Three Revenue Cycle KPIs Every ASC Should Track Right Now

The Ambulatory Surgery Center (ASC) revenue cycle community has not had specific measurement tools readily available, which has led money to be left on the table or missed altogether. To fix this issue, Senior Director of Regent Revenue Cycle Management Erin Petrie and her team authored benchmarks that provide the intel necessary to gauge performance across all functions of the revenue cycle. This is a game changer for administrators and ASC leaders who are looking to obtain a better handle on their financial health in 2020.

On Thursday, October 17th at 11:00 a.m. CST, Erin Petrie and two members of her team, Leslie Favela and Luz Renteria, will be hosting a webinar that will outline 4 of the 9 exclusive benchmarks.

You will learn:

  • How KPIs allow you to evaluate and optimize your center’s revenue cycle
  • How payer mix impacts A/R
  • How to proactively identify denial trends
  • How to establish processes to attain benchmarks – including our gold standards – and how often they should be measured

Join us for our webinar by registering here and take the first step in getting your ASC on the road to success in 2020.

Leslie Favela

Meet the Team: Leslie Favela

As RCM, Manager of Business Development, Leslie Favela mentors Regent RCM’s team of revenue cycle specialists and provides recommendations for process improvement and optimization as she assesses the entire business office and revenue cycle for centers. She also strengthens Regent RCM’s business strategy and drives growth for Regent RCM’s client portfolio.

Prior to joining Regent RCM, Leslie worked as a front office coordinator for an ambulatory surgery center then honed her expertise as a business office manager and marketing director for a pain management practice with multiple locations in Chicago.

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There are misunderstandings and outdated beliefs related to ambulatory surgery centers (ASC) upfront financial counseling collections.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.

key payer metrics

Tracking Key Payer Metrics Can Help ASCs Manage Financials and Negotiate

As ambulatory surgery centers (ASCs) become more sophisticated about financial management, they’re beginning to adopt a practice that has been used by many hospital administrators. This practice is grading the major insurance payers on key metrics. This is done in order to inform future contract negotiations and for the overall profitability of the ASC.

Regent RCM’s Senior Director Erin Petrie says Regent RCM is developing a protocol for its ASC clients. The process helps track and evaluate major insurance payers and gather insights from side-by-side comparisons.

“The practice of collecting payer data, even in something as simple as a spreadsheet, is helpful for negotiations,” says Petrie, “I think it’s good for the administrator of a surgery center to have that knowledge. Therefore, the administrator can gain a better idea of what’s going to happen to your financials each month. For example, how long should you wait for an expected payment from any particular payer? If you see that work comp is now taking 65 days to pay instead of the 50 days they were previously trending – you want to be able to investigate those types of things.”

Petrie suggests three key metrics as a good start on grading the payers:
  • What they pay for a procedure
  • How fast they pay
  • Each payer’s percentage of claims denied

“Those are the three metrics that stand out for me,” Petrie says. “But there are a lot of additional things that could be measured for the sake of having a better negotiation tool. For example, the reimbursement methodology each payer follows might be another good one. Do they use groupers, are they reimbursing as a percent of Medicare, are they including implants or paying for implants separately? That sort of data is helpful to have.”

While Petrie admits developing and maintaining a process for grading the major payers is resource intensive, she believes the benefits can be compelling. As a result, Petrie and her team are incorporating the practice as a part of Regent RCM’s scope of services for ASC clients.

What might ASC administrators learn from such a process?

“Definitely around denials the information can be pretty eye opening,” Petrie notes. “If you take the time to really look at your Explanation Of Benefits documents (EOBs) and your denials, you’ll learn that payers have many more denials than you thought. But you’ll eventually get paid.”

Implementing a system for grading payers helps answer key questions: Is a payer denying things that they should be paying for? How much time does your staff have to spend to collect from each payer? And, how long is it taking for that money to come in from each? Most importantly, collecting this data gives ASCs better information to use in negotiations.

“ASC admins already do a good job of collecting data to use when we negotiate with the payers around quality metrics, clinical outcomes and cost effectiveness,” she says. “However, the opportunity is to couple that with what we see happening on the financial side. The data may allow us to point out that we’re experiencing too many denials.”

She adds, ” it may also allow us to show that our total short payments are, for example, $200 off on average per case. And we could talk tangibly about days to pay. Maybe they have 30 days to pay in the contract, but your data is showing that they’re averaging 50 days. When we can share hard data, we have additional points to negotiate.”

Petrie believes “grading” insurance payers has value at an enterprise level as well as for individual centers. “Either way, it’s a real value add for surgery centers to understand their payers, both to inform negotiations, and to manage financials more effectively.”

For more information on Regent RCM’s approach to grading insurance payers, contact Petrie. Email her: epetrie@regentsurgicalhealth.com or click here to send a message to the Regent RCM team.

