Three ASC Healthcare Trends

Three Healthcare Trends to Track that Impact ASC Cash Flow and Revenue

Rapid change in the healthcare industry requires that providers cope with a myriad of emerging trends, including increased patient volumes, new reimbursement formulas, an evolving payer mix and a changing regulatory environment. For ambulatory surgery center (ASC) leaders, tracking three key trends in particular is critical to effective cash flow and optimal revenue cycle management. Two of these trends to watch are triggered by changing patient needs, while the third is focused on their employers.

1. Price Transparency

As higher deductible plans drive up the percentage of the healthcare bill that is the patient’s responsibility, consumers are demanding more advance price transparency. Especially for elective procedures but for others as well, prospective patients want to know what their costs will be in advance. In response, earlier this year the Centers for Medicare & Medicaid Services (CMS) implemented new regulations requiring providers to post charges for procedures, and some states have even more demanding requirements.

For ASCs, this trend makes it increasingly important to analyze operational data (such as case costing) as you create a viable fee schedule and estimate costs on a patient-by-patient basis. Click here to learn additional details about upfront patient financial counseling & collections from our newest whitepaper.

2. New Financing Needs

The second patient-driven trend ASCs should track diligently also stems from the shift of more of the healthcare cost burden toward consumers. In spite of the trend making them more financially responsible for their care, many patients simply can’t afford to pay: In fact, A 2018 report by the Federal Reserve revealed that 4 in 10 adults would not be able to cover a $400 emergency expense.

As a result, patients need new ways of paying for surgical procedures, namely payment plans. And ASCs are turning to third-party resources in order to stay out of the consumer loan business. For a fee, these organizations cover the patient’s costs upfront, and then take on the responsibility of collecting the balance over time. ASCs much determine whether the fee involved is worth it, by examining their uncollectible patient debt costs and loss ratio.

3. New Ways of Contracting

Employers are impacted by rising healthcare premiums as well, and some have attempted to contain rising premium costs by contracting directly with providers (a form of self-insurance). For ASCs, this trend creates another reason to truly understand the drivers of a center’s revenue and case volume.

Again, having the information technology and analytics in place to get the answers is critical. ASCs need data in order to ask and answer the right questions about their profitability. Only with the ability to analyze how these healthcare trends are impacting their revenues and cash flow can they proactively manage revenue to avoid potential adverse financial outcomes.

Regent Revenue Cycle Management (RCM) provides turnkey billing and collections services focused only on ambulatory surgery centers in the United States, approaching revenue cycle in a unique way that consistently outperform industry benchmarks and allows ASC managers to focus on what they do best: providing high quality care. For more information on how Regent RCM can help ASCs manage these key trends, click here.

Doctor smiling - three myths whitepaper

New Whitepaper Debunks Three Myths about Upfront Patient Financial Counseling and Collections

To combat climbing health insurance deductibles and co-pays that push a larger portion of the cost of surgery from insurers to patients increasing collections risk, ambulatory surgery centers (ASCs) have responded with more robust financial pre-registration processes to maintain efficiency and profitability. A new whitepaper offers insights into this trend, while separating myth from reality regarding implementation.

Regent RCM’s Erin Petrie, Director of Revenue Cycle Management, says while there was resistance in the marketplace to upfront patient financial counseling and collections just a few years ago, the practice is rapidly gaining acceptance today. More than 90% of patients want to know their payment responsibility prior to a provider visit or scheduled procedure.

“In response to the trend, we’re making sure to include in our financial planning process an upfront review of the patient’s benefits,” she says. “Taking this step helps ensure transparency about out-of-pocket expense, so costs can be estimated, explained, and ideally, collected in advance of services being rendered. It makes patients more comfortable about their financial commitment and reduces our risk on the backend.”

Regent RCM, a leading provider of innovative and cost-effective revenue cycle management services exclusively for ASCs, is working with leading ASCs to put programs in place that operationalize upfront patient financial counseling and collections, and to dispel outdated myths that keep centers from benefiting from these proactive processes. The new whitepaper, available for free download here, addresses three common myths:

  • Myth #1: Advance collections won’t work.
    Reality: It’s happening. And it’s helping.

