4 Reasons ASCs Fail and How to Manage for Success

While many trends in healthcare today point to the value of outpatient care, ambulatory surgery centers can still falter if they fail to actively manage risk in critical areas. The experts at Regent Revenue Cycle Management have observed four common mistakes, and together with Regent Surgical Health, can help centers turn each challenge into an opportunity for growth.

  1. Poorly Managed Contracts
    ASC administrators face a variety of challenges when it comes to successfully managing their payor contract negotiations. One common problem is that often hard-working and well-intentioned administrators and office managers are too busy balancing numerous job responsibilities to dedicate the needed persistence and focus required to successfully negotiate expiring payor contracts. But with careful preparation, ASC administrators can keep more money to reward and fuel center growth by negotiating payor contracts that will adequately cover the full cost of services and ultimately streamline healthcare costs for all. Key strategies include: incorporating Centers for Medicare & Medicaid Services (CMS) changes into contracting, planning for future case mix changes and updated procedures, building in annual increases and multi-year contract increases, and overall caution/careful attention to terms when it comes to preferred provider organizations (PPO) and third-party administrators (TPA).
  2. Skyrocketing Costs
    Monitoring expenses and tracking trends are essential to managing costs. For example, if a center is losing money on unprofitable cases and inefficient supply management, tools that help keep administrators in the know can help immensely. To address this problem, Regent has spearheaded solutions like the use of electronic preference cards to replace old, less precise metrics. Electronic preference cards provide a wide swath of data, as information is collected and compared across member facilities to get a clear picture of supply expenditures. This allows surgery centers to discern which physician items are driving up costs, and find out where real savings can be captured. In addition, Regent has found that integrating the information with the help of electronic procurement systems like Inventory Optimization Solutions (IOS) helps ASCs better manage costs throughout a single center as well as throughout the entire organization.
  3. Failure to Bring in High-Reimbursement Cases
    To succeed in an era of tightening reimbursement practices, an ASC needs to stay ahead of the competition by adding profitable procedures that may not be available elsewhere, or risk losing such cases to the competition. Procedures with potential to deliver strong profits include (among others) major spine cases and total joint replacements (TJR). Moving TJR surgeries to an ASC makes sense for many reasons, both clinical and financial. It is important to first assess outcomes on an inpatient versus outpatient basis to see whether the results vary by setting type or provider.
  4. Revenue Cycle Management
    The way an ASC manages the revenue cycle can make or break its profitability. And with the Affordable Care Act, Medicare and Medicaid payment bundling, and updated ICD-10 guidelines looming, the revenue cycle landscape is changing at a rapid pace. Specialized expertise is required to ensure optimal results while anticipating new opportunities, and revenue cycle management can’t be an afterthought. The team Regent RCM understands the intricacies of the ASC revenue cycle, where problems commonly occur and how to fix them, as well as how to optimize reimbursement.

Are you interested in auditing your operations to ensure your ASC is maximizing revenue? A self-audit guide is available download here and will help identify your center’s financial stress points, strengths, and opportunities.

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.

Meet the Team: Alejandra Perez

In our ongoing Meet the Teamfeature, we introduce the many members of our team who make Regent RCM so successful. In our last post, we learned more about revenue cycle specialist Ivette Gomez. Today we’ll shine the spotlight on:

Alejandra Perez

Where is your hometown?  I hail from Cicero, Illinois.

What do you do at Regent RCM? I work as a Revenue Cycle Specialist for one of clients in the Midwest, giving them my focused attention to help enhance their cash-flow process while continuously measuring performance metrics and improving collections.

How long have you been working at Regent RCM? I joined Regent RCM in Spring 2017 after working for Allstate Insurance for six years.

What is your favorite part about working at Regent RCM? When I interviewed for the Revenue Cycle Specialist position there was a lot of talk about how important a positive work environment is to Regent RCM – and it really is true. At Regent RCM, are guided by a values-driven culture that aligns our team in a positive way and helps us stay focused on our goal of leveraging our ASC expertise while providing consistent service and expertise to our clients.

What has been your greatest professional achievement? In our business there will always be hurdles and challenges. I enjoy not only coming up with solutions, but making sure that I stay positive, and I take pride in my approach.  I have always been passionate about dealing with customers and patients and I’ve found that a positive approach allows for an overall pleasant experience, regardless of the situation.  

What is one fun fact about yourself your co-workers don’t know? I love to interact with others on a personal level. I see myself as someone who can help people turn a negative into a positive.  Another passion is cooking; I may not be the world’s greatest chef but my kitchen is certainly the place to be at dinnertime.

ASC Physicians in Operating Room

Physicians are Key to Revenue Cycle Success

While they may feel more comfortable managing matters related directly to patient care, physicians also have an important role to play in the overall financial sustainability of the ambulatory surgery center (ASC) where they practice. Whether their compensation is tied directly to productivity or collections or not, understanding the ins and outs of revenue cycle management is important.

But often, revenue cycle management isn’t a memorable lesson from medical school. The experts a Regent Revenue Cycle Management (Regent RCM) understand the importance of educating physicians on the financial aspects of providing quality healthcare.

