Meet the Team: Gina Rice-Hill

In our ongoing Meet the Team feature, we introduce the many members of our team who make Regent RCM so successful.  In our last post, we learned more about revenue cycle specialists Lisa Thomas.  Today we shine the spotlight on:

Gina Rice-Hill

Where is your hometown?

Born and raised in Downers Grove, IL, just outside Chicago.

What do you do at Regent RCM?

As a revenue cycle specialist, I work with a surgery center to handle their billing, payment posting, and accounts receivable. This allows me to focus my efforts to a single client, giving them 100% of my expertise and attention.

How long have you been working at Regent RCM?

I’ve been with Regent RCM for about a year now.  Preceding my work here at Regent RCM I worked with ATI physical therapy as an accounts receivable specialist.  Before that I worked as a patient account representative and financial analyst for a national operator of surgical facilities.

What is your favorite part about working at Regent RCM?

We’re a team here a Regent RCM and our team has a willingness to help each other; that’s hard to find in most workplaces, not here. It’s part of our culture, defined by our R.I.S.E. program. This has helped me to grow as a professional and as a person.

What has been your greatest professional achievement?

I don’t know if I can point to a single event that has been my greatest professional achievement, but I can point to my main motivator as an accounts receivable specialist – my drive to exceed clients’ expectations. I like knowing that I am preforming my job at the highest level possible and I am always trying to grow and improve, I take great pride in this.

What is one fun fact about yourself your co-workers don’t know?

Like a lot of people in Chicago, I’m a huge sports fan!

4 Coding & Billing Best Practices

Erin Petrie, Director of Revenue Cycle Management at Regent RCM, has worked in the medical field for nearly a decade, specializing in hospital administration and revenue cycle management. She draws from her experience to share best practices to help billers and coders manage a successful revenue flow.

  1. Verify patient information.

Prepare or update patient files in advance of their appointments. Check benefits and eligibility, making sure you have accurate information on factors such as copayments, deductibles, and balances due. Patients aren’t always aware of details related to their medical insurance – for example, if their employer has switched insurance companies, or if they need a referral from their general practitioner before seeing a specialist. Verify that the procedure code is billable under the patient’s insurance plan.

  1. Clarify patient financial responsibility.

Train your staff to communicate with patients about what payments they are responsible for. Make your ASC’s payment policies clear; ask front desk staff to confirm them when scheduling appointments, and post them in a visible area near check-in. Collect copay or co-insurance from patients at the time of service, and require payments toward past balances before scheduling new procedures.

  1. Submit correct claims the first time.

Be meticulous in producing error-free claims. Submitting an insurance claim, only to have it rejected, fixed, and resubmitted, can delay a payment by weeks or months. Avoid this frustrating cycle by double-checking claims for any errors in patient, provider, insurance, or billing information.

  1. Use proper codes and modifiers.

Go through each claim with a fine-tooth comb to confirm that you are using the appropriate codes for the services provided. Follow a standardized process to check information and minimize errors. Have you included all the necessary procedure and diagnosis documentation? Are you using the correct modifier for a procedure’s specific circumstances? Attention to detail in coding is critical for fast and accurate claims processing.

Learn more about Regent RCM’s expert billing services for ASCs.

Meet the Team: Lisa Thomas

In our ongoing Meet the Team feature, we introduce the many members of our team who make Regent RCM so successful. In our last post, we learned more about revenue cycle specialist Alejandra Perez. Today we’ll shine the spotlight on:

Lisa Thomas

Where is your hometown?  

Originally, I am from the highly unique and great city of New Orleans, LA.

What do you do at Regent RCM?

I work with an independent ASC where I devote my time and resources to their revenue cycle management.  This allows me to take billing and coding pressure of my clients and manage and monitor their financial health and performance.

How long have you been working at Regent RCM?

I joined Regent RCM in the fall of 2017 from a physical therapy company where I worked directly with patients and revenue cycle management.

What is your favorite part about working at Regent RCM?

Everyone at Regent is committed to improving the financial health of all the ambulatory surgery centers we serve. We support and encourage each other, which is very rewarding. Since I started in my position, the collaboration and open communication have allowed me to hit the ground running.

What has been your greatest professional achievement?

My work is rewarding. After years of professional growth and development, I’m proud to bring a high-level knowledge and expertise to my job.

What is one fun fact about yourself your co-workers don’t know?

I love music, especially the opera and musical theater.  Also, I volunteer with community and children’s organizations.

How Our Dedicated Staffing Benefits Centers & Patients

Regent RCM is committed to improving the financial health of all the ambulatory surgery centers (ASCs) we serve. Our team has deep knowledge of the entire revenue cycle, from payment posting through payer follow-up, and we use our experience to find solutions to our partner centers’ pain points.

