Going Deep to Understand Surgery Center Financials Helps Minimize Issues

Part 1 of a 2-part Q&A series with Leslie Favela

Getting a good handle on revenue cycle management can make a big difference for ambulatory surgery center (ASC) leaders when it comes to achieving profitability goals.

“What it comes down to is really understanding and knowing your center,” says Leslie Favela, manager of the business development team at Regent Revenue Cycle Management. “It’s all about being aware of all of your payer contracts and tracking your center’s trends. It’s important to be ahead of the game with the payers. If you know your center’s contracts, and the overall health of your revenue cycle, you know where you stand with the payers. And that helps you catch issues in the beginning so you’re able to minimize them as they come up in the future.”

Favela recently sat down to answer some of the most frequently asked questions she and her team receive from ASC professionals:


Our center would like to increase revenues this year and we have an aggressive goal of 8-10%. Is that doable?


Yes, that level of improvement is doable. Whenever we bring on a new client, because of our best practices and our work quality, our statistics show that our team increases center revenues a minimum of 10% or more in that first year, and then we help our centers maintain that level or improve in the ensuing years. We start by reviewing the existing overall health of a center, and then help them improve by adopting the correct focus, making sure that we’re looking at the correct benchmarks, the correct business office processes and workflow, and making sure that we’re maintaining our expected net revenue of at least 97%. On a high level, it’s about having that mindset on how to improve revenue, that’s number one. And two, it’s efficiencies – making sure that you have the correct resources to ensure you’re auditing and managing your revenue cycle the right way.


Our surgery center is having issues with outstanding claims going well past 30 days. Do you know how we can improve on this metric?


Yes, there are several steps centers can take to minimize past due claims. One way to start is to begin tracking all of the payers that are having that delay and look for trends. Then, start asking yourself some questions: What’s the source of the delay? Are you submitting the claims correctly, with all of the claim form values that need to be added for successful claim processing? Is there additional information that needs to go out with the claim, such as a medical record or a copy of the implant invoices? The goal is to identify how the payer likes to receive their claims and to be ahead of game. If you can identify payer trends, then you’ve got that data on your side and you can improve on-time reimbursement. 

For more information on efficiently managing your center’s revenue cycle, contact the Regent RCM team or contact Leslie Favela directly at

Patient Counseling Positively Impacts Revenue Cycle

Nearly one-third of Americans are currently shopping for health insurance. Recent research suggests many don’t have a full understanding of their options or basic insurance concepts including: plan premium, deductible, co-insurance and out-of-pocket maximum. Regent RCM has found that patient counseling positively impacts revenue cycle.

“There’s no argument that insurance can be confusing. This is an issue, not only for patients, but also for our partner centers,” said Matt Lau, Chief Financial Officer at Regent Surgical Health and VP of Regent Revenue Cycle Management (Regent RCM). “Now, with high-deductible plans on the increase and patients paying more out-of-pocket, it is critical to counsel patients, to be transparent about fees, and provide payment options, if needed.”

Lau advises that, whenever possible, healthcare providers should provide financial guidance to patients prior to their scheduled procedure. “While not every patient’s individual financial situation will be addressed, we counsel them on why they owe the amount that they do, and of course, we’re prepared to answer a wide variety of questions,” explained Lau.

In addition, helping patients understand deductibles is especially important. “High-deductible plans are becoming increasingly popular because that’s what’s affordable, from a premium perspective,” said Lau. “With reimbursements for ASCs shrinking, it is important that every dollar is collected. Counseling is one key aspect of collections but we recognize it’s also linked to patient satisfaction. We value that. And we take the time to get it right.”

Regent RCM is a leading provider of cost-effective billing and collection services for ambulatory surgery centers in the United States. Leveraging deep ASC industry expertise, Regent’s revenue cycle services consistently outperform industry benchmarks and allow surgery center leaders to focus on high-value activities. If you are looking for a revenue cycle partner, contact our team to schedule a no-obligation check-up of your revenue cycle.

