Monitor

ICD-10, One Year Later: What’s the Impact on Revenue Cycle Management?

Healthcare providers went through a massive change in billing operations last year, as the shift from ICD-9 to ICD-10 went into effect on Oct. 1, 2015.

The new coding system brought with it not only an increase in diagnostic codes (from about 14,000 to over 68,000) and procedure codes (from 4,000 to 87,000), but also an increase in operational concerns for providers. Even though the ultimate goal of ICD-10 was to improve quality reporting and outcomes measurement, and also to bring efficiency to reimbursement processes, providers around the country feared the shift would cause productivity to plummet, as well as increased denials and reduced revenue.

Other developed countries such as Canada, Australia and various countries throughout Europe transitioned to ICD-10 years before the United States, and had a rough go of it. Canada’s healthcare system, for instance, reported a 50% drop in coder activity after the implementation of ICD-10 in 2001. 

But in the United States, the numbers did not suffer nearly as much. Initially, the industry reported a decrease of only 25% in charts coded per hour. And a year after implementation, coding productivity has stabilized and now providers report only a 10-15% decrease.

Optimally-trained billing staffs reduced the chance of negative impact on healthcare facilities. To that end, Regent Revenue Cycle Management (Regent RCM) provides tenured, proven revenue cycle management to ambulatory surgery centers (ASCs) with the skills to handle ICD-10 efficiently.

“Our team understands how ICD-10 can impact each segment of the revenue cycle from claim denials to days outstanding/days in A/R,” said Michael Orseno, VP of Revenue Cycle at Regent RCM. “It has been a year since ICD-10 implementation and our team has mastered the changes and updates. Your center may have a solid business office in-house who can sufficiently handle RCM; but if not, consider transitioning to outsourced RCM services with an external provider that is fully prepared.”

If you’re considering outsourcing to optimize your center’s revenue cycle, Ed Tschan and the experienced team at Regent RCM are available to your answer questions, explore a revenue cycle audit or discuss a cost benefit analysis. Ed can be reached directly at 312-882-7228.

Reasons to Outsource

Top 6 Reasons to Outsource RCM – Part One

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

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

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

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

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

Click here to continue to Part Two.

ASC revenue cycle benchmarking

Automating RCM with Three Core Technologies

Automating RCM with Three Core Technologies

Regent RCM recently hosted a webinar aimed at helping ambulatory surgery center (ASC) personnel gain more control and efficiency over their revenue cycle. The following post examines the core technology that forms the foundation of billing and collections and how automation contributes to a predictable revenue cycle.

Automating revenue cycle management (RCM) is as much about efficiency as it is analytics. Three core areas of technology that form the foundation of ASC billing and collections include:

  • ASC Management Information System (MIS platform)
  • Clearinghouse
  • Reporting, analytics, and dashboard capabilities

ASC Management Information System (MIS platform)

While Regent RCM can integrate with any Health Level-7 (HL7) compliant MIS platform, in many cases, the team is asked to recommend a software platform. Regent’s primary goal is to identify a platform that fully captures the individual needs of a center; one that can manage billing, scheduling, and inventory management, as well as seamlessly interface with clearinghouse and other software platforms. Bottom line, implementing an MIS that optimizes and automates workflow results in measurable efficiencies, decreased A/R, and improved profitability.

Clearinghouse software

ASC clearinghouse software provides essential process automation including the ability to send claims and receive electronic remittance advice (ERA), provide claims management, eligibility verification, and patient out-of-pocket estimation. ASC staff no longer have to call insurance companies to assess a patient’s eligibility. With the click of a mouse, a user can verify and pull a patient’s eligibility information into the MIS and view it – including deductible, remaining deductible, coinsurance, co-pays, and out-of-pocket maximums. This information may be used to estimate out-of-pocket expenses and establish patient financial responsibility prior to a procedure.

Reporting, analytics, and dashboard capabilities

Reporting and analytics tools offer detailed insights into the way an ASC operates and highlight opportunities to make changes that can improve outcomes. ASCs can access reports and analytics via a real-time dashboard. This dashboard displays both financial and clinical key performance indicators (KPIs) that can be customized with facility-chosen parameters, alerting an ASC about issues in priority areas. Dashboard capabilities are explained in greater detail in a blog post on real time measurement and reporting.

If you would like to learn more about these core technologies that form the foundation of ASC billing and collections, please contact a revenue cycle specialist or click here to learn more.

revenue cycle management return investment

New Regent RCM ROI Calculator Helps Surgery Centers Determine the Value of Outsourcing RCM

The big question when it comes to outsourcing is “will it really save money for my organization?”   Regent RCM recently published a white paper aimed at answering that question for ASC revenue cycle management (RCM). The paper provides the equation on how to determine the value of outsourcing, and now, to make it even easier, Regent RCM has developed a calculator that actually does the math.

