reimbursement

Three Revenue Cycle Trends to Watch

An increasing need for timely insurance claims processing and reimbursement in a rapidly changed healthcare market is sparking a growing need in the industry for more — and better — revenue cycle management support.

A recent report from Global Market Insights shows the healthcare revenue cycle management market reached $39 billion in 2015, and is expected to continue to grow at a rate of 11 percent annually between 2016 and 2024. The report highlights three trends underlying that growth and impacting revenue cycle professionals and the healthcare provider organizations they serve:

  1. The medical coding process is becoming more complex even as the need for efficient claims processing increases, underscoring the critical role of professional revenue cycle management solutions to reduce billing errors.
  2. The significant growth in revenue cycle spending in the healthcare sector through 2024 could lead to the government implementing cost-cutting measures.
  3. Physician billing organizations are a major end user of revenue cycle: they comprised 40 percent of the overall healthcare revenue cycle management market in 2015, and that percentage is expected to grow at a rate of 12.3 percent through 2024.

Parallel growth in revenue cycle technology and products underscores the increasingly important role of healthcare revenue cycle in the healthcare market of the future.

In response to these trends, Regent Revenue Cycle Management (Regent RCM) continues to pioneer strategies for ambulatory surgery centers, developing, executing, and refining ASC-specific revenue cycle management solutions as well as investing time and resources in the technology, training and staffing to help ASC leaders stay profitable in the changing healthcare marketplace.

To learn about Regent RCM’s expanding services to support this growth, contact a member of our team.

Protect Reimbursement 4 Ways as Payers Narrow Payable Diagnosis Codes

For ambulatory surgery centers (ASCs), it’s a “perfect storm” story: the number of Americans with knee osteoarthritis has doubled since the mid-20th century, affecting 19% of those 45 and older, and continues to grow as our population ages. Meanwhile, insurance companies are narrowing payable diagnosis codes for treatment in their drive toward value-based care. Today, surgeons need to prove patients have a very specific diagnosis of knee osteoarthritis before payers will preauthorize surgery, as “knee pain” is no longer an acceptable criterion for approval for many payers.

To help ensure ASCs avoid negative financial consequences of these trends, the experts at Regent Revenue Cycle Management have identified four key steps to protect reimbursement against denied preauthorization and payment when it comes to surgery related to knee osteoarthritis.

  1. Get the Diagnosis Right – As payers narrow the payable diagnosis codes, ASCs need to be aware of payers’ coverage and preauthorization guidelines, ensuring surgeons are aware of and using the acceptable diagnosis codes for each payer to indicate specific diagnoses. Aetna, for example, considers patients with mild-to-moderate osteoarthritis, with knee pain as well as mechanical symptoms, to be candidates for arthroscopic debridement based on medical necessity, but the payer considers the same surgery for persons with osteoarthritis presenting with knee pain only to be experimental. ASCs also should be sure to follow through with claims the physician’s office submits after preapproval so the diagnosis codes match.
  2. Negotiate to Avoid Preauthorization Denial – Since little recourse is possible after a preauthorization is denied, ASCs that include carve-outs for certain diagnosis codes when they negotiate payer contracts are a step ahead. Do this by pulling together evidence-based literature and letters justifying specific procedures and data on their cost and medical necessity to present to the insurance companies during the negotiation. Groups like the American Academy of Orthopedic Surgeons also provide resources on medical necessity and coverage for certain diagnoses. It is also important to stay current on updates to insurance company coverage, and to update your contracts to avoid losing ground.
  3. Track Processed Claims, Audit Payment Patterns — Especially for orthopedic and spine procedures, many orthopedic and spine codes aren’t clearly defined. Know them well, and keep track of processed claims against each. In addition, regular audits can help detect patterns such as minor errors responsible for denials or underpayment, and prevent similar future issues. Be sure to focus on both diagnosis codes used as well as final payment as you audit. Details matter, so consider having a professional revenue cycle management organization like Regent RCM review your contracts and help with the audit.
  4. Bundled payments – As ASCs experiment with new payment models that are directly tied to diagnosis, such as bundled payments, understanding the codes becomes even more important. Recent studies show 80 percent of payers find bundled payments appealing, and providers are beginning to embrace the new model as well. Make sure to stay apprised of any new changes or requirements that occur within the bundles, and the ASC and affiliated physicians are providing the right documentation and verification for the value-based reimbursement — if the diagnosis code is incorrect, the surgery won’t qualify for the bundled payment and the ASC could lose money.

For additional information on protecting reimbursement in today’s evolving healthcare payment environment, call Erin Petrie, Regent’s Director of RCM at (708) 492-0531 or visit www.regentrcm.com.

