Illinois Sports Medicine and Orthopedic Surgery Center
Case Study: Center Achieves 82% Increase in Upfront Patient Collections Through Patient Financial Counseling
To improve transparency among patients regarding the cost of their surgery, Illinois Sports Medicine and Orthopedic Surgery Center (ISMOSC) began a program of upfront patient financial counseling several years ago. In addition to serving the payment planning needs of patients, the effort improved the facility’s self-pay collections and reduced losses due to bad debt – a win-win for both patients and the center.
But with higher health insurance deductibles saddling patients with even higher payment responsibilities, coupled with the center’s surgical case volume growth, ISMOSC needed a more robust process for financial pre-registration in order to maintain patient satisfaction, operational efficiency, and profitability.
As a 100% physician-owned ASC, ISMOSC had worked with Regent Surgical Health for several years, initially tapping Regent’s management counsel for center development and operations and later taking advantage of billing and collections expertise. Those financial services evolved to a relationship with Regent RCM, providing the center with more comprehensive revenue cycle management.
In late 2018, Business Office Manager Kari Sroka, reached out to Regent RCM to inquire if they had any solutions to more efficiently handle insurance verification calls and collections in advance of surgical procedures.
To address this issue, Regent RCM approached ISMOSC with a new service designed to meet those needs. “When Erin Petrie called me to discuss the idea, I thought it was a good concept for facilities that have staffing issues and space issues, and for us certainly both were true,” recalls Larry Parrish, Administrator at ISMOSC.
Kari Sroka agreed. “Due to the high number of cases that were being scheduled, we had a backlog of cases for which we needed to contact the insurance companies in order to ensure coverage and gain authorizations,” Sroka explains. “We promise our physicians’ offices that we will get cases scheduled and verified within 24 hours of them submitting them, but we were finding that we could no longer reach that goal. We also needed to contact each patient to go over their insurance coverage and estimate the out-of-pocket expenses they should expect with their upcoming surgery.”
In fact, an operational audit determined the center’s business office was short-staffed by 1.5 full time employees, based on the number of cases performed each month and the amount of time it takes to process each. Outsourcing the insurance verification and advanced collections process addressed the staffing need.
After only one month, ISMOSC’s Sroka has been very pleased with both the ease of transition to the Regent RCM service and with the financial improvements the center has seen. So far, the team effort is achieving or exceeding all ASC-specific benchmarks, and the effort has resulted in:
- 82% increase in upfront patient collections
- 36% reduction in self-pay account receivables
- 16% increase in percentage of amount due collected upfront
“The outsourcing of this process could not have come at a better time,” says Sroka. “Now we are able to schedule our cases, confirm those cases, and organize our schedule to best accommodate the surgeons and their patients. The significance of this relationship allows us to better do our jobs, improve our relationships with our patients, and now we are able to do the pre-collections on all accounts that we just did not have the time for before.”
“Regent RCM provides dedicated expertise, they’re more efficient because they’re not getting pulled away to admit patients, they’re not getting pulled away to schedule a case, and they don’t need space to work in our office,” Parrish explains. “Before we outsourced this function, our surgery scheduler did a lot of the insurance verification calls. Now she can focus on scheduling. Our receptionist could do some insurance verification calls but she had other distractions, too. So, to have a dedicated person who is appropriately trained, doesn’t have the distractions, and has co-workers who can then cover for that individual’s absence, is something that we could never do without falling behind. It’s a huge advantage.”