“In many cases, surgeons do not understand all the interrelated aspects of how the organization bills and collects for services,” says Erin Petrie, Regent RCM’s Director of Revenue Cycle Management, “so they often need help understanding how the revenue cycle works and the key areas that require physician involvement.”

Petrie outlines three areas where physician involvement in RCM is critical:

  1. Coding

To facilitate insurance company payment, it is critical for physicians to facilitate proper coding for their procedures. While in some academic settings a staff person may select the specific ICD-10 and CPT codes for cases, under most circumstances it is the physicians who must own code selection. If they don’t, the case may remain unbilled or risk non-payment due to timely-filing limits, which can be as short as 20 days. Need help learning coding specifics? The American Academy of Orthopedic Surgeons offers a coding and reimbursement course.

  1. Documentation

Documenting what was done in a specific and detailed way is a critical part of the surgeon’s role in any ASC procedure, and using CPT language is the most efficient way to link the service to the correct CPT codes for appropriate reimbursement. For example, Petrie explains, it is no longer enough to specify “joint pain.” Instead, specifying the joint and the laterality in detail enables specific coding and increases the likelihood of timely reimbursement.

  1. Reviewing Accounts Receivable

Finally, Petrie suggests surgeons take active interest in understanding the ASC’s accounts receivable. Ask for a monthly A/R report and review it, she advises. Watch out for any increase in the number of accounts more than 90 days old, and ask for details about accounts in the 60-day column. When surgeons begin to take an active interest in the billing process, chances are the staff will, too.

 

 

For more information about understanding the ins and outs of revenue cycle management, contact Petrie or a member of her team at (708) 492-0531.

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.

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.

revenue cycle management

3 Secrets to Successful ASC Revenue Cycle Management

Effective ambulatory surgery center (ASC) revenue cycle management can be hard to achieve, particularly as internal and external forces exercise their influence. According to Regent RCM’s Vice President of Revenue Cycle Management Michael Orseno, ASCs that pay attention to three key success factors are well-suited for the challenge.

“The first key success factor is driven by the healthcare industry’s shift toward value-based care,” Orseno says. “While assuming reimbursement risk from payers along with the responsibility to provide quality care has created some uncertainty and challenges for ASCs, managed care is in better hands. ASCs are equipped to both deliver quality care and manage costs more effectively than insurance companies ever were. But to be successful in revenue cycle management (RCM), ASCs need to become more adept at both managing costs and collecting additional revenue directly from patients, many of whom have selected healthcare insurance plans with lower premiums but higher deductibles.”

Another factor is also closely related to the evolution of value-based care. While many ASCs are succeeding at streamlining procedures and costs for procedures new to out-patient treatment, such as total joint replacement, payment bundling and reimbursement declines introduce new pressures. For example, payers are beginning to scrutinize payment of high-cost implant procedures and are driving a hard bargain when it comes to bundled payment agreements. As ASCs assume leadership of these bundles, a second key success factor is careful negotiation along the way. “You need to be diligent – check your costs, factor in economies of scale but also account for patient-driven variation, and renegotiate contracts annually,” Orseno suggests.

A third way to ensure successful RCM is to optimize business office staffing. “The best-run ASCs make sure their RCM staff is motivated and incentivized to aggressively pursue revenue, rather than just remaining content with the status quo,” Orseno says. “If an ASC’s staff is accepting only what the insurer pays and not fighting for what the center is contractually entitled to or higher than ‘usual and customary,’ that particular facility may be leaving a lot of money on the table.”

Becker's ASC and Spine Review

Join Regent RCM in Chicago at Becker’s Annual Spine, Orthopedic and Pain Management Conference

Regent Revenue Cycle Management (RCM) is counting down to the 14th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine conference hosted by Becker’s ASC Review.

Taking place June 9-11 in Chicago, the conference offers attendees a variety of sessions featuring 131 physicians, primarily spine surgeons, covering a spectrum of topics ranging from Current Issues in Spine and Pain Management to Developing a Spine Program at an Ambulatory Surgery Center (ASC). In total, more than 215 speakers will cover 117 sessions during the three-day event.

Several sessions that will be of particular interest to ASC billing and collections staff include:

  • Key Concepts to Improve the Profitability and Outcomes of Spine Programs – Thursday, June 9, 2:40 – 3:15 p.m.
  • Bundled Payment for Spine and Orthopedics – Thursday, June 9, 2:00-2:35 p.m.
  • The Changing Healthcare Environment, Implications of Medicare and Impact on Commercial Payor Contract Negotiation for Spine, Orthopedics and Pain Management – Thursday, June 9, 2:40-3:15
  • Tough Coding and Billing Issues for Spine and Pain Management – Friday, June 10, 1:05-1:50
  • Bundled Payments in Self-Insured and Self-Pay Patients – Friday, June 10, 1:55-2:35.

For more information on the conference and registration, download the brochure here.