Top 3 Billing Follow Up Procedures

When it comes to ambulatory surgery center (ASC) billing practices, proper charge entry is critical. But an equally essential part of the billing process is following up to ensure that claims are being processed correctly. While follow-up steps can involve up to 60 percent of the billing staff’s time, they are key to optimizing revenue, and directly impact the center’s revenue cycle as a whole.

To maximize efficiency, ASCs should make three follow up steps a routine part of the billing process:

Check claim status with payers

In many instances, payers need additional information to approve a claim, and missing information can lead to issues and delays in payment. By dedicating time every 30 days to call each payer to check claim status, billing specialists find out early if the claims are clean or not, and can get to work immediately if an appeal is needed. This timely action, along with using the correct verbiage in correspondence, helps eliminate any hesitation to pay.

Organize to stay on top of past due accounts

Running accounts receivable (A/R) reports monthly is another way to streamline the follow-up process, and using a software management information system, such as HST Pathways, can make this an easy process for billing specialists. The benefit? Using monthly reports to trigger automatic follow up with every account that becomes 45 days past due helps prevent problematic claims from falling through the cracks.

Follow up with patients, too

To make sure that patient payments are fully accounted for, billing specialists should follow up with patients every 30 days. Early patient follow up allows the ASC to avoid 90-day final notices — and the pain of implementing a delinquent collections process — by collecting the full payment before the invoice is overdue, or setting up a payment plan. This easy step helps maximize revenue and, depending on individual circumstances, can improve patient satisfaction as well.

For more information on best practices for ASC billing services throughout the revenue cycle, click here to speak to a member of our team.

Move to ESOP is a Natural Progression for Regent

Continuing its legacy of private ownership, Regent Surgical Health, the parent company of Regent Revenue Cycle, has successfully sold 100% of its common stock to its employees through the establishment of an employee stock ownership plan (ESOP). The move is a natural evolution for the organization, which started out as an employee-owned company with 14 founders, and has been operating as a small partnership for the past 15 years.

“The owners and investors of Regent considered various strategic financial alternatives as we evaluated the proper ownership transition of the business including the sale of the company to a strategic or financial buyer. We ultimately chose to sell the business to the employees – our true partners – so they can directly participate as owners in the future financial benefits of executing our successful business model,” said co-founder and Chairman Tom Mallon.

Regent CEO Chris Bishop believes establishment of the ESOP sets the company up to better serve both customers and employees. “In an industry marked by massive consolidation, we’ve chosen to retain the ability to best serve our partners as a private company owned by our employees, and not a corporate partner or Wall Street,” he said. “We feel this solution allows us to continue improving our service, refining our processes to best meet our hospital / MD partner’s needs, and most importantly, empowering our employees to provide the highest quality care to our centers and their patients.”

Regent worked with Cognient Advisors, a Chicago-based ESOP financial advisory and Silvermark Partners, a Nashville based investment banking firm to structure the ESOP.

“We’re very happy with this evolution,” said Matt ­­­ Lau, Regent’s Chief Financial Officer. “We were able to finance the ESOP through MD partners, friends and Regent management, without professional or Wall Street capital, which gives us several major benefits. First, an ESOP is a tax-deferred investment vehicle, so it frees resources to better serve our partnerships. In addition, as a private company, we retain more flexibility to structure partnerships with health systems than public companies. And, because every employee is now an owner, we think we’ll see higher retention and lower turnover as well as recruiting benefits from the new structure.”

As co-founder of the company, Tom Mallon led Regent’s exploration of ownership options with careful thought to both succession planning for Regent’s founders and maintaining the R.I.S.E. values that are essential to Regent’s culture (Respectful Caring, Integrity, Stewardship and Efficiency.)

“Some of our partners needed liquidity to fund their retirement, so basically we all agreed on the structure of the deal and it was the right time for us internally to do it,“ he said. “If we had waited another year or two, advisors said we might have made more money, but right now was a good time for a fair deal and it was better timing for our existing leaders and for our ASC and hospital partners.”