Reflecting on 2017, a Banner Year for Regent RCM

For Regent Revenue Cycle Management (Regent RCM), 2017 was full of opportunities to provide leadership and best practices, building on our success as a leading provider of innovative, cost-effective billing and collection services for ambulatory surgery centers (ASCs) across the United States.

Regent RCM not only launched a new self-audit guide, but also welcomed Erin Petrie to the team as the Director of Revenue Cycle Management, driving Regent RCM during this next phase of growth.

“Regent RCM is at the forefront of the industry and it has been amazing working with such well-respected healthcare innovators and leaders,” said Petrie. “I am excited to continue to lead such a dynamic team as we deliver so much more than billing and collections, namely exceptional service and solutions that define protocols and the best practices for the industry.”

Before we ring in the New Year, we would like to reflect on this year’s success and look back on highlights, including launching a new guide and sharing the values that matter most to our organization and team.

  • Conduct a Self-Audit to Improve your ASC’s Financial Health. This new guide helps center administrators audit operations to ensure their ASC stays within compliance while producing maximum revenue. As ongoing consolidation among healthcare payers squeezes surgery center reimbursements, periodic business office audits can be key to identifying a center’s financial stress points, strengths, and opportunities. “Conducting a self-audit is the fastest way for centers to get on track and stay on track,” says Petrie. “A routine audit gives your center the mechanism it needs to ask and answer the questions that lead to stronger financial health.”
  • The Value of R.I.S.E. at Regent RCM. Regent RCM’s R.I.S.E program is the cornerstone of our culture and stands for four specific corporate vales: Respectful Caring, Integrity, Stewardship, and E We created a four-part series to highlight each individual value. In part one, we learn about Respectful Caring, part two focuses on Integrity, part 3 is about Stewardship and part 4 features Efficiency. “This program was created to develop a values-driven culture,” says Andrea Woodell, Vice President of Managed Care. “It helps us stay focused on our goal of leveraging our ambulatory surgery center expertise, while providing consistent high-value customer service to clients.”

On behalf of everyone at Regent RCM, we thank you for being part of our success in 2017 and look forward to partnering with you in 2018.

Tips Help ASCs Self-Audit Revenue Cycle, Improve Financial Health

Conducting a revenue cycle audit can help ambulatory surgery center (ASC) administrators evaluate operations and identify their centers’ financial stress points, strengths, and opportunities. To facilitate the process, the experts at Regent Revenue Cycle Management have developed a free guide, “How to Self-Audit and Improve your ASC’s Financial Health” to help ASCs take an in-depth look at key revenue cycle functions, ensuring their ASC stays within compliance while producing maximum revenue.

“Conducting a self-audit is the fastest way for centers to get on track and stay on track,” says Erin Petrie, Director of Revenue Cycle Management at Regent RCM. “A routine audit gives your center the mechanism it needs to ask and answer the questions that lead to stronger financial health.”

To conduct a self-audit, ASC administrators should examine four areas affecting the financial function of an ASC: reimbursement, coding and billing, staffing, and observation (workflow and process). The Guide provides tips and examples to help bring substantial benefits associated with surfacing potential issues, correcting them, and creating new strategies and processes to prevent their recurrence.

In addition, to bring clarity to surgery center billing, Regent RCM’s Petrie suggests centers monitor ASC-specific benchmarks such as accounts receivable days, net collection rate, statement lag and charge lag, for information to trigger a new audit.

“When you notice negative changes in important benchmarks, a business office audit can be the best course of action,” Petrie contends. “A full business office audit examines both quantitatively and qualitatively all components of the revenue cycle process to determine strengths and weaknesses.”

Click here to download the guide, or if the audit process is more than your center can support on its own, contact us to learn how a no-cost business audit can be a good first step to evaluating center performance.

Focusing on Efficiency: Regent RCM’s R.I.S.E. Program

Regent Revenue Cycle Management’s R.I.S.E. program was created to develop a values-driven culture that helps us stay focused on our goal of leveraging our ambulatory surgery center (ASC) expertise, while providing consistent high-value customer service to clients.  While at the same creating an environment that sets up our employees for successful and rewarding work.

In the last of our four-part series, we’re highlighting our four corporate values. Our R.I.S.E. program has been fully incorporated into how we effectively lead our employees:  Respectful Caring, Integrity, Stewardship, and Efficiency.  In part four of our series, we look at efficiency, the appropriate identification, selection and management of all resources to ensure excellent clinical and financial outcomes. At Regent we consistently outperform industry benchmarks in large part due to our efficiency, this allows our clients to then focus on high-level activities.

Efficiency is defined by Regent RCM as the ability to excel in six essential skills.  In summary, these skills are:

  1. Effective utilization of staff resources
  2. Cost effective utilization of supplies and equipment
  3. Demonstrate proactive approach to problem identification and solutions
  4. Demonstrate appropriate time management skills, prioritization and task completion
  5. Utilize technology to improve processes while reducing costs
  6. Optimize the use of available resources through corporate partnership

Our value based culture is crucial to ensure we consistently provide innovative, cost-effective billing and collection services for surgery centers.  It guides us in all that we do and is fully incorporated into how we effectively lead our employees.