Visit Regent RCM at booth #7 to find out more about turnkey ASC billing and collections services and how Regent RCM’s services consistently outperform industry benchmarks allowing surgery center leadership to focus on high-value activities. Click here to contact a member of the Regent RCM team to learn more.

Regent RCM Employees

Regent RCM Hosts Business Office Manager Conference

Regent RCM recently hosted a Business Office Manager Conference April 12-13 in Lafayette, California. Ambulatory Surgery Center (ASC) business office managers from Alaska to Florida were in attendance.

“It was great to have so many managers in one room all sharing ideas and best practices, while learning from industry leaders and innovators,” stated Regent RCM Vice President Michael Orseno. “Our partners from Regent Surgical Health, including Founder and CEO Tom Mallon and Vice President of Risk Management and Clinical Operations Kathy Bernicky, were also on hand and weighed in with their industry insights and expertise and addressed a variety of ASC specific questions from the attendees.”

Regent RCM slated an information-packed conference with speakers from ZirMed, Surgical Notes, MedTek, HSTpathways and MedHQ, as well as CEO Mallon.

The keynote address was delivered by Delise Crimmins, partner with Redline Leadership Associates. She shared her deep experience and highlighted the importance of leadership for business office managers in the ASC setting.

“I’m so glad I got to attend the conference this year,” said Diane Ethan, business office manager at Plaza Surgery Center in Portland, Oregon. “From leveraging technology, to understanding new ASC revenue cycle benchmarks, and measuring the health of our ASC, this conference was time well spent and I’m thrilled to have had the opportunity to connect with and learn from my peers in the industry.”

In addition to sharing industry insights and information, Regent RCM also honored employees at this year’s conference. Sue Campbell, business office manager at Knightsbridge Surgery Center in Columbus, Ohio, received recognition and a special retirement gift in honor of her service. Rachel Caksackkar from The Center for Specialized Surgery in Ft. Myers, Florida was awarded the 2016 Business Office Manager of the Year award for her outstanding performance and her dedication to improving all pertinent ASC revenue cycle metrics during the past year.

The Business Office Manager Conference was held in conjunction with the HSTpathways user’s conference where Regent RCM Director of Business Development Ed Tschan and Revenue Cycle Supervisor Leslie Favela shared their extensive ASC revenue cycle knowledge with specific attention to staffing, standardized workflow processes, automation and technology. They also discussed nine ASC revenue cycle benchmarks aimed at dispelling myths, and outlined which benchmarks stand on their own and which ones are affected by outside forces.

Pictured:

(Front Row)

Nick George – Knightsbridge

Sherrie Wiseman – High Plaines

Amanda Mellott – High Plaines

Kari Sroka – ISMOSC

Rachel Caksackkar – TCSS Ft. Myers (2016 BOM of the Year)

Sandy Lagunas – Regent

Tanya Ramirez – Lodi

Vicki Webb – Reno

Sue Campbell – Knightsbridge

Mary McGill – Palos

Linda Reid – RWJ Endo

Vianca Bautista – Regent

Leslie Favela – Regent

(Back Row)

Mary Kearns – Glasgow Medical Center

Michael Orseno – Regent

Diane Ethan – Plaza

Kathleen Fischer – Andrews Institute

Joan Vassilogambros – Midland

Susan Bryson – Wasilla

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Top Revenue KPIs for ASC Stakeholders

Ambulatory surgery center administrators are often asked by stakeholders to evaluate their center’s revenue cycle management (RCM) process for strengths and weaknesses. As every administrator knows, this can be easier said than done. Key Performance Indicators (KPIs) are used as a scorecard to highlight issues and determine how well an ASC is performing compared to other ASCs. For example, wild swings month-to-month in Days in Accounts Receivable Outstanding could highlight billing and collections process problems, while a high percent of AR greater than 90 days may emphasize an issue with patient collections processes and/or insurance denials.

In an effort to lighten the load for administrators, here are six KPIs to track against goals set for ourselves internally:

  • Days Outstanding or Days in A/R – Regent RCM standard is less than 30 days
  • Claim Lag and Charge Lag – Regent RCM standard is less than 3 days
  • % of A/R Greater than 90 Days – Regent RCM standard is less than 15%
  • Net Collection Rate – Regent RCM standard is greater than 97%
  • Denial % and Clean Claim % – Regent RCM standard is 98% clean/less than 5% denial rate
  • Business Office Staff per 1,000 Cases – Regent RCM standard is 1.5 FTEs per 1,000 cases

“A number of our clients sought our services after an internal KPI audit identified gaps and weaknesses in their RCM process,” stated Vice President Michael Orseno. “We understand the intricacies of the ASC revenue cycle, where problems commonly occur and how to fix them, as well as how to optimize reimbursement. Measurement and reporting will always be key to helping our clients achieve success.”

Over the coming weeks we will break down each of these metrics, explain how we set our internal standards, and share with you common issues and how to overcome them.

If your KPI audit reveals more weaknesses than strengths, Regent RCM can perform a free business audit. To schedule an audit or learn more call 312-882-7228.

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