Since learning about the ESOP via an internal announcement in late 2016, employees also have embraced the new structure. In a letter to Mallon, Recent RCM Revenue Cycle Supervisor Vianca Bautista, had this to say:

“I would like to express my heartfelt gratitude for the opportunity that you have given each and every single person within your Regent family. What you did for us is very commendable, I am at a loss for words with the faith that you have in us. I am sure that it would have been easier for you and the rest of the owners to go a different route. It was very generous of you to make sure “WE”, your Regent family, are taken care of and considered at every decision you make. You are the epitome of R.I.S.E. values!”

Bookmark our blog to stay up-to-date on revenue cycle news. To learn more about our R.I.S.E values, click here.

Revenue Cycle

Top 4 ASC Payer Contracting Practices – Part 1

Ambulatory surgery center (ASC) administrators face a variety of challenges when it comes to successfully managing their payer contract negotiation deadlines. In the first of a two-part series, we outline two of four top strategies to ensure seamless payer negotiations.

According to Andrea Woodell, Vice President of Managed Care at Regent Surgical Health, hard-working and well-intentioned administrators and office managers are often too busy balancing numerous job responsibilities to dedicate the needed persistence and focus required to successfully negotiate expiring payer contracts.

Two of four top strategies to ensure seamless payer negotiations include:

  1. Incorporate Centers for Medicare & Medicaid Services (CMS) changes into your contracting

There must be ample room in the budget for contractual changes to occur, says Woodell. “You should not rely on the payer to be responsive or have the bandwidth to renegotiate your contract. There’s just not enough staffing to do that,” she advises.

Medicare has been making a series of significant adjustments causing sizable reimbursement changes, Woodell says. “Codes 62310 and 62311 are being deleted and replaced with 62321 and 62323,” she explains. Facilities performing hundreds of these cases will incur cost reductions at $53 apiece, she adds. “This could add up to tens of thousands of dollars – and that’s just under Medicare patients,” Woodell estimates.

Woodell also emphasizes codes 64490 and 64493 will soon take an even bigger hit, decreased under Medicare by $115 each. Woodell therefore recommends budgeting for changes within your current negotiations.

“Not every payer contract pays based off a percent of current year Medicare, some contracts will have language stating the contract is based off 2015 Medicare. Your current rates will remain and will not be impacted,” Woodell says. “But the contracts that are based off current year Medicare will immediately see a decrease.”

“One large payer gave me an eight percent increase for a two-year contract,” she explains. “Subsequent to adjusting for 2017 CMS changes, this eight percent increase then became a 4.7 percent increase. Eight percent from a large payor plan is a slam dunk – but 4.7 for a two-year? Not so much. So, I was right back at the table,” she says. “It’s not done, but I’m fighting the fight.”

  1. Plan for the future with case mix changes

Woodell says more focus needs to be placed on negotiating contracts and planning for the future with case mix changes and updated procedures.

“Most payers are unwilling to open up negotiations during a normal existing contract term,” she says. “Therefore, it’s critical to plan for the future. Even if you’re 9-12 months away, put it in your contract now.”

Adds Woodell, “If you have it carved out already, you can avoid when Medicare releases it and adds it to their list because they’re not going to be generous.”

To learn more about payer negotiations, contact Andrea Woodell. She has negotiated on behalf of health care providers and professionals for over 20 years, working in tandem with business offices to enhance collections.

In part two of Regent RCM’s blog series, Woodell details how to optimize annual contract negotiation increases and what is most overlooked regarding TPA & PPO contracts.

Click here to read part two!

Reasons to Outsource

Top 5 Regent RCM Blogs of 2016

2016 was a banner year for Regent RCM. We posted over 70 blogs ranging from the launch of our benchmarking webinar series and the benefits of auditing for ASCs, to articles about Regent RCM successfully increasing revenue for partner centers as well as our 2016 Business Office Manager of the Year.

The following blog posts were the most popular of 2016, and represent areas of particular interest to ASC leaders on the front lines of ASC billing and collections and revenue cycle management. We wish you every success in 2017 — and let us know what topics you would like to see more of in the New Year. We’re listening. And we’re here to help.

