5 Steps to Take to Improve ASC Billing and Collections

For your ambulatory surgery center to operate efficiently and deliver quality care to patients, you must establish streamlined billing and collections processes. Obstacles like coding errors and delayed payments have a negative impact on your ASC’s revenue flow. These five steps will help you improve the way you manage your billing and collections procedures.

  1. Update all your payer contracts in your software.

Some payers change their rates at the beginning of the year, so check your billing and collections software to ensure that all your existing contracts are accurate and up to date. This information will feed into other parts of your revenue flow, such as an electronic remittance advice (ERA) — an electronic version of a payment explanation — and contractual variance reports. For more tips on payer contract negotiations, read Part 1 and Part 2 of Andrea Woodell’s series, Top 4 ASC Payer Contracting Practices.

  1. Review your managed care contracts for correct payment.

When your contracts are fully entered into your billing and collections system, you can easily track which payments have cleared and which are still outstanding.

“This allows you to run reports to determine how much you were paid versus how much you were supposed to be paid for different procedure codes,” said Erin Petrie, Director of Revenue Cycle Management. “That way you can identify where you’re being underpaid, or if you’re not charging enough for a particular procedure.”

  1. Enable ERA and EFT with all payers.

Automating time-consuming steps in the revenue cycle will help your ASC decrease costs and increase efficiency. The majority of payers can send payment via electronic remittance advice (ERA) or electronic funds transfer (EFT). Once you have established these forms of payment, your ASC can begin auto-posting payments, which will help you get paid more quickly and more accurately.

  1. Use your clearinghouse to send attachments to payers electronically.

Many delays in the A/R process are a result of payers requiring documentation to support submitted claims, such as operative reports and implant invoices. Clearinghouse software improves this workflow by scanning and sending these documents electronically. It also keeps records of patients’ insurance benefits – co-pays, deductibles, co-insurances and out of pocket maximums – to estimate their responsibility for procedures in advance. This information facilitates a positive patient experience and decreases outstanding balances.

  1. Arrange for payment up front.

Decrease collections costs and days in A/R by arranging for payment on all unmet deductibles and co-insurance ahead of time.

“It’s important to clarify this point: ASCs should arrange for payment, not necessarily collect on them,” said Petrie. “Collecting on them can lead to issues, including increased staff costs and legal complications.”

Because it’s challenging to determine how much of the deductible will apply to the ASC, you can use a credit card authorization form, take a patient’s credit card information, and authorize the charge of a certain amount. Then when the claim is adjudicated, you are able to call the patient and inform them how much you’re going to charge the credit card at that time.

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

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.

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.

Reasons to Outsource

Top 6 Reasons to Outsource RCM – Part Two

Why is the revenue cycle management (RCM) market projected to experience a 12 percent uptick in growth through 2021? Two primary forces are at play: Value-based care’s emphasis on improving quality while reducing costs, and the increased complexity that comes with a more accountable organization. Ambulatory surgery center (ASC) leaders see the need to achieve real transparency, predictability, and performance, and outsourcing RCM is the ideal way to increase cash flow, cut costs and optimize their centers’ revenue cycle.

In a two-part series, Regent RCM’s VP of Revenue Cycle Michael Orseno identifies the top six reasons for outsourcing RCM. The <<first blog>> focused on expertise, technology and staffing. This second installment focuses on transparent reporting, legalities and location-specific savings.

