3 More Advantages to Outsourcing Revenue Cycle

The revenue cycle market is projected to grow at a rate of 12% by 2021, according to a MicroMarket Monitor report. Why? Because administrators recognize they have to fight for every dollar but are stretched thin as revenue cycle is demanding and time consuming.

“ASCs are increasingly focused on delivering value-based care, which aims to improve quality while reducing costs,” said Regent RCM Director of Revenue Cycle Management Erin Petrie. “ASC leaders are also trying to build organizational accountability. Outsourcing revenue cycle aligns with both of these goals; it is the ideal way to increase cash flow, cut costs, and optimize a center’s revenue cycle, while strengthening transparency.”

In a recent blog post, Regent RCM outlined three competitive advantages to outsourcing RCM. Here are three more important ways ASCs benefit when they outsource their revenue cycle.

  1. Transparent Reporting

ASCs often lack the expertise, technology, resources, or time needed to execute transparent measurement and reporting in their finances. Outsourcing to experts gives ASC leaders access to sophisticated financial analysis and tracking tools.

Revenue cycle experts use third-party reporting software to offer deep insight into centers’ financial performance, analyzing and addressing the root causes of problems. For example, by outsourcing revenue cycle, an ASC can receive a thorough audit of its accounts receivable processes. The center can then use this helpful information to reduce days in A/R and improve cash flow.

  1. Staying Ahead of Requirements

Healthcare laws and regulations are constantly changing. ICD-10, for instance, is frequently re-shaping coding, and ASCs must stay ahead of the curve. But centers also have numerous other day-to-day priorities to complete, and new regulations sometimes fall through the cracks.

Outsourcing  solves this challenge seamlessly. Professional revenue cycle vendors must proactively keep tabs on industry laws and regulations, ensuring that their ASC clients remain updated and protected.

  1. Saving Space to Increase Revenue

Outsourcing revenue cycle can free up physical space within an ASC. Because an outside vendor is handling the revenue cycle, the center acquires valuable extra square footage, which opens up new possibilities and opportunities. An ASC can use the available space to enhance value-added aspects of the business; for example, buying more testing equipment or adding new services that will increase the reputation and revenue of the center.

Are you considering outsourcing to optimize your center’s revenue cycle? The experienced team at Regent RCM is available to your answer questions and discuss a revenue cycle evaluation. Contact Regent RCM.

Billing Mistakes and How to Avoid Them: Part 1

A streamlined revenue cycle management (RCM) process is critical to the success of an ambulatory surgery center (ASC). For an ASC to maintain its financial health and operate efficiently, it must develop an revenue cycle solution that handles every aspect of billing and collections, measurement and reporting, and payer contract negotiating, using industry expertise and up-to-date automation technologies.

Billing errors at any point during the revenue cycle can delay payments, impede a center’s cash flow, and have a negative impact on an ASC’s financial future.

In this two-part series, Regent RCM will explore nine common ASC billing errors – and give expert advice on how to avoid them. Here are the first four mistakes to steer clear of.

  1. Not Completing a Full Patient Record

The first step in the revenue cycle process is compiling a comprehensive patient record, including the patient’s medical history, payment receipts, and insurance benefits verification and authorization. An incomplete record can be a roadblock for coders, who often need to reference a patient’s documentation to choose the correct codes and modifiers for a procedure. Delays in coding impede reimbursement, which damages an ASC’s cash flow.

Solution: Assemble complete records for every patient, including pathology reports, implant logs, past invoices, and anything else that may influence billing. Work with a revenue cycle partner, preferably one with ASC specific experience, to identify and remedy common missing pieces in patient records.

  1. Not Verifying Eligibility

In advance of a procedure, an ASC must confirm that the claim is eligible for coverage, clarifying who is responsible for payment and what coverage is included. Costly delays often occur when claims are sent to the wrong carrier or plan, or specific authorizations for procedures or supplies aren’t approved.