  1. Regent RCM Launches Webinar Series
    In March, Regent RCM announced a three-part webinar featuring VP of Revenue Cycle Michael Orseno. The videos expanded on the benchmarking series, which consistently measures the health of an ASC’s revenue cycle. The webinar series included – Part One: Optimal Business Office FTEs per 1,000 Cases; Part Two: ASC RCM Benchmarks; and Part Three: Net Collections – the Great ASC RCM Lie Detector. Click here to learn more.
  2. The Benefits of Auditing for ASCs
    Regent RCM believes that for ASCs to be successful, they must have intimate knowledge of their business and an audit is the quickest way to pinpoint strengths and opportunities, both qualitatively and quantitatively. This February blog takes a look at how an ASC can benefit from the audit. Click here to read more.
  3. Case Study: Regent RCM Nearly Doubles Monthly Revenue Collections for High-Volume ASC

When the Andrews Institute Ambulatory Surgery Center (AIASC) sought to address coding and A/R process and workflow challenges impacting its monthly collections, the surgery center turned to Regent RCM for help. Just eight months later, AIASC nearly doubled its monthly collections without significant changes in volume or case mix. Click here to read the case study.

  1. Regent RCM Awards 2016 ASC Business Office Manager of the Year

This blog from May highlights Rachel Caksackkar of The Center for Specialized Surgery (TCSS) in Ft. Meyers, Florida. She received the 2016 Regent RCM Business Office Manager of the Year award at Regent RCM’s annual Business Office Manager Conference. “Rachel exemplifies the best qualities in an ASC business office manager,” said Orseno during the award presentation. Click here to learn more.

  1. Part One: Regent Partner ZirMed Weighs in on High Deductible Plan

ZirMed®, which has the nation’s only comprehensive end-to-end platform of cloud-based financial and clinical performance management solutions, has partnered with Regent RCM since 2011 to make sure ASCs have the shortest revenue cycle possible and get paid on time for services rendered. In the first of a two-part blog series, ZirMed Partner Relationship Manager Emily Reder shares her perspective on the rise in patient responsibility and how this trend impacts the revenue cycle. Click here to read Part One. Click here to read Part Two: Regent Partner ZirMed Weighs in on Patient Responsibility.

For more information call 312-882-7228 and join our conversation via Facebook and Twitter, @RegentRCM.

ASC Collections

New Year’s Revenue Cycle Resolution: Consistent Clean Claims

Clean claims reduce days in A/R and increase cash flow, saving valuable time and money, helping ambulatory surgery centers (ASCs) stay ahead of the revenue cycle curve in 2017. From rigorous attention to detail and accurate coding to utilizing a clearinghouse, the Regent RCM team shares advice on how to maintain a healthy reimbursement flow with fewer denials and consistent clean claims for the New Year ahead.

Avoidable administrative errors can be a revenue cycle hindrance. Denial responses may take at least 30 days to process before the billing process must revert back to the very beginning. An ASC’s front office staff must prevent unnecessary errors and remain focused on collecting accurate information on the front-end and avoid miscalculations when verifying patients’ healthcare insurance. “Ultimately, we want to ensure that there aren’t any administrative errors going into the claim,” says Michael Orseno, Regent RCM’s Vice President of Revenue Cycle Management, “and attention to detail is critically important.”

Surgery center billing staff must be well-trained and current on evolving coding practices – many of which are in a constant state of flux due to ever changing healthcare regulation including ICD-10 implementation coding policy and HIPAA (Health Insurance Portability and Accountability Act of 1996) covered entities.

Ongoing training and education are key. “It has been a year since ICD-10 implementation and our team has mastered the changes and updates, says Orseno.

“Diligence is also paramount,” notes Orseno. “Coders must continually research proper procedure codes prior to claims submission because even one coding error can lead to a denial and cause weeks of delay.”