  • Myth #2: The practice lacks physician support.
    Reality:
    Physicians understand that healthcare providers must embrace good business practices in order to stay solvent and continue to provide quality care.

  • Myth #3: Attempting advance collections might prompt surgery cancellations.
    Reality: Patients appreciate transparency around what charges they’ll be accountable for and understand that high deductibles are the new norm.

The white paper offers proof that payment only after services are delivered is an outdated mindset in healthcare, citing the advance collections experiences of two leading ASCs, Glasgow Medical Center in Newark, Delaware, and Palos Surgicenter in Palos Heights, Illinois. The paper also offers four suggestions for ASC leaders interested in implementing advance collections.

To learn more about Regent RCM’s work with ASCs to implement upfront patient financial counseling and collections, contact Favela at lfavela@regentrcm.com.

See You at ASCA in Nashville!

The Regent RCM team will be at the ASCA 2019 Conference and Expo, the largest and most diverse conference of the ambulatory surgery industry. Scheduled for May 15-18 in Nashville, TN, at the Gaylord Opryland Resort & Convention Center, the conference is presented by the Ambulatory Surgery Center Association (ASCA.)

ASCA 2019 offers top notch educational programming and networking opportunities, along with the ASC industry’s largest exhibit hall featuring hundreds of new products, services and technologies representing nearly 200 vendors.

In addition to more than 50 ASC-specific educational sessions, two keynote speakers promise to be motivational highlights of the conference: Alex Sheen, CEO and founder of the international social movement and nonprofit because I said I would, dedicated to bettering humanity through promises made and kept; and Scott Hamilton, Olympic gold medalist in figure skating, best-selling author of “Finish First: Winning Changes Everything,” and cancer survivor-turned-activist.

Want to schedule an appointment to connect with Regent RCM at the conference? Contact us here.

Payer Contract Adhesion – And What They Can Do For Your Revenue Cycle Audit

Every ambulatory surgery center (ASC) strives to manage its revenue cycle as efficiently as possible. Mistakes or delays in coding, billing, and collections can lead to financial challenges. No center wants to show a loss in revenue because of flawed revenue cycle management practices.

Regent Revenue Cycle Management encourages ASCs to perform three regular audits to detect and correct errors before they become larger problems. Regent RCM has created a new guide that details how centers can take simple, concrete steps to track and improve their revenue cycles:

  • Denied claim cause and management
  • Coding accuracy
  • Payer contract adhesion

Payer Contract Adhesion

In our third and final blog of our three-part series, we focus on why negotiating fair payer contracts – and making sure that all terms are met – is a critical part of revenue cycle management.  Your revenue cycle team needs to know every detail of their contracts, so they can fight for every dollar.

Regent RCM advises centers to conduct an audit on each of their payer contracts to understand what the contract says, what their center is allowed to bill, and how they can avoid over- or under-payments. The ultimate goal is for ASCs to receive exactly what they are owed – no more and no less.

When negotiating a contract, Regent RCM recommends following these five steps:

  • Start at least four months before the anniversary of the contract
  • Check the terms of the contract carefully
  • Build relationships with payers
  • Be aware of evergreen contracts that roll forward without renegotiation or a termination date
  • Keep all contracts current to make sure they aren’t falling behind

Learn how to perform our three audits to enhance your ASC’s financial performance. Download the guide here.

Leslie Favela Promoted to Manager, RCM Business Development

Leslie Favela, a seven-year veteran of Regent Surgical Health (RSH) who most recently served as Revenue Cycle Coordinator with Regent Revenue Cycle Management (RCM), was promoted in January to the newly created position of Manager of RCM Business Development. Reporting to Erin Petrie, Regent RCM’s Director of Revenue Cycle Management, Favela will continue to perform business audits for ambulatory surgery centers (ASCs), providing them with valuable business metrics while also adding business development responsibilities to her plate.