  1. Transparent Reporting. While ASCs often lack the necessary expertise, technology and resources, or time needed to devote to transparent measurement and reporting, outsourcing these processes offers access to the tools and expertise needed to analyze the data and track changes in financial performance. Expertise with third party reporting software allows revenue cycle experts to pull specific reports to find the root cause of a problem. For example, outsourcing RCM can help determine what it means if an ASC has either a very low or very high percentage of A/R over 90 days. The center can then take steps to correct course.
  2. Keep up with rules and regulations. Never has it been so important to stay abreast of healthcare laws and regulations. ICD-10, for example, is constantly re-shaping coding, and ASCs must stay ahead of the curve. But centers also have numerous otherpriorities that must be completed, and new regulations can fall through the cracks. Outsourced RCM vendors, by the nature of their business, proactively keep tabs on industry laws and regulations.
  3. Save space to enhance revenue. Outsourcing RCM can create added space within a facility, and the extra square footage can be used to enhance value added aspects of the business. More testing equipment can be brought in for example, enabling services that create an increase in revenue. “Outsourcing RCM frees up physical space in an ASC, and that can give centers the opportunity to add new services, which can be beneficial financially,” said Orseno.

Are you considering outsourcing to optimize your center’s revenue cycle? Ed Tschan and the experienced team at Regent RCM are available to your answer questions and discuss if a revenue cycle evaluation makes sense for you. 312-882-7228.

If you missed part one, read it here.

Reasons to Outsource

Top 6 Reasons to Outsource RCM – Part One

Revenue cycle management (RCM) is one of the functions healthcare providers outsource the most. In fact, the RCM market is projected to experience a 12 percent uptick in growth through 2021, according to a MicroMarket Monitor report.

Outsourcing is projected to expand due to two primary market forces: Value-based care’s emphasis on improving quality while reducing costs, and the increased complexity that comes with a more accountable organization. Ambulatory surgery center (ASC) leaders are recognizing the need to make RCM more transparent and predictable, and outsourcing RCM is the optimal way to increase cash flow, cut costs and stabilize their centers’ revenue cycle.

In a two-part series, Regent RCM’s VP of Revenue Cycle Michael Orseno identifies the top six reasons for outsourcing RCM. The first installment focuses on expertise, technology and staffing.

  1. Expertise. With the Affordable Care Act, Medicare and Medicaid payment bundling, and updated ICD-10 guidelines looming, the RCM landscape is changing at a rapid pace. Ensuring optimal results while keeping up with the latest opportunities related to RCM requires specialized expertise. The team at Regent RCM specializes in developing, executing and refining billing and collection strategies, and invests in the most up-to-date tools and technologies. “Revenue cycle management can no longer be an afterthought,” said Orseno. “With the vast overhaul that the healthcare industry continues to undergo, business office managers at surgery centers must employ RCM experts that have seen it all, and can not only roll with the changes, but anticipate what’s around the bend.”
  2. Best-in-class technology. With tighter margins, and priorities favoring patient care over improved billing resources, ASCs are often not equipped to excel at managing the revenue cycle in-house. By outsourcing RCM, centers can take advantage of economies of scale and gain access to best-in-class technology. At Regent RCM, staff use a trio of technologies: ASC Management Information Systems (MIS platform), clearinghouse software, and next generation dashboard and real-time monitoring and management. “RCM providers have a deep knowledge of which tools work well together and which work in silos,” said Orseno. “We have enterprise dictionaries already built for one MIS platform, so that only facility-specific information needs to be inputted. This makes implementing new technology easier, too. At an ASC, implementation typically takes more than three months, but for our partner centers, we can cut that time in half.”
  3. Smart staffing/no succession planning. For ASCs, an experienced billing and coding staff with built in redundancies is now a necessity. Cutting corners by hiring inexperienced staff can cost an ASC hundreds of thousands of dollars per year, not to mention direct impact on workflow and efficiencies. Outsourced RCM providers have the resources to attract experienced staff because they can pay well, provide good benefits, and situate themselves in desirable locations. In addition, because outsourcing RCM is what they do, these specialists know how to find and hire the best of the best, and often have a pipeline of qualified applicants waiting for a spot to open up.

Are you considering outsourcing to optimize your center’s revenue cycle? Ed Tschan and the experienced team at Regent RCM are available to your answer questions and discuss if a revenue cycle evaluation makes sense for you. Please call 312-882-7228.

