survivor-turned-activist.

Want to schedule an appointment to connect with Regent RCM at the conference? Contact us here.

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

The Center for Specialized Surgery in Ft. Myers (TCSSFM), Florida is growing rapidly, in part because the center leverages Regent RCM benchmarks to gauge performance across all functions of the revenue cycle.  A new case study outlines the center’s positive experience with the benchmark for Accounts Receivable Follow-Up.

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 case study outlines steps TCSSFM has taken to achieve an amazing result: increasing collections by $125,000 per month in the past year. While center growth and the addition of high reimbursement procedures have contributed as well, efforts to follow up with payers on at least 95% of claims every month have been a big part of that success.

Erin Petrie, Regent RCM’s Director of Revenue Cycle Management says: “This metric allows us to drill down into the actual 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.”

Want to learn more? Read the full case study here.

Adding a Specialty? Make Sure Contracts Support Profitable Reimbursement

As ambulatory surgery centers (ASCs) change and grow, they add new specialties. Making sure contracts keep up with these changes is critical to ongoing success. Andrea Woodell, Regent’s vice president of managed care, has extensive experience negotiating payer contracts – and helping ASCs keep them current. In this final blog in a 3-part series, she shares tips for specialty-specific contracts.

“As surgery centers age, physician partners come and go, and new specialties are frequently introduced,” Woodell says. “Many ASCs are actively recruiting new partners to replace physicians who have relocated or retired. When evaluating the addition of new lines of business, centers should analyze their contracts to evaluate how the new specialty cases will be reimbursed. For example, if you’re locked into 2-3-year contracts with your top three payers and you’re adding a new specialty that is not reimbursed, adding that specialty is not a profitable option until the contracts can be renegotiated.”

When it is time to negotiate, Woodell advises ASCs build contracts for current specialties and consider how the contract would support added new business lines as well. Below are tips for two popular specialties, ENT and TJR:

Expanding into ENT

Adding an ear/eye, nose, and throat (ENT) specialty to your ASC can be a challenge, Woodell says, due to payer payment on multiples. She cites United Healthcare’s (UHC’s) preference to contract at 100/50/25, rolling implants into their groupers and carve outs.

“Sinus cases often bill out 6-8 CPTs (Current Procedural Terminologies) when repriced through UHC’s enhanced groupers and multiple methodology,” she says, “so these cases often end up south of Medicare payment, which is unacceptable. While the ENT CPTs are not on UHC’s standard carve out list, they will carve them out if you negotiate wisely. It is important to respect their position and take the time to build a thoughtful quantified response.”

Taking on TJR

Total Joint Reconstruction (TJR) is a specialty many ASCs would love to add, as acceptance grows for outpatients handling of these procedures. Woodell says the challenge typically faced is how to get paid fairly – rewarding the partners and facility for the additional risk they assume providing TJR in an ASC.

“What often happens is a GI (gastroenterology) center down the street will have language in a payer contract agreeing to TJR reimbursement at $12,000. They don’t think about it, because they don’t see joints. But then that payer tells the next provider that $12,000 is the market rate, proving it with the contracts they have in place.”

If it happens to you, Woodell suggests asking what TJR volume was successfully pulled from hospitals by those contracted centers who agreed to accept $12000-. Even better, know your competition and who is performing TJR. If there are no centers in your vicinity that objection can easily be overcome.

“If you have obtained EOBs (Explanation of Benefits) and know the surgeon’s current hospital site of service is paid $30,000 and the payer is only offering $15,000, ask the payer ‘Why is 20% savings not enough?’” she advises. “My argument is, ‘You are underrating the value of our service, disincentivizing surgeons from bringing cases here, and ensuring our center won’t invest in capital equipment to encourage the migration of TJR cases.’”

In addition, she suggests ASCs should not overlook tools payers themselves provide online for their members. For example, Blue Cross and Blue Shield recently published an article highlighting the variance in hospital payments within a city – this is very useful information for negotiating fair rates for outpatient joints.

“Those carriers posting rates at different venues will guide you to what the market bears, and often include the volume tied to a specific type of case. So, if you spot a lowball rate, it may be that the facility does not even provide the service,” she explains.