Petrie says Favela’s experience across several other roles within Regent – and especially her recent support for RCM business audits, new business pitches and presentations – makes her transition into this new role a perfect move. “Leslie has been a valued player for several years and understands both our capabilities and our clients’ points of pain,” Petrie says. “And, she has the personality to bring it all together to help us grow.”

Favela believes the evolution of business within healthcare reimbursements makes the billing and collection services provided by Regent RCM even more valuable to ASCs. “The timing is right for this new position,” she says, “because payers today are undergoing dramatic changes that make it even harder for an employee of any one ASC to stay up-to-date on all of the policies. We have our view across many different ASCs. This allows us to leverage best practices as we bring each new center on, as well as identify strategies to improve current processes and deliver true value.”

Favela started her RSH career as an office coordinator and has worked her way up through several departments and promotions to gain a thorough understanding of ASC management, more specifically the ins and outs of revenue cycle.

“I have a huge passion for the work of Regent RCM because I have been involved since we doubled the number of centers we serve. I want to continue to build the company’s reputation so that new ASCs come to us for billing and collections and the value that we bring.”

To learn more about Regent RCM’s turnkey billing and collections services exclusively for ASCs, click here.

Demystifying Managed Care Contracts, Part Two: 5 Contract Language ‘Watch Outs’ for ASCs

In any negotiation, both parties come to the table with their own list of terms they’d like to see in the final agreement. In this second blog in a 3-part series on demystifying the process ambulatory surgery centers (ASCS) go though in negotiating contracts with health plans, Regent RCM Vice President of Managed Care Andrea Woodell shares language “red flags” to help ASCs leaders avoid common pitfalls in payer contracts.

“In our work with ASCs across the country, we see hundreds of contracts – that’s one of the benefits Regent RCM brings to the table as a management partner,” says Woodell. “A local ASC leadership team doesn’t always have that perspective, but the health plans they’re negotiating with do. So it’s really helpful to know some of the language to watch out for, and to be armed with the ammunition you’ll need to come to agreement on payer contracts that allow you to stay profitable.”

Woodell outlines five areas where ASC leaders should be on the lookout for sub-optimal contract language:

Term of the contract: If the contract extends more than one year, have you successfully negotiated a cost-of-living increase for each subsequent year?

“Lesser of” language: You’ll see this with TPAs or national PPOs. They’ll negotiate 65% of bill charge for example, and the ASC may say ‘great, I’ll take that all day.’ But then the language goes on to read ‘or the lesser of’ xyz. Any time you see the language ‘or the lesser of, ‘buyer beware. I’ve seen commercial business get repriced to 100% of Medicare or 100% of Medicaid. This happens regardless of what you’ve negotiated, because they have ‘the lessor of’ language allowing default to a lower state or federal mandated fee schedule.

Escape clause: What’s your ability to get out of the contract? Most contracts will read that you’re unable to cancel within the initial term of the contract, typically 3 years. It’s important to be certain that you can get out of a contract when you need to — a 90- or a 120-day out clause is ideal.

Indemnification: If they want to be indemnified, we get to be indemnified. It’s reciprocal, or not at all.

Timely payment: Strong contracts stipulate payment of a clean claim within 30 days. One metric driving margin is how quickly you collect your money. But often, you’ll see 45 or 60 days in a draft contract. Be on the lookout for that.

For more help with negotiating you next contract, contact Woodell here. And, watch for the final installment in this series, focused on specialty-specific contract tips.

How to Improve Your Revenue Cycle Audits through Coding Accuracy

Disorganized revenue cycle management practices are damaging to an ambulatory surgery center’s (ASC’s) financial performance. A flawed process can lead to lost staff productivity and worse – missed revenue.

An efficient revenue cycle is established when all the details of coding, billing, and collections are submitted on time and correctly the first time. ASCs can improve how they manage their revenue cycle by implementing a few simple but effective steps to recognize problems and determine solutions.

