Upfront Collections: Lessons Learned at Glasgow Medical Center

COVID-19 has made running an ASC even more challenging with slower reimbursement from payers, which has created cash flow issues for some centers. Regent Revenue Cycle Management is working closely with its ASC partners to help them collect as much of their revenue as possible during this challenging time.

At Glasgow Medical Center, efforts paid off in notable achievements for the month of May with total dollars outstanding over 90 days decreased by $31K compared to the previous month and was the center’s lowest amount in that category since 2016, said Regent RCM Revenue Cycle Manager Vianca Bautista. This accomplishment was one to celebrate, given that the majority of outstanding dollars in the aging bucket were patient self-pay, one of the toughest categories to collect at the backend.

Year-over-year, Glasgow’s results on upfront collections looked great, too, with percentage of due collected improving from 11% in 2019 to 40% in 2020. And, financial counseling accounted for 43% of upfront collections in 2019, compared to 100% in 2020.

“It makes a significant difference when patients are aware of what they will owe when they check in,” said Regent RCM Manager, Leslie Favela. “Before we defined our process around upfront financial counseling and upfront collections, patients would check in, have their surgery, and afterwards in the billing notes, it would say, ‘Couldn’t collect because patient was not aware of balance.’ Now the patients are coming in either with a plan or with payment. They are already educated, and that eases patients’ minds as well.”

So far in 2020, Glasgow achieved 155% of its cash goal, and saw a significant 17% decrease in AR days over 90, and had average AR Follow Up over the last three months of 99%.

“While payers have incurred new costs due to the pandemic, they have also realized savings that balance those,” said Alex Reyes, Vice Presidents of Operations for Glasgow. “The decrease in elective surgery cases has resulted in savings for health plans. And with cases lower, there is now a more dedicated effort to get claims processed correctly and efficiently.”

In addition, at Glasgow, according to Favela, the upfront collections process was adjusted this year to utilize patient phone calls instead of letters to communicate with patients about upfront collections. “I think that helps increase the number patients actually paying upfront. We make contact directly with them, versus relying on a letter in the mail.”

Download our white paper to learn more.

5 Ways to Optimize Your ASC’s Revenue Cycle

As your ambulatory surgery center (ASC) navigates ongoing challenges, such as rising healthcare costs and complex insurance environments, it is critical that you take a more proactive approach to managing your center’s profitability and cash flow. When you improve your billing and collections processes, you get paid quickly and accurately, strengthening the overall financial health of your center.

Follow these five strategies to optimize your ASC’s revenue cycle management.

  1. Triple-check insurance eligibility

Collect patients’ current insurance information to prevent billing errors and denials. Have front desk staff update pertinent data in your records, including:

  • Insurance company, phone number, and claims address
  • Patient’s name and date of birth
  • If different, the name and date of birth of the primary plan holder (and their relationship to the patient)
  • Policy and group ID numbers
  • Dates covered by the policy

It’s a good practice to ask patients for a copy of their insurance card at each visit, even if they say they have the same plan. Triple-check the information you have on file against the card before sending a claim.

  1. Communicate with your billing and coding team

Whether you have an in-house team or you outsource to a partner, it’s important to have full transparency into your center’s billing and coding workflow. How quickly are claims billed out and followed up on? When claims are denied, how fast are appeals sent? Look for inefficiencies or communications gaps in the billing process that you can address.

  1. Monitor your AR

Monitoring the % over 90 days is key for a healthy revenue cycle and will identify trends and issues. Are you experiencing payment delays or denials because of missing documentation or incorrect insurance information? Do you have an up-front collections process in place? Set A/R benchmarks for your ASC; for Regent RCM clients, our gold standard is below 25% for A/R over 90 days.

  1. Capture all charges

Record all charges for every patient encounter. Centers sometimes under-code patient services because staff don’t receive all of the necessary information or are worried about potential audits. But faulty capture processes are problematic and can lead to significant revenue losses for your ASC. Outline a comprehensive checklist for documenting charges so your team can bill accurately.