Click here to continue to Part Two.

revenue cycle management

3 Secrets to Successful ASC Revenue Cycle Management

Effective ambulatory surgery center (ASC) revenue cycle management can be hard to achieve, particularly as internal and external forces exercise their influence. According to Regent RCM’s Vice President of Revenue Cycle Management Michael Orseno, ASCs that pay attention to three key success factors are well-suited for the challenge.

“The first key success factor is driven by the healthcare industry’s shift toward value-based care,” Orseno says. “While assuming reimbursement risk from payers along with the responsibility to provide quality care has created some uncertainty and challenges for ASCs, managed care is in better hands. ASCs are equipped to both deliver quality care and manage costs more effectively than insurance companies ever were. But to be successful in revenue cycle management (RCM), ASCs need to become more adept at both managing costs and collecting additional revenue directly from patients, many of whom have selected healthcare insurance plans with lower premiums but higher deductibles.”

Another factor is also closely related to the evolution of value-based care. While many ASCs are succeeding at streamlining procedures and costs for procedures new to out-patient treatment, such as total joint replacement, payment bundling and reimbursement declines introduce new pressures. For example, payers are beginning to scrutinize payment of high-cost implant procedures and are driving a hard bargain when it comes to bundled payment agreements. As ASCs assume leadership of these bundles, a second key success factor is careful negotiation along the way. “You need to be diligent – check your costs, factor in economies of scale but also account for patient-driven variation, and renegotiate contracts annually,” Orseno suggests.

A third way to ensure successful RCM is to optimize business office staffing. “The best-run ASCs make sure their RCM staff is motivated and incentivized to aggressively pursue revenue, rather than just remaining content with the status quo,” Orseno says. “If an ASC’s staff is accepting only what the insurer pays and not fighting for what the center is contractually entitled to or higher than ‘usual and customary,’ that particular facility may be leaving a lot of money on the table.”

Regent RCM Supervisors Named to Becker’s List of Revenue Cycle Wiz Kids

Regent Revenue Cycle Management (Regent RCM) is proud to announce that Revenue Cycle Supervisors Vianca Bautista and Leslie Favela have been recognized as revenue cycle leaders in a recent list published by Becker’s Health IT & CIO Review.

“We are thrilled that Becker’s has acknowledged Vianca and Leslie’s talent,” said Michael Orseno, Regent RCM Vice President of Revenue Cycle. “Both are dynamic and results-focused and during their careers at Regent RCM, have shown their dedication to helping partner centers meet and exceed ASC-specific benchmarks. Vianca and Leslie possess the intangible leadership qualities that will serve our organization and our clients for many years to come.”

Bautista joined Regent RCM in June 2015, and made an immediate impact by sharing her skills in medical assisting, billing and collections, and also claims examining. She boasts a decade of healthcare experience.

“It is an honor to be included on the Becker’s list,” said Bautista. “Our team strives to stay ahead of revenue cycle and industry trends as we work to streamline processes and optimize the revenue cycle for partner centers; it’s challenging work and very rewarding.”

Favela has been a Regent RCM team member since 2013 and oversees a team of revenue cycle specialists while performing audits to ensure key performance indicator goals are met. Her versatile skill set is well known throughout the company, as Favela also performs full revenue cycle services for one ASC, administrates HST systems and serves as the key component on new client implementations and transitions.

“I am happy that a publication like Becker’s has recognized Vianca and me,” said Favela. “But we couldn’t have made the list without our co-workers at Regent RCM. We truly work together as a team.”

Click here to see the full list of “32 Health IT and Revenue Cycle Wiz Kids.” And click here to view the full leadership roster at Regent RCM.

Revenue Cycle

Regent RCM and ZirMed Partner to Improve Revenue Performance

Authored by Vice President of Revenue Cycle Michael Orseno, Regent Revenue Cycle Management (RCM) this week released an article that outlines five ways in which Regent RCM and ZirMed combine to improve revenue performance.