Are you interested in working with Regent RCM?  Contact us today to learn about how you can join our team and make a valuable contribution to our partner centers.

Learn more about our first three parts of our R.I.S.E. Program:  Respectful Caring, Integrity and Stewardship.

Effective Management of Claim Denials Increases Revenue, Improves Patient Satisfaction

Managing claim denials is a critical component of effective revenue cycle management, and careful attention to the process can help ambulatory surgery center (ASC) leadership increase revenue and collections rates while improving patient satisfaction.

The experts at Regent Revenue Cycle Management (Regent RCM) understand the importance of maintaining an organized system to keep track of claim denials, so they don’t accumulate unnoticed over time. As one strategy, many providers use technological tools to manage denials and track claims that still need attention to maximize collections revenue.

“The process of managing denials starts with a thorough understanding of when and why patient claims are denied,” says Erin Petrie, Regent RCM’s Director of Revenue Cycle Management. “Many times, patients don’t understand how the claims process works, and need help solving issues that arise. Being organized and ready to provide support goes a long way toward heading off potential claims denial problems, and helps boost patient satisfaction as well.”

Petrie offers three suggestions for providers seeking to improve claim denial management:

Streamline Workflow:  Every denied claim should be addressed within a week of receiving the denial from an insurance company. Efficient tracking of claims as they enter and exit your system eliminates the risk that a correction can’t be made because the claim has passed the insurance company’s time limit for appeal.

Keep Score: When appealing denied claims, it helps to know what has worked in the past, and what processes need more support. Collecting analytics regarding the reasons claims are denied, the time spent on denials, and lost or expired opportunities can improve efficiency.

Watch for Patterns: Finally, knowing which types of denials your organization sees most – whether they stem from errors like misspelled names, procedural missteps, or missing information – can help guide a more effective denial management process. Understanding your organization’s denial patterns can guide the steps needed to prevent predictable issues.

While investment in these activities pays off, given other priorities, the staff required to manage claim denials well isn’t always available within an ASC. In those cases, Petrie recommends providers consider outsourcing the process to an experienced revenue cycle management firm.

“One benefit of outsourcing the process comes from the experience and efficiency of trained specialists, who are adept at negotiating and who thoroughly understand the complexity of insurance claims,” Petrie says. “Another benefit? It frees your own people to focus on helping your organization deliver optimal patient care.”

Claim denial management is a core competency at Regent Revenue Cycle Management. For more information, go to www.regentrcm, or call (708) 492-0531.

ASC Surgery in action

Effective Out-of-Network Strategy helps ASCs Rise to Reimbursement Challenges

Changing payor reimbursement policies were a big topic of discussion at Becker’s 15th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine, held recently in Chicago. But as the healthcare landscape evolves, developing a profitable out-of-network strategy is one way ambulatory surgery centers (ASCs) can rise to the challenge.

But profitable is the key word. To make out-of-network reimbursement strategies pay, the experts at Regent Revenue Cycle Management suggest ASCs take a measured approach to embracing out-of-network, testing first, and taking on risk as they have resources to support it with persistence and know-how. Following are three key steps to embrace in the process:

  1. Test and Learn

Some ASC contracts have more potential in terms of out-of-network reimbursement than others. Analysis of payer mix and market share will help ASCs understand which contracts may offer out-of-network opportunity. From there, shifting a few procedures over a short period of time to out-of-network status with a payer can be a good test. If assessment of the results is positive, more services can be moved out-of-network with that payer. This approach helps manage risk, while enhancing understanding through trial and analysis.

  1. Work the Appeals Process

Dogged pursuit of the appeals process is another key to making an out-of-network strategy successful – capturing out-of-network reimbursement funds is not for the faint of heart. Staying organized through what can be a drawn-out process, renegotiating, following up, reviewing the explanation and assignment of benefits – to succeed, ASCs must play the appeals game to win.

  1. Be Smart About Payers

Employers and payers use a variety of tactics to control out-of-network cost on their end, by minimizing providers’ reimbursement. For example, narrow network plans force ACSs into an out-of-network environment in some markets, while payers’ use of third-party vendors to manage obligations to providers often can confuse and slow negotiations.

“You really have to do your homework and dig deep to develop a profitable out-of-network strategy,” says Erin Petrie, Director of Revenue Cycle Management at RegentRCM, “but if you do the work, the opportunity is there.”

For information about how RegentRCM can help you develop and implement a profitable out-of-network strategy click here, or call (708) 492-0531.