Solution: When a procedure is scheduled, verify beforehand the reimbursement plan and carrier details. Pre-arrange any necessary authorizations and determine who will pay for any uncovered elements.

  1. Settling for Deficient Payer Contracts

Successfully negotiating the best payer contract rate will result in the highest reimbursement for your surgery center, but the process isn’t easy, and expertise and consistency are essential.

Solution: Andrea Woodell, VP of Managed Care, has a 20-year history of negotiating payer contracts and securing gains. She has a variety of best practices and recommendations but always warns centers to begin early, starting at least four months prior to the anniversary of your contract. Click here and here to learn more.

  1. Giving Unnecessary Discounts

While there are exceptions, ASCs should not adopt the habit of providing discounts or waiving fees for patients. Routine reductions are likely motivated by good intentions, but they can have a harmful effect on a center’s finances. They also may break terms of some insurance contracts.

Solution: Be open and transparent with patients about financial responsibility when a procedure is scheduled. Inform patients of what will be covered by insurance and what they will be expected to pay, offering payment plans or other alternatives if they are available.

Need expert assistance in improving your revenue cycle management? Contact Regent RCM.

3 Advantages to Outsourcing RCM

Streamlined revenue cycle management (RCM) is key to an ambulatory surgery center’s long-term financial success.

The revenue cycle is multifaceted, involving every aspect of coding, billing, claims submissions, and collections. “Because healthcare providers need to expend significant resources to manage the revenue cycle internally, many are choosing to outsource RCM in order to increase efficiency and reduce expenses,” said Regent RCM Director of Revenue Cycle Management Erin Petrie. The RCM market in North America is expected to experience a growth rate of 12% by 2021, according to a MicroMarket Monitor report.

Outsourcing RCM is projected to expand as ASC leaders recognize its benefits:

  • Enhancing quality of care while reducing costs
  • Increasing transparency and accountability
  • Improving cash flow and stabilizing the overall revenue cycle

Ambulatory surgery centers that opt to outsource RCM gain several competitive advantages:

  1. Specialized Expertise

The revenue cycle management landscape is not static; it is changing at a rapid pace. For healthcare providers to keep up with the latest updates to Medicare, Medicaid, the Affordable Care Act, and other guidelines, they must employ RCM specialists on their administrative staff to get optimal results.

Outsourcing RCM is a far more effective and affordable option for many ASCs. A company that specializes in revenue cycle management offers ASCs expertise in developing, executing, and refining billing and collection strategies. “These RCM experts know how to handle the most complicated challenges and plan for any imminent changes,” said Petrie.

  1. Smart Staffing

For ASCs to manage the revenue cycle internally, they must employ an experienced billing and coding staff with built-in redundancies. This costly investment is a necessity for in-house RCM; cutting corners and hiring inexperienced employees can cost ASCs hundreds of thousands of dollars per year.

Outsourced RCM providers are ideally positioned to attract experienced staff with deep knowledge of the revenue cycle. They are RCM specialists, so they know how to recruit and hire the best employees in the industry, often maintaining a pipeline of qualified applicants waiting for a spot to open up. They also offer competitive salaries and benefits, and situate their offices in desirable locations.

  1. Best-in-Class Technology

ASCs often do not have the appropriate tools or resources to manage the revenue cycle in-house. ASC leaders are juggling tight budgets and favoring patient care over improved billing resources, and it’s simply not practical to invest in the most up-to-date RCM software and tools.

By outsourcing RCM, centers can take advantage of economies of scale and gain access to best-in-class technology. The team at Regent RCM uses three powerful technologies to track and automate the revenue cycle process:

  • A Management Information Systems (MIS) platform that helps maximize profitability, lower A/R days, and achieve faster reimbursement
  • Clearinghouse software that makes workflows more efficient, improving patient experiences and reducing outstanding balances
  • A reporting and analytics dashboard that creates real-time customized reports and offers deep insights into an ASC’s operations

Learn more about optimizing your ASCs revenue cycle through outsourcing by conducting a Self-Audit.