Regent RCM’s Dedicated Staffing

One solution that sets Regent RCM apart from other billing and collection service providers is our dedicated staffing model. Regent RCM assigns one revenue cycle specialist to manage a center’s complete revenue cycle, from start to finish. This specialist becomes an expert in the account, delivering exceptional and detailed service. Regent RCM’s revenue cycle supervisors also oversee high-level operations for a small group of ASCs.

Other companies divide the revenue cycle into tasks delegated to different people –with one employee managing charge entry, and several employees handling payment posting and accounts receivable for all centers.

“Our staffing model is definitely our differentiator,” said Erin Petrie, Regent RCM’s Director of Revenue Cycle Management.

“Our centers appreciate that they have a contact who knows everything about their revenue cycle. When centers need information, they don’t have to talk to four or five people who each managed one piece of a claim; they can just ask one person. And our team of revenue cycle specialists and supervisors have insight into the big picture: overall trends with payers, AR problems, or reasons cash flow is light.”

Partner centers benefit because they build strong relationships with the professionals working on their accounts. And patients receive better service when they have questions about a claim; they can speak directly to the person in charge of the revenue cycle, instead of being transferred to multiple people in an organization.

Our Hiring Philosophy

When hiring new team members at Regent RCM, we look for candidates who demonstrate technical knowledge, industry expertise, and our RISE corporate values (Respectful Caring, Integrity, Stewardship, and Efficiency). Successful candidates are also self-directed, proactive, and persistent. They know how to manage day-to-day and long-term account operations, and they are willing to work tirelessly to get the best outcomes for a center.

“We want someone who shows initiative and dedication; we make sure that whoever we assign to cover each center is really an extension of that center’s staff,” said Petrie.

“They’ll be here working every day to make the revenue cycle run smoothly. Because they’re responsible for the full cycle, they’ll notice trends with payers and denials, and know how to get timely payments. Often the biller is so in tune with the center’s revenue cycle that they can spot a code that a particular payer will deny. And they’ll go back to the coder to get the appropriate code, eliminating denial before the bill even goes out. That’s what we strive for.”

Learn more about Regent RCM’s services.

reimbursement

Three Revenue Cycle Trends to Watch

An increasing need for timely insurance claims processing and reimbursement in a rapidly changed healthcare market is sparking a growing need in the industry for more — and better — revenue cycle management support.

A recent report from Global Market Insights shows the healthcare revenue cycle management market reached $39 billion in 2015, and is expected to continue to grow at a rate of 11 percent annually between 2016 and 2024. The report highlights three trends underlying that growth and impacting revenue cycle professionals and the healthcare provider organizations they serve:

  1. The medical coding process is becoming more complex even as the need for efficient claims processing increases, underscoring the critical role of professional revenue cycle management solutions to reduce billing errors.
  2. The significant growth in revenue cycle spending in the healthcare sector through 2024 could lead to the government implementing cost-cutting measures.
  3. Physician billing organizations are a major end user of revenue cycle: they comprised 40 percent of the overall healthcare revenue cycle management market in 2015, and that percentage is expected to grow at a rate of 12.3 percent through 2024.

Parallel growth in revenue cycle technology and products underscores the increasingly important role of healthcare revenue cycle in the healthcare market of the future.

In response to these trends, Regent Revenue Cycle Management (Regent RCM) continues to pioneer strategies for ambulatory surgery centers, developing, executing, and refining ASC-specific revenue cycle management solutions as well as investing time and resources in the technology, training and staffing to help ASC leaders stay profitable in the changing healthcare marketplace.

To learn about Regent RCM’s expanding services to support this growth, contact a member of our team.

Meet the Team: Alejandra Perez

In our ongoing Meet the Teamfeature, we introduce the many members of our team who make Regent RCM so successful. In our last post, we learned more about revenue cycle specialist Ivette Gomez. Today we’ll shine the spotlight on:

Alejandra Perez

Where is your hometown?  I hail from Cicero, Illinois.

What do you do at Regent RCM? I work as a Revenue Cycle Specialist for one of clients in the Midwest, giving them my focused attention to help enhance their cash-flow process while continuously measuring performance metrics and improving collections.

How long have you been working at Regent RCM? I joined Regent RCM in Spring 2017 after working for Allstate Insurance for six years.

What is your favorite part about working at Regent RCM? When I interviewed for the Revenue Cycle Specialist position there was a lot of talk about how important a positive work environment is to Regent RCM – and it really is true. At Regent RCM, are guided by a values-driven culture that aligns our team in a positive way and helps us stay focused on our goal of leveraging our ASC expertise while providing consistent service and expertise to our clients.