Focusing on Stewardship: Regent RCM’s R.I.S.E. Program

Regent Revenue Cycle Management’s R.I.S.E. program was created to develop a values-driven culture that helps us stay focused on our goal of leveraging our ambulatory surgery center (ASC) expertise, while providing consistent high-value customer service to clients.  While at the same time creating an environment that sets up our employees for successful and rewarding work.

In a four-part series, we’re highlighting our four corporate valuesRespectful Caring, Integrity, Stewardship, and Efficiency.  In part three of our series, we look at Stewardship, the responsibility to properly utilize and develop our people, property and assets while fostering a safe and secure environment.  This approach is a key part of why we can consistently outperform industry benchmarks and allow our clients to focus on high-value activities.

Stewardship is defined by Regent RCM as the ability to excel in five essential skills.  In summary, these skills are:

  1. Mentor others to promote personal and professional growth.
  2. Regularly provide information to create enterprise understanding around the clinical and economic performance of our business.
  3. Communicate difficult information in any direction to improve our business.
  4. Comply with both regulatory requirements and institutional policies and procedures.
  5. Promote and participate in quality improvement initiatives.

Our value based culture is crucial to ensure we consistently provide innovative, cost-effective billing and collection services for surgery centers.  It guides us in all that we do and is fully incorporated into how we effectively lead our employees.

Are you interested in working with Regent RCM?  Contact us today to learn about how you can join our team and make a valuable contribution to our partner centers.

Learn more about our first two parts of our R.I.S.E. Program:  Respectful Caring and Integrity.

Regent RCM Launches New Guide Empowering Surgery Center to Self-Audit Operations

As ongoing consolidation among healthcare payers squeezes surgery center reimbursements, periodic business office audits can be key to identifying a center’s financial stress points, strengths, and opportunities. Regent Revenue Cycle Management (Regent RCM), a leading provider of innovative, cost-effective revenue cycle management services exclusively for ambulatory surgery centers nationwide, recently published a new self-audit guide to help center administrators audit operations to ensure their ASC stays within compliance while producing maximum revenue.

“Conducting a self-audit is the fastest way for centers to get on track and stay on track,” says Erin Petrie, Director of Revenue Cycle Management at Regent RCM. “A routine audit gives your center the mechanism it needs to ask and answer the questions that lead to stronger financial health.”

Revenue cycle management for a surgery center is complex. In the guide, How to Self-Audit and Improve your ASC’s Financial Health, Regent RCM experts suggest ASC administrators examine four areas affecting the financial function of an ASC: reimbursement, coding and billing, staffing, and observation (workflow and process).

In addition, to bring clarity to surgery center billing, Regent RCM’s Petrie suggests centers monitor ASC-specific benchmarks such as accounts receivable days, net collection rate, statement lag and charge lag, for information to trigger a new audit.

“When you notice negative changes in important benchmarks, a business office audit can be the best course of action,” Petrie contends. “A full business office audit examines both quantitatively and qualitatively all components of the revenue cycle process to determine strengths and weaknesses.”

Click here to download the free guide.

Two Reimbursement Trends Facing ASCs

Two reimbursement trends – bundled payments and growth in self-pay – are top-of-mind for ambulatory surgery center (ASC) leaders striving to optimize payment and boost their bottom line.

As the trend continues away from the fee-for-service model, bundled payment is the fastest growing payment type, with projected growth of 6 percent over the next 5 years. If projections by both hospitals and payers are correct this would place bundled payment at 17 percent of all medical payment types in five years. This is per research by ORC International and commissioned by McKesson.

“It’s clear that bundled payment is continuing its growth and for good reason,” says Regent’s Director of Revenue Cycle Erin Petrie. “As providers realize the value of the bundled payment for the population of patients that are more middle of the pack in both projected needs and costs, the shift continues towards value-based reimbursement, and bundled payments will continue along in tow.”

Currently, covered orthopedic and spine procedures include:

  • Total Knee Replacement
  • Total Hip Replacement
  • Total Shoulder Replacement
  • Laminectomy
  • 1-2 Level Fusions
  • Corpectomy
  • Artificial Disc Replacement

Another payment trend continuing its growth, according to Petrie, is self-pay. InstaMed’s “Trends in Healthcare Payments Seventh Annual Report” notes there was a 58 percent uptick from 2013 to 2016 in self-pay patients. It also reports that 92 percent of patients want to know their payment responsibility upfront and prior to a provider visit with most providers finding it can take one month or longer to collect from patients. “Self-pay is here to stay and providers must meet the challenges that come along with growing number of self-pay patients,” adds Petrie.

Regent RCM’s expertise comes from exclusively developing, executing and refining ASC-specific revenue cycle management strategies as well as investing time and resources into the technology, training and staffing to stay ahead of industry trends and updates. To learn more about our services and approach, contact us today. 708.492.0531.

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