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.

Three ASC Healthcare Trends

Three Healthcare Trends to Track that Impact ASC Cash Flow and Revenue

Rapid change in the healthcare industry requires that providers cope with a myriad of emerging trends, including increased patient volumes, new reimbursement formulas, an evolving payer mix and a changing regulatory environment. For ambulatory surgery center (ASC) leaders, tracking three key trends in particular is critical to effective cash flow and optimal revenue cycle management. Two of these trends to watch are triggered by changing patient needs, while the third is focused on their employers.

1. Price Transparency

As higher deductible plans drive up the percentage of the healthcare bill that is the patient’s responsibility, consumers are demanding more advance price transparency. Especially for elective procedures but for others as well, prospective patients want to know what their costs will be in advance. In response, earlier this year the Centers for Medicare & Medicaid Services (CMS) implemented new regulations requiring providers to post charges for procedures, and some states have even more demanding requirements.

For ASCs, this trend makes it increasingly important to analyze operational data (such as case costing) as you create a viable fee schedule and estimate costs on a patient-by-patient basis. Click here to learn additional details about upfront patient financial counseling & collections from our newest whitepaper.

2. New Financing Needs

The second patient-driven trend ASCs should track diligently also stems from the shift of more of the healthcare cost burden toward consumers. In spite of the trend making them more financially responsible for their care, many patients simply can’t afford to pay: In fact, A 2018 report by the Federal Reserve revealed that 4 in 10 adults would not be able to cover a $400 emergency expense.

As a result, patients need new ways of paying for surgical procedures, namely payment plans. And ASCs are turning to third-party resources in order to stay out of the consumer loan business. For a fee, these organizations cover the patient’s costs upfront, and then take on the responsibility of collecting the balance over time. ASCs much determine whether the fee involved is worth it, by examining their uncollectible patient debt costs and loss ratio.

3. New Ways of Contracting

Employers are impacted by rising healthcare premiums as well, and some have attempted to contain rising premium costs by contracting directly with providers (a form of self-insurance). For ASCs, this trend creates another reason to truly understand the drivers of a center’s revenue and case volume.

Again, having the information technology and analytics in place to get the answers is critical. ASCs need data in order to ask and answer the right questions about their profitability. Only with the ability to analyze how these healthcare trends are impacting their revenues and cash flow can they proactively manage revenue to avoid potential adverse financial outcomes.

Regent Revenue Cycle Management (RCM) provides turnkey billing and collections services focused only on ambulatory surgery centers in the United States, approaching revenue cycle in a unique way that consistently outperform industry benchmarks and allows ASC managers to focus on what they do best: providing high quality care. For more information on how Regent RCM can help ASCs manage these key trends, click here.

Doctor smiling - three myths whitepaper

New Whitepaper Debunks Three Myths about Upfront Patient Financial Counseling and Collections

To combat climbing health insurance deductibles and co-pays that push a larger portion of the cost of surgery from insurers to patients increasing collections risk, ambulatory surgery centers (ASCs) have responded with more robust financial pre-registration processes to maintain efficiency and profitability. A new whitepaper offers insights into this trend, while separating myth from reality regarding implementation.

Regent RCM’s Erin Petrie, Director of Revenue Cycle Management, says while there was resistance in the marketplace to upfront patient financial counseling and collections just a few years ago, the practice is rapidly gaining acceptance today. More than 90% of patients want to know their payment responsibility prior to a provider visit or scheduled procedure.

“In response to the trend, we’re making sure to include in our financial planning process an upfront review of the patient’s benefits,” she says. “Taking this step helps ensure transparency about out-of-pocket expense, so costs can be estimated, explained, and ideally, collected in advance of services being rendered. It makes patients more comfortable about their financial commitment and reduces our risk on the backend.”

Regent RCM, a leading provider of innovative and cost-effective revenue cycle management services exclusively for ASCs, 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. The new whitepaper, available for free download here, addresses three common myths:

  • Myth #1: Advance collections won’t work.
    Reality: It’s happening. And it’s helping.

  • Myth #2: The practice lacks physician support.
    Reality:
    Physicians understand that healthcare providers must embrace good business practices in order to stay solvent and continue to provide quality care.

  • Myth #3: Attempting advance collections might prompt surgery cancellations.
    Reality: Patients appreciate transparency around what charges they’ll be accountable for and understand that high deductibles are the new norm.

The white paper offers proof that payment only after services are delivered is an outdated mindset in healthcare, citing the advance collections experiences of two leading ASCs, Glasgow Medical Center in Newark, Delaware, and Palos Surgicenter in Palos Heights, Illinois. The paper also offers four suggestions for ASC leaders interested in implementing advance collections.

To learn more about Regent RCM’s work with ASCs to implement upfront patient financial counseling and collections, contact 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.

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