What has been your greatest professional achievement? In our business there will always be hurdles and challenges. I enjoy not only coming up with solutions, but making sure that I stay positive, and I take pride in my approach.  I have always been passionate about dealing with customers and patients and I’ve found that a positive approach allows for an overall pleasant experience, regardless of the situation.  

What is one fun fact about yourself your co-workers don’t know? I love to interact with others on a personal level. I see myself as someone who can help people turn a negative into a positive.  Another passion is cooking; I may not be the world’s greatest chef but my kitchen is certainly the place to be at dinnertime.

ASC Physicians in Operating Room

Physicians are Key to Revenue Cycle Success

While they may feel more comfortable managing matters related directly to patient care, physicians also have an important role to play in the overall financial sustainability of the ambulatory surgery center (ASC) where they practice. Whether their compensation is tied directly to productivity or collections or not, understanding the ins and outs of revenue cycle management is important.

But often, revenue cycle management isn’t a memorable lesson from medical school. The experts a Regent Revenue Cycle Management (Regent RCM) understand the importance of educating physicians on the financial aspects of providing quality healthcare.

“In many cases, surgeons do not understand all the interrelated aspects of how the organization bills and collects for services,” says Erin Petrie, Regent RCM’s Director of Revenue Cycle Management, “so they often need help understanding how the revenue cycle works and the key areas that require physician involvement.”

Petrie outlines three areas where physician involvement in RCM is critical:

  1. Coding

To facilitate insurance company payment, it is critical for physicians to facilitate proper coding for their procedures. While in some academic settings a staff person may select the specific ICD-10 and CPT codes for cases, under most circumstances it is the physicians who must own code selection. If they don’t, the case may remain unbilled or risk non-payment due to timely-filing limits, which can be as short as 20 days. Need help learning coding specifics? The American Academy of Orthopedic Surgeons offers a coding and reimbursement course.

  1. Documentation

Documenting what was done in a specific and detailed way is a critical part of the surgeon’s role in any ASC procedure, and using CPT language is the most efficient way to link the service to the correct CPT codes for appropriate reimbursement. For example, Petrie explains, it is no longer enough to specify “joint pain.” Instead, specifying the joint and the laterality in detail enables specific coding and increases the likelihood of timely reimbursement.

  1. Reviewing Accounts Receivable

Finally, Petrie suggests surgeons take active interest in understanding the ASC’s accounts receivable. Ask for a monthly A/R report and review it, she advises. Watch out for any increase in the number of accounts more than 90 days old, and ask for details about accounts in the 60-day column. When surgeons begin to take an active interest in the billing process, chances are the staff will, too.

 

 

For more information about understanding the ins and outs of revenue cycle management, contact Petrie or a member of her team at (708) 492-0531.

Protect Reimbursement 4 Ways as Payers Narrow Payable Diagnosis Codes

For ambulatory surgery centers (ASCs), it’s a “perfect storm” story: the number of Americans with knee osteoarthritis has doubled since the mid-20th century, affecting 19% of those 45 and older, and continues to grow as our population ages. Meanwhile, insurance companies are narrowing payable diagnosis codes for treatment in their drive toward value-based care. Today, surgeons need to prove patients have a very specific diagnosis of knee osteoarthritis before payers will preauthorize surgery, as “knee pain” is no longer an acceptable criterion for approval for many payers.

To help ensure ASCs avoid negative financial consequences of these trends, the experts at Regent Revenue Cycle Management have identified four key steps to protect reimbursement against denied preauthorization and payment when it comes to surgery related to knee osteoarthritis.

  1. Get the Diagnosis Right – As payers narrow the payable diagnosis codes, ASCs need to be aware of payers’ coverage and preauthorization guidelines, ensuring surgeons are aware of and using the acceptable diagnosis codes for each payer to indicate specific diagnoses. Aetna, for example, considers patients with mild-to-moderate osteoarthritis, with knee pain as well as mechanical symptoms, to be candidates for arthroscopic debridement based on medical necessity, but the payer considers the same surgery for persons with osteoarthritis presenting with knee pain only to be experimental. ASCs also should be sure to follow through with claims the physician’s office submits after preapproval so the diagnosis codes match.
  2. Negotiate to Avoid Preauthorization Denial – Since little recourse is possible after a preauthorization is denied, ASCs that include carve-outs for certain diagnosis codes when they negotiate payer contracts are a step ahead. Do this by pulling together evidence-based literature and letters justifying specific procedures and data on their cost and medical necessity to present to the insurance companies during the negotiation. Groups like the American Academy of Orthopedic Surgeons also provide resources on medical necessity and coverage for certain diagnoses. It is also important to stay current on updates to insurance company coverage, and to update your contracts to avoid losing ground.
  3. Track Processed Claims, Audit Payment Patterns — Especially for orthopedic and spine procedures, many orthopedic and spine codes aren’t clearly defined. Know them well, and keep track of processed claims against each. In addition, regular audits can help detect patterns such as minor errors responsible for denials or underpayment, and prevent similar future issues. Be sure to focus on both diagnosis codes used as well as final payment as you audit. Details matter, so consider having a professional revenue cycle management organization like Regent RCM review your contracts and help with the audit.
  4. Bundled payments – As ASCs experiment with new payment models that are directly tied to diagnosis, such as bundled payments, understanding the codes becomes even more important. Recent studies show 80 percent of payers find bundled payments appealing, and providers are beginning to embrace the new model as well. Make sure to stay apprised of any new changes or requirements that occur within the bundles, and the ASC and affiliated physicians are providing the right documentation and verification for the value-based reimbursement — if the diagnosis code is incorrect, the surgery won’t qualify for the bundled payment and the ASC could lose money.