What is Regent RCM’s RISE Program?

Regent Revenue Cycle Management (RCM) is a values-driven company. We are committed to upholding our high industry standards and providing essential services to our ASC clients, all while staying true to our fundamental ideals.

We created the RISE program as a way to integrate our core values into every aspect of Regent RCM’s corporate culture, including how we lead our employees, how we nurture our client relationships, and how we meet and exceed our shared goals.

RISE stands for:

  • Respectful Caring
  • Integrity
  • Stewardship
  • Efficiency

Our team strives to leverage these principles to deliver exceptional service and value to our ambulatory surgery center clients. Here’s a little more about each of the RISE values.

Respectful Caring

Compassion is central to Regent RCM’s mission, and our employees exercise it consistently with clients, patients, and other team members. Regent RCM’s revenue cycle professionals are friendly, responsive, and helpful in communicating with all stakeholders. They supply information, answer questions, listen to feedback, and act promptly to serve patient and client needs.

Integrity

We cultivate an environment of commitment, accountability, and honesty – reflecting our beliefs through our actions and words. All of our employees take pride in their work, striving to perform their responsibilities reliably, and go above and beyond expectations. Regent RCM welcomes open communication, celebrating successes and resolving challenges with transparency.

Stewardship

Regent RCM isn’t satisfied to maintain the status quo; our team aims to foster growth and advancement throughout the company. We develop new procedures, educational programs, and quality improvement initiatives to move toward our long-term goals. We also treat our employees as our most valuable asset, hiring people who are passionate about Regent RCM’s work, and offering ongoing mentorship and professional development opportunities to elevate their capabilities.

Efficiency

We identify, select, and manage our company’s resources to achieve the most affordable and effective results for our stakeholders. Regent RCM utilizes a proactive approach to determine the technology, systems, and equipment that will improve processes while lowering costs. We are always looking for innovative solutions to help us manage our time and complete our tasks more efficiently.

Learn more about Regent RCM.

Internal Auditing for ASCs: Are You Receiving Maximum Revenue?

How would you rate the overall financial health of your ambulatory surgery center?

Are you producing maximum revenue – or are you running into obstacles that interfere with your profitability?

As an ASC administrator, you have an extensive to-do list on any given day. However, it’s important to make time to step back and look at your big-picture financial goals and processes.

Conducting an internal revenue cycle audit is an effective way to evaluate your ASC’s operations, identifying financial stress points, strengths, and opportunities. An internal audit examines, quantitatively and qualitatively, all components of the revenue cycle process. It helps you ask the right questions to reveal what is working and what can be improved, helping your center get on track and stay on track.

If you’ve noticed negative changes in important benchmarks, such as accounts receivable days, net collection rates, or statement and charge lags, a revenue cycle audit may be the best course of action.

According to Regent RCM’s Director of Revenue Cycle Management Erin Petrie, a successful self-audit focuses on four main financial areas of an ASC:

Reimbursement

Do a thorough examination of your center’s billing and reimbursement procedures, paying close attention to payer contracts and total revenue collected.

Coding and Billing

Evaluate coding procedures, whether your ASC has a certified coder on staff or outsources services. Determine if cases are coded and billed correctly, identifying inaccuracies that could delay, reduce, or invalidate claims.

Staffing

Assess how administrative employees spend their time and what causes their pain points. What

facilitates smooth operations? What requires excessive time or effort to accomplish?

Observation

Scrutinize business office functions over time, noting recurring inconsistencies or inefficiencies. Look for solutions, through technology or processes, that could address these problems.

To help you get started, the experts at Regent Revenue Cycle Management have developed a free guide, “How to Self-Audit and Improve Your ASC’s Financial Health.” It takes an in-depth look at key revenue cycle functions, giving you the information you need to keep your ASC within compliance while producing maximum revenue. Download the full guide 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.

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

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.

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.

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.

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