Additionally, ambulatory surgical center billing services should proactively try to understand the possible root causes of a high denial rate, which may either be linked to recurring issues with a particular payer or a low clean claim percentage.

Utilizing a robust clearinghouse can help ASC leadership by flagging claims that don’t meet standards prior to submission, then building custom edits to improve processes and results moving forward.

“Regent RCM strives for 97 percent clean claim submission, the gold standard in the industry,” says Orseno. “In our increasingly competitive healthcare landscape ASCs need to get paid and consistent clean claims put them on the right road, right out of the gate.”

While no center can achieve a 100 percent clean claim rate, the Regent RCM gold standard is within reach. Has your ASC resolved to increase clean claims in 2017? Regent RCM can help. Contact a member of our team today.

ASC Revenue Cycle Management

3 ASC Revenue Cycle Things to Know This Month

Each month Regent Revenue Cycle Management (Regent RCM) explores the top news and headlines affecting the ambulatory surgery center (ASC) industry. This month in the news: a list of six payer contracting mistakes to avoid; two provisions in the recently passed 21st Century Cures Act that benefit ASCs; and five common coding pitfalls ASCs should avoid.

6 ASC payer contracting missteps to avoid

Payer contract negotiations can be a difficult process. But, ambulatory surgery center (ASC) administrators can lower stress levels by preparing thoroughly and avoiding common missteps. Jessica Nantz, president of Outpatient Healthcare Strategies in Houston, reveals six payer contracting mistakes that administrators need to avoid, including the belief that the ASC can make up the difference between contracted pricing and actual cost, and accepting vague language. Click here to learn more.

ASCA Applauds House and Senate Passage of Legislation that Impacts ASCs

The Ambulatory Surgery Center Association (ASCA) commends the U.S. Senate and House of Representatives for passing the 21st Century Cures Act. The bipartisan bill includes a pair of key provisions that benefit Medicare patients and the physicians who care for them in ambulatory surgery centers. One directs the Secretary of the U.S. Department of Health and Human Services (HHS) to create a public, searchable web site that allows Medicare beneficiaries to compare differences in their out-of-pocket costs and in the total expenses for various surgeries when those procedures are performed in hospital outpatient departments (HOPDs) and ASCs, while the other protects physicians who practice in an ASC from potential penalties tied to the Medicare meaningful use program. Click here for more.

Common Coding Pitfalls in ASCs to Avoid

Stephanie Ellis, RN, of Franklin, Tenn.-based Ellis Medical Consulting, divulges five common coding traps ASCs fall into, as well as key strategies for avoiding these pitfalls. Ellis said ASCs specializing in orthopedics, pain management, gastroenterology, podiatry as well as ear, nose and throat, should especially take note, as the coding is quite complex. Learn more here.

Reasons to Outsource

4 Steps of a Regent RCM Business Office Audit

A Regent Revenue Cycle Management (Regent RCM) audit goes beyond a traditional reimbursement assessment. “The benefits of an audit are clear,” said Michael Orseno, VP of Revenue Cycle at Regent RCM, “and we ensure that facility time commitment is minimal. Our ASC-specific expertise allows us to complete the process in about two weeks.”

This is a quick turnaround, particularly considering the potential upside. In the case of one client, a business office audit uncovered coding errors which led to recouping more than $590,000 in additional funds.

An audit is comprised of four steps:

  • Initial Data Request*. Access to information is vital, and centers will provide a variety of data including but not limited to year-to-date case count and payer mix.
  • Initial Analysis. After collecting and reviewing initial data, Regent RCM selects multiple cases for a more detailed review and analysis.
  • Full Analysis. Pinpointing a number of cases, the Regent RCM team dives deeper using an internal audit tool set.
  • Once the audit is complete, Regent RCM will present findings on-site and provide detailed, strategic recommendations to ASC leadership.

In an upcoming blog, Regent RCM will further define the four key components of an audit including reimbursement, coding, staffing and observation (workflow and process).

Ready to get started? Call Regent RCM’s dedicated team today (312) 882-7228 to schedule an audit for your center.