More Quick Contract Tips

Woodell offers additional specialty-specific contract considerations:

  • Podiatry is a specialty likely impacted by multiples – increases in hammertoe payment by Medicare within the last couple years have helped support the ASC’s position.
  • New technology in orthopedics continues to mitigate margins – rotator cuff implant costs have jumped $1000-1200 per case, taking a bite out of margins.

For more help and other tips on demystifying contract negotiations, contact Woodell here.

ASC Nurse evaluating revenue cycle

Decreasing Days Outstanding by Managing Charge and Claims Lag

Building on our latest guide where Regent RCM updated is established Key Performance Indicators (KPIs) to highlight issues and determine how well an ASC is performing compared to other ASCs, the following post examines charge and claims lag.

Managing a financially successful ambulatory surgery center (ASC) hinges on efficient revenue cycle management (RCM), yet many center administrators struggle with charge lags leading to delayed claims submissions and ultimately delayed reimbursement. Lag days contribute to an uncertain revenue cycle. One of the most effective ways to decrease days outstanding is to manage lags and turnaround time.

Charge entry lag is calculated by the number of days from the date of service to the date charges are entered. Claim lag is defined as the date of service to the charge billing date. The best practice for ASCs for both lags together is less than three days. Charges should be entered as soon as they are coded and claims should be sent the same day, so there should be no difference between the claim lag and the charge lag.

“If centers are experiencing a difference between the two lags, this is an indication that the billing department may be holding claims or entering charges but not sending them out,” stated Erin Petrie, Director of Revenue Cycle Management. “Transcription should each be completed in 24 hours – that is the gold standard.”

Coding and physician dictation may also be contributing to slow turnaround times, and those are more complicated problems to solve. “At Regent RCM we get to the root of the lag problem by running daily reports on unbilled cases and from there, our staff will begin the research to understand the source of the problem,” explained Petrie. “Whether it is coding, transcription or dictation, we arm center staff with the necessary information to put processes in place to correct the problem.”

If your center is struggling with high charge and claims lag, click here to download our latest guide, and learn how to gain more control and efficiency.

Congratulations to our Q4 Award Winners

Regent Revenue Cycle Management announced individual and team 2018 award winners for the fourth quarter recently, honoring recipients for stellar performance in accordance with the Departments’ Key Performance Indicators and company’s RISE values .

Casey Eazell was the individual winner for the fourth quarter of 2018, meeting or exceeding benchmark metrics for the quarter for Cash Collection, AR Follow-Up, and Decrease in % of AR over 90 days. Eazell was also part of the group that took fourth quarter team honors. That team, led by Manager Vianca Bautista , also included Windy Cortez, Dacia Aviles and Lorena Gonzalez. All involved were honored earlier this year for their outstanding achievements.

“We’re so proud of this group of employees,” said Leslie Favela , RCM Manager Business Development “The fourth quarter is a tough time of year in our business, and each and every one of these folks went above and beyond to deliver excellence. They truly embody team spirit and the RISE values we stand for.”

Regent RCM’s RISE values are: Respectful Caring, Integrity, Stewardship, and Efficiency.
Our team strives to leverage these principles to deliver exceptional service and value to our ambulatory surgery center clients.

Congratulations!

Regent RCM Releases Updates to ASC-Specific Benchmarks

Since introducing nine ASC-specific revenue cycle management benchmarks in 2017, Regent Revenue Cycle Management (Regent RCM) has seen the ambulatory surgery centers (ASCs) that use them gain a much better handle on their financial health. A new white paper offers insights from that experience and provides an update on Regent RCM’s metrics.

“ASC-specific measurement tools simply did not exist before we authored them,” says Regent RCM Director of Revenue Cycle Management Erin Petrie. “Having the tools and intel to gauge performance across all functions of the revenue cycle has been a game changer for center leadership.”

Regent RCM, a leading provider of innovative and cost-effective revenue cycle management services exclusively for ASCs, developed the initial ASC revenue cycle benchmarks with a plan to refine them as key learning emerged. The white paper updates the original benchmarks based on two years of data and insights and adds a new benchmark: Accounts Receivable Follow Up. This metric  goes deeper than overall center performance to provide a true measure of individual biller/collector performance.

Since early 2017, ASCs tracking the benchmarks have been especially successful against the benchmarks for Clean Claims and Denials.