“The ASC revenue cycle is complex and we both know that. Through our partnership, we leverage our expertise and provide ASCs with the support and technology needed to effectively manage the revenue cycle,” said Orseno. “With this article we drill down on five keys to getting paid quickly and efficiently.” Strategies include:

  1. Verify insurance coverage.
  2. Code claims correctly the first time.
  3. Minimize claim denials.
  4. Act quickly against denials.
  5. Arrange for/Collect patient out-of-pocket expense up front.

“Surgery centers need revenue cycle strategies that work and together with ZirMed, we deliver breakthrough revenue cycle management solutions that enable partner centers to collect every dollar they are entitled to,” added Orseno.

The article, Regent RCM, ZirMed Work Together to Solve ASC Revenue Issues, appears exclusively online at Becker’s ASC Review. Click here to read the full article.

ASC Revenue Cycle Statement Lag

ASC Revenue Cycle Benchmark Video #7 – Statement Lag

Regent Revenue Cycle Management (Regent RCM) Vice President Michael Orseno and his team developed nine industry-specific benchmarks to gauge the health of an ambulatory surgery center’s (ASC) revenue cycle in answer to an ongoing need to better manage billing and collections. A series of videos discussing these metrics explains how each is utilized to improve revenue cycle processes.

The seventh video focuses on statement lag, which is the time between the balance becoming the patient’s responsibility and the time the statement goes out the door. The Regent RCM gold standard is less than five days. Although it is recommended that patients be put on a 30-day cycle, statements should be run at least once per week.

With the probability of collecting patient balances decreasing every day since the procedure was performed, it is paramount for facilities to send statements out to patients as soon as their payment portion is known.

Click here to watch the video and learn more about this meaningful metric and what it means when a facility has a high statement lag.

Find more detailed information on this metric and others that will help your center monitor and manage its revenue cycle by watching the three-part webinar series that explores the topic in-depth. Regent RCM revenue cycle specialists are also available to answer further questions. Click here to contact the team.

Tricare logo

How Regent RCM Leverages TRICARE Expertise to Maximize Reimbursement

Regent RCM has developed a high level of TRICARE expertise, another core competency that sets Regent RCM apart from other revenue cycle management (RCM) providers. This unique experience offers ambulatory surgery centers (ASCs) valuable knowledge to maximize their reimbursements.

TRICARE, the health care program for uniformed service members and dependents, is managed by the Defense Health Agency and covers nearly 9.5 million beneficiaries around the world. TRICARE serves active duty, retired and Guard/Reserve service members and their families, and benefits and plans vary widely depending on the beneficiary category and the region. Other insurance carriers also process claims for TRICARE, which adds to the complexity of billing and collecting payment for health care facilities.

“It’s a complex process to understand  – determining how to bill appropriately, how you should be getting paid, what they should reimburse you, and what’s included in reimbursement,” said Leslie Favela, revenue cycle supervisor at Regent RCM.

Favela explained that many ASC administrators are under the wrong impression that TRICARE won’t pay for certain procedures when billed, which makes centers reluctant to accept TRICARE patients in the first place. “This is an unfortunate misconception,” said Favela. “TRICARE offers set reimbursements for many procedures, but it is necessary to understand the intricacies of billing the claims correctly in order to maximize reimbursement.”

Regent RCM has conducted extensive research into TRICARE: How the billing process works, what to charge, and what procedures are allowed and not allowed. Importantly Favela notes, TRICARE rates change each year on November 1. “Regent RCM makes it a priority to maintain the most up-to-date reimbursement information as part of our team’s standard process,” explained Favela. “We pride ourselves on having an expert understanding of TRICARE expected reimbursement, which we then leverage to get the maximum payments for our ASC clients.”

TRICARE has an enormous reach, and Regent RCM’s proficiency in reimbursement is highly beneficial for centers located near military bases or serving uniformed patients and their families.

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