upfront financial counseling advisor

Common Myth Related to ASCs: Upfront Financial Counseling & Collections Lack Physician Support

There are misunderstandings and outdated beliefs related to ambulatory surgery centers (ASC) upfront financial counseling collections. Our first blog in this 3-part series disproved the myth that “advance collections won’t work”. In the 2nd post of our series, we focus on the myth that upfront financial counseling & collections lack physician support.

Myth: Physicians feel protective toward their patients and find it crass to talk about money before providing quality care … so they won’t support advance collections.

Reality: Physicians understand that all healthcare providers in today’s marketplace must embrace good business practices in order to stay solvent and continue to provide quality care. Palos Surgicenter adopted a new policy in February 2019 requiring payment in full prior to surgery, supporting it with a program of upfront patient financial counseling. Mary McGill, Business Office Manager at Palos Surgicenter, says physicians have been very supportive of the new approach.

“Our doctors’ offices are overwhelmingly supportive. They’re facing some of the same financial challenges themselves, so they’re aware of why it’s important.”

Palos Surgicenter made a concerted effort to educate both center staff and physicians’ offices in advance of the change upfront financial counseling collections. They sent letters to their doctors, business office managers, and schedulers explaining the new policy and approach. “Our communication and transparency were key to our success with the new policy” said McGill. Education and preparation allowed physicians and their office to feel comfortable with the payment changes.

To learn more, click here to download our full white paper, or contact Leslie Favela at lfavela@regentrcm.com.

Q2 Award Winners Smiling

Congratulations to our Q2 Award Winners

Regent Revenue Cycle is pleased to present our 2019 Distinguished Performance Q2 award winners. Each recipient met or exceeded all Regent gold standard performance benchmarks including:

  • A/R follow up
  • Decrease in % of A/R over 90 days
  • Highest quality audit results for Q2

Our revenue cycle specialists continue to deliver excellent quality service in the industry’s competitive field.  

“Everyone is so proud of this group of employees,” said the RCM Management team. “The Regent gold standard performance benchmarks are extremely difficult to meet, yet alone exceed, and these individuals went above and beyond to deliver excellence. In addition to reaching or surpassing these goals, this group exemplifies our R.I.S.E. values of Respectful Caring, Integrity, Stewardship, and Efficiency that we all strive to reach.” 

Congratulations Gabriela Alcarez, Ariana Treto, Denise Soriano, Lila Casas and Angela Valentin. We look forward to seeing what you all accomplish in Q3.

advance payment collections won’t work

Common Myth Related to ASCs: Advance Collections Won’t Work

There are misunderstandings and outdated beliefs related to ambulatory surgery centers (ASC) upfront financial counseling collections. In this post, the first in a 3-part series, we focus on a common myth: Advance Collections Won’t Work.

Myth: In the healthcare industry, it’s not feasible to collect for procedures not yet completed.

Reality: It’s happening. And it’s helping. Proof abounds that payment only after services are delivered is an outdated mindset, even in healthcare. For example, when leaders at the Glasgow Medical Center in Newark, Delaware, began considering proactive patient financial counseling, they noted a trend in their market of increased patient responsibility, both in terms of deductibles and co-pays.

“Our research suggested collections in advance would be feasible because patients, for the most part, expect to make a payment,” says Mary Kearns, Business Office Manager at Glasgow Medical Center. “Upfront financial counseling helps us help them understand how much they’ll owe, allowing them to budget or apply for credit. As a result, our center has increased upfront money collected. Overall it has been a great experience helping to resolve and minimize our bad debt.”

Glasgow’s results align with an industry statistic that states that more than 90% of patients want to know their payment responsibility prior to a provider visit or scheduled procedure.

Regent RCM is working with leading ASCs to put programs in place that operationalize upfront patient financial counseling and collections, and to dispel outdated myths that keep centers from benefiting from these proactive processes. To learn more, click here to download our white paper, or contact Leslie Favela at lfavela@regentrcm.com.

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.

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.

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, we identify 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.

Are you considering outsourcing to optimize your center’s revenue cycle? We 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.

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