Regent Revenue Cycle Management released a new guide uncovers three regular audits ASCs can perform to analyze inefficiencies and enhance revenue cycle performance. The latest guide recommends analyzing these three areas:

  • Denied claim cause and management
  • Coding accuracy
  • Payer contract adhesion

Coding Accuracy

In our second installment of a three part series, we focus on how coding accuracy is critical for an ASC to minimize denied claims that result in wasted staff time and lost revenue. A center should set an aggressive goal for coding accuracy – Regent RCM’s gold standard is 97% – but first, it must understand its baseline.

A coding audit reviews codes submitted to payers and compares them to what is supported in the documentation. A successful audit identifies problem areas and creates an opportunity to regulate coding compliance and potentially enhance revenue.

Regent recommends following these steps to ensure coding accuracy:

  • Conduct an audit twice a year. Catching errors early gives better odds of rebilling or appealing claims.
  • Use a third party. An external auditor can more objectively examine data and information.
  • Analyze and understand trends. Familiarize staff with common procedures and best billing practices to be able to catch any errors on coding.

Learn more about the other audits and how to perform to improve your ASC’s revenue cycle management. Download the guide here.

Demystifying Managed Care Contracts to Keep Your ASC Profitable Part 1

Getting a handle on managed care contracts can be a mind-boggling task for ambulatory surgery center (ASC) leaders, but it is critical to profitable operations. Andrea Woodell, Regent RCM’s vice president of managed care, has extensive experience negotiating payer contracts. In this first blog in a 3-part series, she explores key payer contracting questions that impact profitability. Part 2 will offer “red flag” language to watch out for in negotiations with health plans, and the third blog will address specialty-specific contract tips.

According to Woodell, a center’s primary specialty is an overall driving force for payer contract negotiations. “And when a center adds a new line of business, it’s important to update contracts accordingly,” she says. “Each specialty has unique requirements that mandate how you structure a fee schedule in order to safeguard that specialty.”

When negotiating payer contracts, three key questions can have a big impact on ASC profitability:

How is your center performing overall by payer by service line?

“If you’re a single specialty ASC, this will be a fairly simple exercise,” Woodell says. “For example, if you’re doing GI or ophthalmology, you can evaluate as a percent of Medicare how each of the health plans is paying you for that specialty. In addition, you should always take into consideration the payer mix, prioritizing those contracts that you can influence.”

Beyond specialty and payer prioritization, factors influencing contract negotiations include what carve outs you can negotiate, how multiple surgeries and implants are paid, and how non-grouped procedures are paid.

“As a rule, there’s going to be an established rate baseline of what payers think they can contract in your community,” Woodell explains. “And they’re going to come in low. It’s important that you reply with an objective, logical approach to why their offer is not adequate. You want to give them little snippets of what the cost of the case is, by providing implant invoices or data on operating room time, associated recovery, disposables. Work with your partners to quantify outcomes, recovery or back to work and share this data with the payers. Member satisfaction remains a priority for carriers. All are important as you evaluate your service lines and how each payer reimburses.”

Once you’ve identified a health plan that’s reimbursing well, that contract can become your target for others. Woodell recommends a focus on best price, best customer to avoid enabling other payers to pay lower than a good customer.

How does performance by service line and payer affect operational margins?

“If you’re not making money, that’s the operational impact,” Woodell says. “You could have a contract that reimburses GI great, but if you also start doing general surgery and your implants aren’t covered you have a problem. For example, general surgery uses implants, hernias require mesh. Laparoscopic cholecystectomy uses a great deal of disposables that are expensive. When you negotiated your contract for just GI cases, you didn’t care if implants were covered, because you didn’t use them. But now you’re broadening the scope of your ASC and there’s no margin on the general surgery. Margin is driven by reimbursement by product line

What data should you be tracking for each payer?

Woodell suggests ASCs collect data on timely payment, payment accuracy, and data to ensure implants are being paid at the contracted rate. For instance, if a payer is late paying claims, are they paying the state penalty? And while there’s very little ASCs can do if payers stall, Woodell suggests they appeal and be sure to collect the interest. In addition, she says having patients call the health plan can help: “Health plans don’t like member complaints. If you have patients who are good advocates for themselves and for the surgeon, the health plan won’t hesitate to pay – with the shift in payment responsibility, patients pay a lot for their healthcare, and will be eager to step up to ensure the health plan is paying their share as dictated by benefit structure.

