Andrews Institute ASC

Case Study: Combination Effectiveness & Efficiency Leads to Nearly Doubled Collections in Eight Months

SITUATION

The Andrews Institute Ambulatory Surgery Center (AIASC), a specialized facility located in Gulf Breeze, Florida, is a joint venture between Baptist Health Care and area physicians. It offers an array of orthopaedic and sports medicine services, featuring eight operating rooms with state-of-the-art digital equipment and high-definition camera and video systems.

A high volume surgery center, AIASC identified challenges that significantly impacted monthly revenue including:

  • Accurate coding
  • A/R process and workflow

Accurate Coding

For AIASC, coding errors, particularly for implants, led to lost revenue. Coding for ASCs is complex; at times ASCs must follow the same coding rules as physicians and at other times, hospital coding rules apply. An inaccurate modifier, for example, can negate or reduce payment on an otherwise clean claim and cost an ASC thousands of dollars.

A/R Process and Workflow

It is critical for ASCs to use a consistent A/R process and workflow to ensure that reimbursement is received in a timely manner. The AIASC identified that A/R performance was lacking with both third-party payers and patients. The center struggled with monitoring and following-up on outstanding claims, as well as resubmitting claims and collecting patient balances.

Recognizing that coding errors and A/R performance had negatively impacted their revenue cycle, the AIASC leadership team sought a revenue cycle management solution to not only correct course, but restore monthly revenue to fully align with Center case volume and performance expectations.

SOLUTION

The AIASC signed with Regent RCM in May 2015, aiming to improve its overall financial health and efficiency. The institute’s leadership was attracted to Regent RCM’s unique ASC experience and proven results. Regent RCM began providing the AIASC with turnkey billing and collections services, process automation and performance analytics, with a particular focus on:

Extensive Research & Coding Expertise

Coding for ASCs can be a specialty unto itself and necessitates an experienced and consistent approach. With accurate CPT codes and modifiers in hand, Regent RCM bills all claims immediately upon obtaining diagnosis and procedure codes from the coders.  Regent RCM thoroughly analyzes all implants on a case-by-case basis capturing all reimbursable costs – particularly important for AIASC, a dedicated orthopaedic and sports medicine ASC utilizing a substantial amount of implants.

Clean Claims

Regent RCM ensured each claim was submitted accurately. . Through the years, Regent has been able to work hand-in-hand with its clearinghouse to develop custom edits to ensure clean claim submission. This has allowed Regent to set their clean claim benchmark at 97 percent clean claim submission, the industry gold standard.

A/R Process and Workflow

Regent RCM leveraged deep experience with third-party payers to establish and maintain a rigorous process for following up on outstanding claims, resubmitting claims that had been previously denied or not billed, and aggressively appealing all underpaid claims.  Regent RCM also addressed patient balances that ensured all patients received timely and detailed statements, as well as follow-up calls.

ASC Expertise

Regent RCM’s experience working exclusively with ASC clients was beneficial in addressing common problems and devising effective solutions tailored to the AIASC’s individual needs.

RESULTS

From May to December 2015, after starting work with Regent RCM, the AIASC nearly doubled its monthly collections. These results were reached with no significant changes to volume or case mix.

“Regent’s peer-to-peer engagement played a key role in maximizing collections,” said Terri Gatton, an Andrews Institute administrator. She added that they were surprised how quickly Regent RCM’s efforts were able to obtain results and optimize Andrews Institute’s revenue stream.

diagnostic results

“Regent’s peer-to-peer engagement played a key role in maximizing collections,”

— Terri Gatton, Andrews Institute administrator.

asc revenue cycle billing analysis