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ASC Revenue Cycle October Industry News Wrap-Up

Each month Regent Revenue Cycle Management (Regent RCM) explores the top news and headlines affecting the healthcare industry. This month in the news: The new MACRA final rule released by the Centers for Medicare and Medicaid Services (CMS) contains aspects that will impact ASCs; A new editorial weighs the pros and cons of “condiminiumizing” ASCs; Key specialties coming for ASCs next year; And a Deloitte survey reveals that a large number of physicians are still paid under fee-for-service payment model.

MACRA Final Rule Released

On Friday, October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) released its final rule that established the new Medicare payment methodology for physician services furnished under Medicare Part B, known as the Quality Payment Program (QPP). The rule contains many components that will impact ASCs. The QPP was enacted in 2015 as part of the Medicare Access and CHIP Reauthorization Act (MACRA) and has two participation options for physicians: The Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). Reporting for the first year of the QPP begins in 2017. Click here to read more.

ASCs: To Be or Not To Be “Condominiumized”

In an editorial, Stephen Sheppard, CPA, COE, reveals the pluses and minuses around the concept of “condominiumizing” ambulatory surgery centers (ASCs). This model involves separating a single physical ASC plant temporally among two distinct legal entities. For example, ASC-A could operate on Monday, Wednesday, and Friday, while ASC-B could operate on Tuesday and Thursday. Sheppard outlines the opportunities and obstacles. Click here to read more.

Key Specialties Coming for ASCs in 2017 

Ambulatory surgery centers are performing higher acuity cases and presenting opportunities for the healthcare system to provide quality care for patients at a lower cost. Paul Eiseman, vice president of business development at Regent Surgical Health, shares insights into specialties that have fared well in the ASC space and what is in store for 2017. Click here to read more.

Deloitte Survey: 86% of Physicians Are Still Paid Under Fee-For-Service Payment Model

Deloitte’s “2016 Survey of U.S. Physicians” survey has revealed that many physicians are reimbursed under a fee-for-service model instead of the value-based system in which providers are paid according to outcomes. Click here to read more.

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Regent Revenue Cycle Management Expands Service Infrastructure; Ensures Dedicated Staffing

Regent Revenue Cycle Management (Regent RCM), a leading provider of innovative, cost-effective revenue cycle management services exclusively for Ambulatory Surgery Centers (ASC) in the U.S., announced today that the company is investing in new talent to provide seamless service delivery to a growing customer base.

The company has hired Ivette Gomez to serve as Revenue Cycle Specialist.  In this role, Gomez will handle billing, payment posting, and accounts receivable for her surgery center, while delivering high-value and high-touch customer service to ASCs.

“Dedicated staffing is essential to achieving patient satisfaction and revolves around a team that possesses an all-inclusive knowledge of the revenue cycle,” said Michael Orseno, Regent RCM Vice President. “Ivette is a wonderful addition to our team and I’m certain her contribution will benefit our clients and enable us to continue to outperform industry benchmarks.”

Gomez will be responsible for a center in the Southeast. She previously served as Senior Reimbursement Specialist at Midwest Orthopaedics at Rush. In this position, Gomez followed-up on outstanding claims and performed reimbursement audits to ensure payments matched contracts and fee schedules.

“I am pleased to begin my new career at Regent RCM,” said Gomez. “There is an incredible team in place, and I’m truly excited to share ideas with them. Together, we will continue to provide the best solutions for our centers and their patients.”

Regent RCM’s services optimize ASC workflow and processes, and generate real-time analytical dashboards that are critical to assessing an ASC’s financial health. Regent RCM consistently outperforms industry benchmarks allowing ASC managers to focus on high-value activities.

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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.”

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New Regent RCM ROI Calculator Helps Surgery Centers Determine the Value of Outsourcing RCM

The big question when it comes to outsourcing is “will it really save money for my organization?”   Regent RCM recently published a white paper aimed at answering that question for ASC revenue cycle management (RCM). The paper provides the equation on how to determine the value of outsourcing, and now, to make it even easier, Regent RCM has developed a calculator that actually does the math.

“We are excited to launch the ROI calculator because it gives ASC leadership a tool that quickly delivers a ballpark estimate of value,” stated Regent RCM Vice President Michael Orseno. “If the numbers make sense, they can move forward with a business audit. If the numbers don’t add up, they can move on with very little time invested.”

Regent RCM’s ROI calculator guides centers to enter top-level, easily accessed information, and immediately returns a high-level estimate to determine if outsourcing will translate to cost savings. Results are based on industry averages. The ROI Calculator is available here.

“Of course, cost is just one part of the revenue cycle value equation,” adds Orseno. “When we perform a business operations audit we focus our attention on finding opportunities to improve RCM performance through payor contracting and billing and coding expertise, detailed reporting, automating processes, and more.”

Regent RCM’s services optimize ASC workflow and processes, as well as generate analytics and real-time dashboards that are critical to assessing an ASC’s financial health. Regent RCM consistently outperforms industry benchmarks allowing ASC managers to focus on high-value activities.

To learn more visit www.regentrcm.com or register for the upcoming webinar focused on gaining control and realizing greater efficiency through outsourcing RCM.