Another data point Woodell recommends: make sure payers are not inadvertently transferring the balance of what they owe to a patient responsibility. She says such transfers can happen within payer systems for several reasons.

Want to know more about demystifying the payer contracting process? Watch for the next two blogs in this series, or contact Woodell here.

How Does Your ASC Measure Up? Benchmarking Basics for Revenue Cycle Health

Until recently, when it came to “diagnosing” revenue cycle health, ambulatory surgery centers (ASCs) often turned to hospital or physician practice metrics, due to a lack of revenue cycle measurement tools developed specifically for them. But ASCs really needed a view into revenue cycle performance that factored in the business challenges unique to their business model and circumstances.

Regent Revenue Cycle Management (Regent RCM) has addressed that need head on with development of ASC-specific benchmarking tools that ASC leaders can customize and deploy. In a white paper titled, “Using ASC-Specific Benchmarks to Assess the Health of Your Revenue Cycle,” Regent RCM shares nine ASC-specific benchmarks to help track and measure revenue cycle performance. The paper outlines how surgery centers can use the benchmarks to assess their revenue cycle; including understanding how numbers can be improved, why they might fluctuate and how they can often be misleading.

The benchmarks dive deep into key components that shape and define revenue cycle health, offering both a benchmark and a Regent RCM “Gold Standard” to help ASCs understand what’s optimal and work to improve in each of the following areas:

1. FTEs/1000 Cases
2. Days Outstanding/Days in AR
3. Percent of AR Over 90 Days
4. Claim Lag
5. Charge Lag
6. Statement Lag
7. Claim Denial Percent
8. Clean Claim Percent
9. Net Collection Rate

The white paper also includes examples of success gained through application of the benchmarks. For example, one facility in the southeast significantly improved the efficiency of its Accounts Receivable efforts through consistent follow-up with accounts and a more thorough understanding of how each payer processes claims. In another ASC, a high volume orthopedic center, collections were nearly doubled from May to December, with no significant changes to volume or case mix. In this case, Regent RCM’s benchmarks helped the ASC work with its clearinghouse to develop custom edits to ensure clean claim submission.

Regent RCM is a leading provider of innovative and cost-effective revenue cycle management services exclusively for ASCs. To learn more about the company’s benchmarking tools for ASCs, download the white paper here.

asc revenue cycle billing analysis

Uncovering Improvements through Denied Claim Cause Audits and Management

No ambulatory surgery center wants to miss out on revenue because of inefficient revenue cycle management practices.

An organized and streamlined revenue cycle requires an ASC to get every detail of coding, billing, and collections right the first time – and on time. By following a few straightforward – but important – steps, ASCs can review their current revenue cycle management processes and identify any problem areas that need to be resolved.

Regent RCM has developed a new guide that outlines three regular audits ASCs can incorporate to uncover mistakes and inefficiencies in order to enhance revenue cycle performance. The guide recommends three strategies to analyze and improve:

  1. Denied claim cause and management
  2. Coding accuracy
  3. Payer contract adhesion

In this blog, we outline the denied claim assessment and how to better manage these audits.

Around 10 to 20% of healthcare provider revenue is tied up in denials, and the top two causes for denied claims are missing information and inaccurate information. ASCs can dramatically improve their financial performance just by reducing the number of claim denials.

Regent recommends taking these actions to manage denials more effectively:

  • Act immediately. – Address every denied claim within a week of receiving notice from an insurance company.
  • Investigate the cause. – Reach out to the payer to understand why the claim was denied and how it can be amended.
  • Track past claims. – Analyze the reasons for denied claims and approaches that have been successful to tweak current processes.
  • Watch for patterns. – Pay attention to which errors, like misspelled names or missing information, are most common in denials.
  • Focus on prevention. – Remember that avoiding denied claims is the most effective way to minimizing days in A/R.

Learn how to implement this audit and our other strategies to uncover revenue cycle inefficiencies and boost financial performance. Download the guide.

1 2 3 6