“We’re increasing the Clean Claims benchmark in 2019 from 97% to 98% based on experience,” Petrie says. “We use a clearinghouse to provide us with data on whether or not our claims have all of the correct information to go out to the payers. And if they don’t, we’ve created an expectation for our staff to fix them in a timely fashion and get them out. That process has helped us make sure all of our claims go out clean, but in addition, our staff is now more aware of the issues, so they don’t make those omissions or errors in the first place.”

Similarly, since beginning to track denials and to shoot for a benchmark of less than 10% of claims denied two years ago, Regent RCM’s centers are now exceeding that gold standard. As a result, the benchmark is changing in 2019 to a gold standard of less than 5%.

The Regent RCM ASC Revenue Cycle Benchmarks have been embraced as a critical measurement tool to help surgery centers accurately measure revenue cycle health, and ultimately, account for every dollar they are entitled to. Regent RCM’s gold standards will continue to evolve as the Regent RCM team culls insights from the data and shares them to educate center business staffs, negotiate with payers, and assist ASCs around the country in receiving the most revenue for care that they can.

To learn more, download the free white paper here.

Payer Contract Adhesion – And What They Can Do For Your Revenue Cycle Audit

Every ambulatory surgery center (ASC) strives to manage its revenue cycle as efficiently as possible. Mistakes or delays in coding, billing, and collections can lead to financial challenges. No center wants to show a loss in revenue because of flawed revenue cycle management practices.

Regent Revenue Cycle Management encourages ASCs to perform three regular audits to detect and correct errors before they become larger problems. Regent RCM has created a new guide that details how centers can take simple, concrete steps to track and improve their revenue cycles:

  • Denied claim cause and management
  • Coding accuracy
  • Payer contract adhesion

Payer Contract Adhesion

In our third and final blog of our three-part series, we focus on why negotiating fair payer contracts – and making sure that all terms are met – is a critical part of revenue cycle management.  Your revenue cycle team needs to know every detail of their contracts, so they can fight for every dollar.

Regent RCM advises centers to conduct an audit on each of their payer contracts to understand what the contract says, what their center is allowed to bill, and how they can avoid over- or under-payments. The ultimate goal is for ASCs to receive exactly what they are owed – no more and no less.

When negotiating a contract, Regent RCM recommends following these five steps:

  • Start at least four months before the anniversary of the contract
  • Check the terms of the contract carefully
  • Build relationships with payers
  • Be aware of evergreen contracts that roll forward without renegotiation or a termination date
  • Keep all contracts current to make sure they aren’t falling behind

Learn how to perform our three audits to enhance your ASC’s financial performance. Download the guide here.

Leslie Favela Promoted to Manager, RCM Business Development

Leslie Favela, a seven-year veteran of Regent Surgical Health (RSH) who most recently served as Revenue Cycle Coordinator with Regent Revenue Cycle Management (RCM), was promoted in January to the newly created position of Manager of RCM Business Development. Reporting to Erin Petrie, Regent RCM’s Director of Revenue Cycle Management, Favela will continue to perform business audits for ambulatory surgery centers (ASCs), providing them with valuable business metrics while also adding business development responsibilities to her plate.

Petrie says Favela’s experience across several other roles within Regent – and especially her recent support for RCM business audits, new business pitches and presentations – makes her transition into this new role a perfect move. “Leslie has been a valued player for several years and understands both our capabilities and our clients’ points of pain,” Petrie says. “And, she has the personality to bring it all together to help us grow.”

Favela believes the evolution of business within healthcare reimbursements makes the billing and collection services provided by Regent RCM even more valuable to ASCs. “The timing is right for this new position,” she says, “because payers today are undergoing dramatic changes that make it even harder for an employee of any one ASC to stay up-to-date on all of the policies. We have our view across many different ASCs. This allows us to leverage best practices as we bring each new center on, as well as identify strategies to improve current processes and deliver true value.”

Favela started her RSH career as an office coordinator and has worked her way up through several departments and promotions to gain a thorough understanding of ASC management, more specifically the ins and outs of revenue cycle.

“I have a huge passion for the work of Regent RCM because I have been involved since we doubled the number of centers we serve. I want to continue to build the company’s reputation so that new ASCs come to us for billing and collections and the value that we bring.”

To learn more about Regent RCM’s turnkey billing and collections services exclusively for ASCs, click here.

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