3 Tips to Maximize Surgery Center Billing and Coding

Regent RCM’s gold standard for days outstanding is 30 days or less, although the right number for a center could range from the mid- to high teens all the way up to 50, depending on payer mix and case mix. In this blog post, we’ve summarized 3 ways to keep days outstanding in check.

Manage Lags and Turnaround Time

Claims should always be sent the same day charges are entered, so the claim lag should be the same as the charge lag. If centers are experiencing a significant difference between the two, this is an indication that your billing department may be holding claims or that they’re entering charges prior to receiving the operative report. Managing lags and turnaround time is one of the easiest ways to decrease your days outstanding. “The charge entry lag is measured from the date of service to the date charges are entered. The charge entry lag should be less than five days, with the gold standard being less than two and a half days.” Said Erin Petrie, Regent RCM’s Director of Revenue Cycle Management.

Conduct Periodic Coding Audits

It is extremely important to conduct periodic coding audits by an outside coding company, whether your center outsources its coding services or employs a certified coder. “Regent coordinates bi-annual audits on all of our centers using an outside firm. By doing so, we eliminate the conflict of interest a regular coding company may have in finding coding errors in the hopes of gaining additional clients. All centers should be held to an acceptable standard above 90 percent accuracy but be given a chance to rebut coding inaccuracies found during an audit,” said Petrie.

Some disparities found during our coding audits center around what was performed during the procedure and what was dictated. Sound coding practice is to always code from the operative report and not from the procedure.

Choose the Right Clearinghouse

Choosing the right clearinghouse can make a significant difference in the efficiency of your business office. Most clearinghouses can send electronic claims and receive electronic remittance (ERA). ZirMed and others set themselves apart by performing electronic eligibility in either batch or individual mode, providing real-time statuses and having the ability to setup center-defined, custom claim edits. In addition, ZirMed rolled out a new enhancement recently which allows some of our centers to send worker’s comp claims, traditionally sent on paper, electronically by matching up a scanned operative report to the electronic claim. This has caused a decrease in our A/R greater than 90 days for worker’s comp, which is habitually one of the more challenging financial classes.

Keeping days outstanding to a minimum is a worthy task for all ASCs, one that requires constant diligence and strong organizational efforts from everyone involved in the process. The fruits of this labor can lead to steadier collections, a more organized business office, and more integrity in your reporting data

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

Meet the Team: Ariana Cisneros

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 Gina Rice-Hill.  Today we shine the spotlight on:

Ariana Cisneros

Where is your hometown? Born and raised in Chicago

What do you do at Regent RCM? As a revenue cycle specialist, I help with self-pay for a couple of centers, calling patients to resolve their balances, and help with any billing questions they might have. I’m also training for insurance verification. After that I will hopefully take over responsibility to do billing, posting, and a little bit of everything for a center. I’m looking forward to learning lots of new things!

How long have you been working at Regent RCM? I’ve been with Regent RCM for about a month and a half now.

Where did you work before joining Regent RCM? Before making my way to Regent, I was working at Loyola University Medical Center in the billing customer service area.

What is your favorite part about working at Regent RCM? So far, my favorite part is having great coworkers that who’ve welcomed me onto their team. They’ve been very accommodating and have offered their help more times than I can count. It is always great to feel welcomed and see that at the end everyone works as a big team.

What has been your greatest professional achievement? I’m not sure what has been my greatest professional achievement as of yet, my mindset is to work hard every day and continue to out do my greatest achievement on a consistent basis. My goals are to be a great employee, work hard and be a good team member in order to help Regent RCM achieve its goals.

What is one fun fact about yourself your co-workers don’t know? A fun fact about myself is I love doing crafts, I like baking and I also enjoy decorating around my house or even helping decorate special events. I like being creative!

4 Reasons ASCs Fail and How to Manage for Success

While many trends in healthcare today point to the value of outpatient care, ambulatory surgery centers can still falter if they fail to actively manage risk in critical areas. The experts at Regent Revenue Cycle Management have observed four common mistakes, and together with Regent Surgical Health, can help centers turn each challenge into an opportunity for growth.

  1. Poorly Managed Contracts
    ASC administrators face a variety of challenges when it comes to successfully managing their payor contract negotiations. One common problem is that often hard-working and well-intentioned administrators and office managers are too busy balancing numerous job responsibilities to dedicate the needed persistence and focus required to successfully negotiate expiring payor contracts. But with careful preparation, ASC administrators can keep more money to reward and fuel center growth by negotiating payor contracts that will adequately cover the full cost of services and ultimately streamline healthcare costs for all. Key strategies include: incorporating Centers for Medicare & Medicaid Services (CMS) changes into contracting, planning for future case mix changes and updated procedures, building in annual increases and multi-year contract increases, and overall caution/careful attention to terms when it comes to preferred provider organizations (PPO) and third-party administrators (TPA).
  2. Skyrocketing Costs
    Monitoring expenses and tracking trends are essential to managing costs. For example, if a center is losing money on unprofitable cases and inefficient supply management, tools that help keep administrators in the know can help immensely. To address this problem, Regent has spearheaded solutions like the use of electronic preference cards to replace old, less precise metrics. Electronic preference cards provide a wide swath of data, as information is collected and compared across member facilities to get a clear picture of supply expenditures. This allows surgery centers to discern which physician items are driving up costs, and find out where real savings can be captured. In addition, Regent has found that integrating the information with the help of electronic procurement systems like Inventory Optimization Solutions (IOS) helps ASCs better manage costs throughout a single center as well as throughout the entire organization.
  3. Failure to Bring in High-Reimbursement Cases
    To succeed in an era of tightening reimbursement practices, an ASC needs to stay ahead of the competition by adding profitable procedures that may not be available elsewhere, or risk losing such cases to the competition. Procedures with potential to deliver strong profits include (among others) major spine cases and total joint replacements (TJR). Moving TJR surgeries to an ASC makes sense for many reasons, both clinical and financial. It is important to first assess outcomes on an inpatient versus outpatient basis to see whether the results vary by setting type or provider.
  4. Revenue Cycle Management
    The way an ASC manages the revenue cycle can make or break its profitability. And with the Affordable Care Act, Medicare and Medicaid payment bundling, and updated ICD-10 guidelines looming, the revenue cycle landscape is changing at a rapid pace. Specialized expertise is required to ensure optimal results while anticipating new opportunities, and revenue cycle management can’t be an afterthought. The team Regent RCM understands the intricacies of the ASC revenue cycle, where problems commonly occur and how to fix them, as well as how to optimize reimbursement.

Are you interested in auditing your operations to ensure your ASC is maximizing revenue? A self-audit guide is available download here and will help identify your center’s financial stress points, strengths, and opportunities.

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.

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