  1. Measure key numbers

Identifying shortcomings in your billing and collections systems is an important first step. But to optimize your revenue cycle, you need to implement new processes that measure key numbers and set ongoing goals. What statistics will help you evaluate progress and keep you on track toward your objectives? Look at metrics such as the number of claims that are denied each month, the percentage of patients who pay their balance, and AR % over 90 days. Make small, incremental changes to try to improve each of these key metrics.

Click here for access to two case studies where two partner centers followed best practices and improved collections compared year-over-year.

Strategic Approach to Upfront Financial Counseling Proves Success at East Hills Surgery Center

COVID-19 has created cash flow issues for most ASCs due to decreased volume and slower reimbursement. In response, we are working closely with our centers to ensure they are collecting as much of their revenue as possible during this time. And our approach is paying off.

At East Hills Surgery Center, a focused approach to upfront collections has been key to improving revenue cycle management and has resulted in significant improvements, even when New York state had more coronavirus cases than any single country outside the US, in April. Percentage of due collected improved from 16% in 2019 to 36% in 2020, and financial counseling accounted for 36% of upfront collections in 2019, compared to 99% in 2020.

“Basically, it all comes down to having the correct processes in place,” explains Leslie Favela, Regent RCM’s manager of revenue cycle business development. “It’s about making sure that we’re reviewing every single case and ensuring that we’re making the best decisions for the center and the patient.”

Attention to correct processes and disciplined focus have delivered very strong revenue cycle management statistics for East Hills over the past months: The center achieved 149% of its cash goal, and saw a significant decrease in AR days over 90 on the strength of an average for AR follow up over the last three months of 99%.

Favela attributes the success at East Hills to having dedicated staff focused on collections, and a strategic approach to upfront financial counseling.

“Often we find that centers are kind of open-ended on what they’re asking patients to pay upfront,” she says. “We always start with the highest estimate, and then work from there. I think that the centers tend to reduce it right away without explaining the potentially highest amount to the patient. So we start high and then give wiggle room, rather than starting in between and later having to lower it from there. We find then that another result of increasing upfront collections is a drop in AR, so we have less bad debt to write off, and fewer receivables moving into the aging buckets.”

“East Hills reached their cash collection goal,” Favela continued. “The team has been diligent on working on the AR, and then we took advantage of a slower business period to make sure that we touched all accounts to bring in the most money. This has been an effective formula.”

Learn more in our white paper, Proactive Cash Flow Management. Download your copy now.

negotiations

Fact-Based Payer Contract Negotiations Key as ASCs Reopen

A side effect of COVID-19, disrupted contract updates between health insurance payers and ambulatory surgery centers (ASCs) have created a new normal for negotiations. For ASCs, leveraging a thorough understanding of the pandemic business realities for both payers and providers is more critical than ever as the industry recovers.

“Payer resources have been intently focused on their provider networks capacity to manage COVID — whether it was ensuring enough beds or ventilators, teleconference access, physicians’ capabilities, or testing,” says Andrea Woodell, Vice President of Managed Care at Regent RCM. “The virus caused a seismic shift in the payers’ focus. Naturally, we lost momentum in our ASC contract negotiations. Now, 12-16 weeks into it, we’re picking up the discussions again.”

As contract talks resume, Woodell shares observations to keep ASCs’ negotiations focused on the facts:

  1. Costs, But Also Savings: While payers have incurred some new costs due to the pandemic, they also have realized savings that balance out those costs. “The decline in elective cases has resulted in substantial savings for health plans. As a negotiator, we should incorporate the savings which offset new COVID expenses,” Woodell says.
  2. Shifting Payer Mix:COVID-19 has forced a change in payer mix that should be addressed in negotiations. Says Woodell: “Because of COVID, there are 40 million people unemployed now. We’re going to see a spike in uninsured, an increase in Exchange coverage, an increase in Medicaid, and especially in metropolitan areas, we’ll see some commercial coverage migrating from PPO and HMO plans to a lower-paying Exchange product. The impact of these payer mix changes, if not offset during negotiations, would decrease ASC reimbursement for surgeries.”
  3. A Better Site of Care: Woodell says the benefits of moving procedures to the ASC setting have never been clearer. ASCs afford Medicare patients 55% savings over the same procedure at a hospital. And, with hospital space and priorities stretched by COVID, the advantages of a separate location for elective surgeries become even more important and valuable. “I think it’s important to include in negotiations what the spend would be on their managed Medicare product for an HOPD setting versus your ASC setting,” she explains. “Use that. If I have both a managed Medicare product and a commercial product with a certain payer, I quantify the amount saved by moving the case to an ASC versus HOPD setting. We know the Medicare population does not want to go to the hospital right now, and they are unlikely to go there due to COVID. A shift in site of service is great for the payers, but often leaves the ASC unprofitable. My goal is to demonstrate the saving on their managed Medicare lives and shift some of that savings to the commercial cases It is a fair and logical discussion to support long-term success of both the ASCs and the health plans”

Finally, Woodell predicts ASCs will see a quick uptick in volume as things reopen, followed by a plateau or decline as the industry satisfies demand that was put on hold. “The volume will come, but it’s going to come back slowly. In terms of reimbursement and payer contract negotiations short term, if we push the money will be there. ASCs’ value should be recognized and rewarded.”

For more information on managing ASC payer contracts, contact Woodell here.

missteps

ASCs Can Avoid Revenue Missteps with the Right Business Office Structure

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

With some strategic advanced planning, ambulatory surgery centers (ASCs) can put policies and procedures in place, along with tracking mechanisms, to effectively manage their revenue cycle.

For this second blog in a two-part series, Leslie Favela, an eight-year veteran of Regent Revenue Cycle Management (RRCM) and manager of the RRCM Business Development team, sat down to answer some of the most frequently asked questions that RRCM receives from ASC professionals around the country:

Question:

My colleagues and I are trying to find ways to improve our collections and are considering asking for upfront collections from patients. How can we do this without irritating our clientele?

Answer:

There are several ways to sustain the goal of improving collections overall, and we have had several successes with centers starting to do the upfront collections. In another recent blog, we addressed some of the myths out there, but on a high level, before you start upfront collections, education is key. It is critical that you begin by educating your surgeons, educating the center staff, and educating the patients on exactly what it means and why collecting upfront is the right thing to do. For us, a big focus has been advising the patient and educating them on their financial liability for their healthcare. Once they understand that piece of it, I think that definitely takes away the irritation.

Within our industry, times have changed. Now, we have the capability to really know how much a patient is estimated to pay for a given procedure. So, step one is making sure the patient understands that information: what their deductibles are, what their liability is. The same thing is true for the surgeons: they can prep the patients on their end by telling them “Hey, we can save you time and money by doing the surgery you need at the surgery center instead of at a hospital. We’ll help you understand your deductible and the percentage of the total cost you’ll need to pay, and we collect that upfront.”

Question:

Last year my center merged with two other surgery centers and it has been so hectic that I am worried some administrative chores may be falling through the cracks. Do you have any suggestions on how we can ensure nothing gets missed?

Answer:
Yes, merging two surgery centers can definitely be hectic, but establishing standard policy and procedure helps. At RRCM, we follow a check list that details what reports we should be running on a monthly basis and helps ensure that all of the critical work of revenue cycle management gets done. Self-audit is really key here, whether it’s you who’s completing the tasks or managing someone else who is implementing. It’s all about making sure that once you have the process in place, you follow through on all of your business office policies and procedures, and that you tend to them each month.

“It all comes down to advance planning,” Favela says. “Overall, the secret is really focusing on revenue cycle management and working to ensure that you have an effective structure in place within your business office. In addition, centers should educate everyone from the staff to the surgeons to the patients on standard operating procedures for the center and overall expectations. With those things in place, it’s all about doing regular self-audits to make sure you’re doing everything right and catching any issues early.”

For more information about effective revenue cycle management, contact Favela.