“We are excited to launch the ROI calculator because it gives ASC leadership a tool that quickly delivers a ballpark estimate of value,” stated Regent RCM Vice President Michael Orseno. “If the numbers make sense, they can move forward with a business audit. If the numbers don’t add up, they can move on with very little time invested.”

Regent RCM’s ROI calculator guides centers to enter top-level, easily accessed information, and immediately returns a high-level estimate to determine if outsourcing will translate to cost savings. Results are based on industry averages. The ROI Calculator is available here.

“Of course, cost is just one part of the revenue cycle value equation,” adds Orseno. “When we perform a business operations audit we focus our attention on finding opportunities to improve RCM performance through payor contracting and billing and coding expertise, detailed reporting, automating processes, and more.”

Regent RCM’s services optimize ASC workflow and processes, as well as generate analytics and real-time dashboards that are critical to assessing an ASC’s financial health. Regent RCM consistently outperforms industry benchmarks allowing ASC managers to focus on high-value activities.

To learn more visit www.regentrcm.com or register for the upcoming webinar focused on gaining control and realizing greater efficiency through outsourcing RCM.

surgery patient monitor

The Top 3 Technologies Every ASC Can’t Live Without

Utilizing best-in-class technologies for workflow and process optimization is critical to the success of ambulatory surgery centers (ASCs), especially when it comes to billing and collections. There are three types of technologies instrumental to an ASC’s success:

Management Information Systems: An ASC software platform integrates core ASC workflow functionality including inventory management, insurance verification, patient billing and surgical scheduling. Some advanced MIS use workflow management, which enables end users to attend to real-time tasks assigned by leadership, ensuring the greatest level of efficiency. With these systems in place, ASCs can maximize their profitability, lower A/R days and achieve faster reimbursement.

Clearinghouse software: Secure, centralized, electronic claims submission and management including significantly reduced cycle time to catch and fix claim errors as well as reduced reimbursement time.

Reporting and analytics: Analytics tools that allow you to customize data and a real-time management console that gives you access to financial and clinical metrics of your choice are key. The deeper insight you have into the way your ASC operates, the more opportunities you have to make changes, optimize outcomes and continue to improve.

Download Regent RCM’s latest whitepaper on learn more about the Top 4 Benefits of Outsourcing RCM for ASC’s, including workflow and process optimization that utilizes best-in-class technologies.

Revenue Cycle Dashboard

The Benefits of Outsourcing RCM: Transparent Measurement and Reporting

 Over the course of March, we are diving deep into four key benefits of outsourcing revenue cycle management (RCM) for ambulatory surgery centers.  Last week, we examined how outsourcing RCM provides ASCs with smart staffing solutions and helps them avoid the need for succession planning. This week, we take a closer look at the importance of transparent measurement and reporting, which provides a greater insight into accounts receivable and collection trends.

With the ever-changing landscape of healthcare, including the fast approaching implementation of ICD-10, it’s imperative that ASCs have solid and transparent means of measurement and reporting to understand how the center is performing, where changes need to made and how to improve the bottom line.

Internally, ASCs may not have the necessary expertise, technology and resources – not to mention time – needed to devote to measurement and reporting. To truly track and trend change, these processes can be outsourced to a firm whose employees possess the training and knowledge needed to analyze the data and make a real difference in the center’s financial performance. Outsourcing RCM makes this entire process more efficient with better end results.

Spending time reviewing reports and analytics provides critical insight. Not only does the data offer valuable feedback for the ASC, but having this information can drive change by reducing AR days and tracking collection rate trends. However, internal employees may only have access to canned reports from which they can pull only generalized data. One of the key benefits of outsourcing revenue cycle management is that the RCM provider can develop customized reports and slice-and-dice the most pertinent information for more specified results.

Expertise with third party reporting software allows the RCM provider to pull these specific reports in order to find the root cause of a problem. For example, outsourcing RCM can allow an ASC to determine exactly when and why AR days began increasing so that the center can take steps to reverse this trend.

A management console is a useful tool for seeing various metrics change in real time. The RCM provider can customize each dashboard to display certain key performances indicators (KPIs) that alert the ASC to how well the center is meeting its bottom line.

Some of the top KPIs that can be included in the management console include:

  • Monitoring AR days
  • Collection rate trends
  • Statement lags
  • Charge lags

For each ASC, the RCM provider can set a range that falls between red, yellow and green stages in order to create a visual representation of when issues arise in real time. In some circumstances, it can be useful to compare specific KPIs to industry benchmarks, but success can also depend on the specific center. An RCM provider can determine when it’s best to judge information against these benchmarks and when it is not.