For additional information on protecting reimbursement in today’s evolving healthcare payment environment, call Erin Petrie, Regent’s Director of RCM at (708) 492-0531 or visit www.regentrcm.com.

Reflecting on 2017, a Banner Year for Regent RCM

For Regent Revenue Cycle Management (Regent RCM), 2017 was full of opportunities to provide leadership and best practices, building on our success as a leading provider of innovative, cost-effective billing and collection services for ambulatory surgery centers (ASCs) across the United States.

Regent RCM not only launched a new self-audit guide, but also welcomed Erin Petrie to the team as the Director of Revenue Cycle Management, driving Regent RCM during this next phase of growth.

“Regent RCM is at the forefront of the industry and it has been amazing working with such well-respected healthcare innovators and leaders,” said Petrie. “I am excited to continue to lead such a dynamic team as we deliver so much more than billing and collections, namely exceptional service and solutions that define protocols and the best practices for the industry.”

Before we ring in the New Year, we would like to reflect on this year’s success and look back on highlights, including launching a new guide and sharing the values that matter most to our organization and team.

  • Conduct a Self-Audit to Improve your ASC’s Financial Health. This new guide helps center administrators audit operations to ensure their ASC stays within compliance while producing maximum revenue. As ongoing consolidation among healthcare payers squeezes surgery center reimbursements, periodic business office audits can be key to identifying a center’s financial stress points, strengths, and opportunities. “Conducting a self-audit is the fastest way for centers to get on track and stay on track,” says Petrie. “A routine audit gives your center the mechanism it needs to ask and answer the questions that lead to stronger financial health.”
  • The Value of R.I.S.E. at Regent RCM. Regent RCM’s R.I.S.E program is the cornerstone of our culture and stands for four specific corporate vales: Respectful Caring, Integrity, Stewardship, and E We created a four-part series to highlight each individual value. In part one, we learn about Respectful Caring, part two focuses on Integrity, part 3 is about Stewardship and part 4 features Efficiency. “This program was created to develop a values-driven culture,” says Andrea Woodell, Vice President of Managed Care. “It helps us stay focused on our goal of leveraging our ambulatory surgery center expertise, while providing consistent high-value customer service to clients.”

On behalf of everyone at Regent RCM, we thank you for being part of our success in 2017 and look forward to partnering with you in 2018.

Tips Help ASCs Self-Audit Revenue Cycle, Improve Financial Health

Conducting a revenue cycle audit can help ambulatory surgery center (ASC) administrators evaluate operations and identify their centers’ financial stress points, strengths, and opportunities. To facilitate the process, the experts at Regent Revenue Cycle Management have developed a free guide, “How to Self-Audit and Improve your ASC’s Financial Health” to help ASCs take an in-depth look at key revenue cycle functions, ensuring their ASC stays within compliance while producing maximum revenue.

“Conducting a self-audit is the fastest way for centers to get on track and stay on track,” says Erin Petrie, Director of Revenue Cycle Management at Regent RCM. “A routine audit gives your center the mechanism it needs to ask and answer the questions that lead to stronger financial health.”

To conduct a self-audit, ASC administrators should examine four areas affecting the financial function of an ASC: reimbursement, coding and billing, staffing, and observation (workflow and process). The Guide provides tips and examples to help bring substantial benefits associated with surfacing potential issues, correcting them, and creating new strategies and processes to prevent their recurrence.

In addition, to bring clarity to surgery center billing, Regent RCM’s Petrie suggests centers monitor ASC-specific benchmarks such as accounts receivable days, net collection rate, statement lag and charge lag, for information to trigger a new audit.

“When you notice negative changes in important benchmarks, a business office audit can be the best course of action,” Petrie contends. “A full business office audit examines both quantitatively and qualitatively all components of the revenue cycle process to determine strengths and weaknesses.”

Click here to download the guide, or if the audit process is more than your center can support on its own, contact us to learn how a no-cost business audit can be a good first step to evaluating center performance.

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