Three Revenue Cycle KPIs Every ASC Should Track Right Now

The Ambulatory Surgery Center (ASC) revenue cycle community has not had specific measurement tools readily available, which has led money to be left on the table or missed altogether. To fix this issue, Vice President of Regent Revenue Cycle Management Erin Petrie and her team authored benchmarks that provide the intel necessary to gauge performance across all functions of the revenue cycle. This is a game changer for administrators and ASC leaders who are looking to obtain a better handle on their financial health in 2020.

On Tuesday, December 10th at 11:00 a.m. CST, Erin Petrie and two members of her team, Leslie Favela and Luz Renteria, will be hosting a webinar that will outline 4 of the 9 exclusive benchmarks.

You will learn:

  • How KPIs allow you to evaluate and optimize your center’s revenue cycle
  • How payer mix impacts A/R
  • How to proactively identify denial trends
  • How to establish processes to attain benchmarks – including our gold standards – and how often they should be measured

Join us for our webinar by registering here and take the first step in getting your ASC on the road to success in 2020.

key payer metrics

Tracking Key Payer Metrics Can Help ASCs Manage Financials and Negotiate

As ambulatory surgery centers (ASCs) become more sophisticated about financial management, they’re beginning to adopt a practice that has been used by many hospital administrators. This practice is grading the major insurance payers on key metrics. This is done in order to inform future contract negotiations and for the overall profitability of the ASC.

Regent RCM’s Senior Director Erin Petrie says Regent RCM is developing a protocol for its ASC clients. The process helps track and evaluate major insurance payers and gather insights from side-by-side comparisons.

“The practice of collecting payer data, even in something as simple as a spreadsheet, is helpful for negotiations,” says Petrie, “I think it’s good for the administrator of a surgery center to have that knowledge. Therefore, the administrator can gain a better idea of what’s going to happen to your financials each month. For example, how long should you wait for an expected payment from any particular payer? If you see that work comp is now taking 65 days to pay instead of the 50 days they were previously trending – you want to be able to investigate those types of things.”

Petrie suggests three key metrics as a good start on grading the payers:
  • What they pay for a procedure
  • How fast they pay
  • Each payer’s percentage of claims denied

“Those are the three metrics that stand out for me,” Petrie says. “But there are a lot of additional things that could be measured for the sake of having a better negotiation tool. For example, the reimbursement methodology each payer follows might be another good one. Do they use groupers, are they reimbursing as a percent of Medicare, are they including implants or paying for implants separately? That sort of data is helpful to have.”

While Petrie admits developing and maintaining a process for grading the major payers is resource intensive, she believes the benefits can be compelling. As a result, Petrie and her team are incorporating the practice as a part of Regent RCM’s scope of services for ASC clients.

What might ASC administrators learn from such a process?

“Definitely around denials the information can be pretty eye opening,” Petrie notes. “If you take the time to really look at your Explanation Of Benefits documents (EOBs) and your denials, you’ll learn that payers have many more denials than you thought. But you’ll eventually get paid.”

Implementing a system for grading payers helps answer key questions: Is a payer denying things that they should be paying for? How much time does your staff have to spend to collect from each payer? And, how long is it taking for that money to come in from each? Most importantly, collecting this data gives ASCs better information to use in negotiations.

“ASC admins already do a good job of collecting data to use when we negotiate with the payers around quality metrics, clinical outcomes and cost effectiveness,” she says. “However, the opportunity is to couple that with what we see happening on the financial side. The data may allow us to point out that we’re experiencing too many denials.”

She adds, ” it may also allow us to show that our total short payments are, for example, $200 off on average per case. And we could talk tangibly about days to pay. Maybe they have 30 days to pay in the contract, but your data is showing that they’re averaging 50 days. When we can share hard data, we have additional points to negotiate.”

Petrie believes “grading” insurance payers has value at an enterprise level as well as for individual centers. “Either way, it’s a real value add for surgery centers to understand their payers, both to inform negotiations, and to manage financials more effectively.”

For more information on Regent RCM’s approach to grading insurance payers, contact Petrie. Email her: epetrie@regentsurgicalhealth.com or click here to send a message to the Regent RCM team.

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.

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