ASC Nurse evaluating revenue cycle

The Benefits of Outsourcing RCM: Using Best-in-class Technology for Process Automation

Over the course of March, we are diving deep into four key benefits of outsourcing revenue cycle management (RCM) for ASCs. Last week, we examined the importance of leveraging the expertise offered by RCM providers in billings and collections, especially in light of ICD-10. This week, we take a closer look at the ways in which RCM providers can bring workflow and process optimization that utilizes best-in class technologies to your ASC.

There are three types of technologies RCM providers use to optimize the billing and collection process:

  • Management Information Systems (MIS) are the lifeblood of your ASC Business Office. With the right MIS, you can do everything from inventory management to insurance verification and patient billing to surgical scheduling. Some advanced MIS use workflow which enables end users to work from real-time tasks assigned by management, ensuring the greatest level of efficiency. With these systems in place, ASCs can maximize their profitability, lower AR days, and achieve faster reimbursement.
  • Clearinghouse software, aside from sending claims, can also provide claims management, electronic remittance advice (EOBs), eligibility verification, and patient estimation. Users can verify a Patient’s insurance benefits, determine their co-pays, deductibles, co-insurances, and out of pocket maximums. This will accurately estimate the patient’s responsibility, allowing us to financially counsel the patient prior to the date of service, resulting with increased upfront payments and fewer outstanding balances. A clearinghouse that allows users to create customized edits, so unclean claims are kicked back before being sent to the payer, will certainly help in reducing AR days. Clean claims are vital for a healthy revenue cycle; the more efficiently you can process claims, the faster you can get your payment.
  • Reporting and Analytics are the key to constant improvement. The deeper insight you have into the way your ASC operates, the more opportunities you have to make changes and optimize outcomes. An analytical tool that will pull data from your information management system and allow you to slice and dice data in any number of ways yielding useful information is key. A real-time dashboard will give you real-time access to metrics of your choice, and warn you of RCM issues.

But what’s to prevent an ASC from simply going out and buying these tools directly? There are a number of benefits of using an RCM provider to update your systems and integrate new technologies.

First, choosing an RCM technology system is a complicated process. There are many options available in the market, all at different price points, offering very similar benefits. How can anyone be expected to know which one is right for their particular ASC? RCM providers have a deep understanding of not only the tools available, but how they work together, and for which ASCs they work best. They’ve tested, vetted and priced them out so you don’t have to.

Price is another factor here. If your ASC were to go out and purchase this technology, it would cost far more than it would to get it from an RCM provider. They have determined the best tools available, and use them for many clients, receiving heavily discounted rates that they are able to pass along to their clients.

Most importantly, though, is that RCM providers have an intimate knowledge of the systems and their complexities. As we mentioned in the last article, one of the biggest benefits of outsourcing RCM is having pre-trained staff who are already familiar with technology that typically involves a steep learning curve.

But it goes beyond that; they know which tools work well together and which ones work in silos. They have enterprise dictionaries already built for the MIS, so that only Facility specific information needs to be inputted, i.e. doctors, patients, inventory, and chargemasters.  Their familiarity with the systems extends to implementation as well. Implementing new technology at an ASC typically takes more than three months. With an RCM partner, it will take as little as 30 to 60 days.

As ASCs and other health systems scramble to keep up with the changing healthcare landscape, it is imperative to have the latest technology, and a keen understanding of how to use it. Without these essential tools, your ASC stands a good chance of being left behind.

ASC Billing & Coding

New spine codes offer numerous benefits for physicians, ASCs

In October 2014, the Centers for Medicare and Medicaid Services added 9 new spine and neck codes to its list of reimbursable procedures that can now be performed at ambulatory surgery centers.  As of January 1, 2015, the following nine codes are payable as separate procedures:

  • Neck spine fuse & remove bel c2(22551)
  • Neck spine fusion (22554)
  • Lumbar spine fusion (22612)
  • Neck spine disk surgery (63020)
  • Low back disk surgery (63030)
  • Laminotomy single lumbar (63042)
  • Removal of spinal lamina (63045)
  • Removal of spinal lamina (63047)Decompress spinal cord (63056)

CMS approval of these codes followed an industry-led initiative to educate regulators on why these common spine procedures can be successfully and safely migrated to ASCs — and performed at a much lower cost to taxpayers and patients than in a traditional inpatient setting. Even more, while some private payers have a long history of reimbursing ASCs for these cases, the new CMS guidance undoubtedly will pave the way for more insurance companies to take a second look at approving more ASC procedures. This expected shift would offer ASCs and physicians to take advantage of a variety of shifting dynamics in the national healthcare marketplace, including:

Higher volume

Today, millions of individuals in the United States suffer from chronic daily back pain. In its report “The US Spinal Surgery Market Outlook to 2017- Ageing population and Technological Advances to Intensify the Competition,” Ken Research estimates the total annual price tag for back pain in the United States — including diagnosis, treatment and rehabilitation — to be $50 billion.

Back pain sufferers in the United States also seek more surgical treatment than anywhere else in the world, according to Koncept Analytics data. The firm expects this trend to continue well into the future, as active baby boomers continue to retire and more advance treatments reach the marketplace.

“The US is the largest market for spinal surgeries and is expected to achieve significant growth on the account of aging population, growing number of younger patients, changing lifestyles and product innovations,” Koncept concluded.

Ken Research’s findings largely underscore these forecasts. The firm’s data shows that compounded annual revenue growth for U.S. spine procedures increased by nearly 6 percent between 2007 and 2012 – and is showing no signs of it letting up: Between now and 2017, Ken Research expects outlays for U.S. spine procedures to increase 4.8 percent annually.

“The revenues are estimated to largely be driven from the treatment of elderly patients in the US suffering from spine ailments,” the firm concluded.

Novel procedures

An aging U.S. population and increased reimbursements likely will not be the only factors affecting spine centers in the coming years. Clinical advancements, too, are expected to continue to play a major role. According to Koncept, “motion preserving technologies like artificial disc replacement, interspinous spacers and dynamic stabilization technologies in the recent past have provided surgeons with alternatives to fusion which has altered the face of spine market altogether.”

“It is expected that further innovations in minimally invasive surgeries coupled with other advancements will foster the growth in spine market as new and improved tools with enhanced features will make complicated spine surgeries easier to perform,” according to Koncept.

Better implants, transplants and biologic therapeutics are expected to increase demand for spine surgery in the next decade.  According to Ken Research, the market for spine-related allografts grew 6.5 percent between 2007 and 2012 and “is increasing rapidly, driven by the increase in the number of fusion surgeries carried in the US.” Nontraditional therapies also are improving the outlook for the sector.

“The advent of orthobiologics in the spinal industry is estimated to further add changes in the market,” Ken Research concluded. “The orthobiologics segment is likely to grow in the future due to an increase in ageing population of the US that will demand for the procedures involving a fast recovery and a quality treatment.”

Block time

By increasing patient volume at ASCs, the new CMS spine codes also help surgeons by maximizing their allocated block time in the operating room. In the past, some spine cases were unnecessarily performed on an inpatient basis because one or more of the procedures were not eligible for reimbursement at an ASC. With the new codes, many new cases can be migrated over to an outpatient setting – saving patients and taxpayers alike – while allowing surgeons to manage their available block time efficiently.

Block times are also an important tool for ASCs. They allow managers to oversee the facility’s business operations and require regular re-evaluation to ensure fairness among surgeons and success of the business overall.

Caveats remain

Although the new CMS rules provide a variety of benefits for surgeons and ASCs, spine procedures remain inherently risky both clinically and financially. As with all cases, patients must be screened rigorously to determine whether they are a good match for outpatient surgery.

Likewise, financial analysis must be performed for many of these new spine cases to ensure ongoing profitability. For example, some spinal fusion reimbursements still remain ungrouped by CMS. Depending on the specific implantation costs, reimbursements for some of these cases might be little more than half of the overall cost of the procedure.

ASC Physicians in Operating Room

ASC Revenue Cycle Management and Technology: The Perfect Match

At the 20th Annual Ambulatory Surgery Centers Conference in Chicago on Oct. 26, Mike Orseno, revenue cycle director for Regent Surgical Health, and Tom Hui, president and CEO of HST Pathways, answered some common questions when it comes to automating revenue cycle performance in ASCs.

Many ASCs are unclear on what should be automated when it comes to their revenue cycle management. Mr. Orseno suggested insurance verification and follow up should be automated. “Gone are the days where you have the collection staff working on paper reports,” he said. “It’s not efficient.” Additionally, payment posting and patient follow up should be automated as well.

Another common concern amongst ASCs is that they are leaving money on the table. To avoid that issue, Mr. Orseno said surgery centers need to take control of the process. “Know exactly what you should be paid for a procedure,” he said. Centers need to be aware of any variance in reimbursement and discover why the variance occurred. At Regent, all of the contracts are in HST and centers run variation reports through HST to keep track, Mr. Orseno said.

In addition to tracking payment variance, ASCs should track other metrics with technology, like days in accounts receivable, staffing costs, charge lag and statement lag.

While technology can help centers improve efficiencies and make sure they get all of the money they should be, technology alone is not the silver bullet, according to Mr. Hui.

“Technology is just the tool and we can’t make the magic happen, but [we] enable the magic to happen,” he said. “We’ve [seen success] when the user or management company takes pride of ownership in use of the tool.”

That being said, automating some aspects of revenue cycle management can definitely help improve performance at ASCs. For instance, a Regent facility on the West Coast saw its days outstanding decrease by 45 percent, and an East Coast facility decreased its days outstanding by 65 percent by using technology to help manage their revenue cycle.