3 Tips to Maximize Surgery Center Billing and Coding

Regent RCM’s gold standard for days outstanding is 30 days or less, although the right number for a center could range from the mid- to high teens all the way up to 50, depending on payer mix and case mix. In this blog post, we’ve summarized 3 ways to keep days outstanding in check.

Manage Lags and Turnaround Time

Claims should always be sent the same day charges are entered, so the claim lag should be the same as the charge lag. If centers are experiencing a significant difference between the two, this is an indication that your billing department may be holding claims or that they’re entering charges prior to receiving the operative report. Managing lags and turnaround time is one of the easiest ways to decrease your days outstanding. “The charge entry lag is measured from the date of service to the date charges are entered. The charge entry lag should be less than five days, with the gold standard being less than two and a half days.” Said Erin Petrie, Regent RCM’s Director of Revenue Cycle Management.

Conduct Periodic Coding Audits

It is extremely important to conduct periodic coding audits by an outside coding company, whether your center outsources its coding services or employs a certified coder. “Regent coordinates bi-annual audits on all of our centers using an outside firm. By doing so, we eliminate the conflict of interest a regular coding company may have in finding coding errors in the hopes of gaining additional clients. All centers should be held to an acceptable standard above 90 percent accuracy but be given a chance to rebut coding inaccuracies found during an audit,” said Petrie.

Some disparities found during our coding audits center around what was performed during the procedure and what was dictated. Sound coding practice is to always code from the operative report and not from the procedure.

Choose the Right Clearinghouse

Choosing the right clearinghouse can make a significant difference in the efficiency of your business office. Most clearinghouses can send electronic claims and receive electronic remittance (ERA). ZirMed and others set themselves apart by performing electronic eligibility in either batch or individual mode, providing real-time statuses and having the ability to setup center-defined, custom claim edits. In addition, ZirMed rolled out a new enhancement recently which allows some of our centers to send worker’s comp claims, traditionally sent on paper, electronically by matching up a scanned operative report to the electronic claim. This has caused a decrease in our A/R greater than 90 days for worker’s comp, which is habitually one of the more challenging financial classes.

Keeping days outstanding to a minimum is a worthy task for all ASCs, one that requires constant diligence and strong organizational efforts from everyone involved in the process. The fruits of this labor can lead to steadier collections, a more organized business office, and more integrity in your reporting data

Learn more about Regent RCM’s expert billing and coding services for ASCs

4 Coding & Billing Best Practices

Erin Petrie, Director of Revenue Cycle Management at Regent RCM, has worked in the medical field for nearly a decade, specializing in hospital administration and revenue cycle management. She draws from her experience to share best practices to help billers and coders manage a successful revenue flow.

  1. Verify patient information.

Prepare or update patient files in advance of their appointments. Check benefits and eligibility, making sure you have accurate information on factors such as copayments, deductibles, and balances due. Patients aren’t always aware of details related to their medical insurance – for example, if their employer has switched insurance companies, or if they need a referral from their general practitioner before seeing a specialist. Verify that the procedure code is billable under the patient’s insurance plan.

  1. Clarify patient financial responsibility.

Train your staff to communicate with patients about what payments they are responsible for. Make your ASC’s payment policies clear; ask front desk staff to confirm them when scheduling appointments, and post them in a visible area near check-in. Collect copay or co-insurance from patients at the time of service, and require payments toward past balances before scheduling new procedures.

  1. Submit correct claims the first time.

Be meticulous in producing error-free claims. Submitting an insurance claim, only to have it rejected, fixed, and resubmitted, can delay a payment by weeks or months. Avoid this frustrating cycle by double-checking claims for any errors in patient, provider, insurance, or billing information.

  1. Use proper codes and modifiers.

Go through each claim with a fine-tooth comb to confirm that you are using the appropriate codes for the services provided. Follow a standardized process to check information and minimize errors. Have you included all the necessary procedure and diagnosis documentation? Are you using the correct modifier for a procedure’s specific circumstances? Attention to detail in coding is critical for fast and accurate claims processing.

Learn more about Regent RCM’s expert billing services for ASCs.

ASC Billing & Collections

Regent RCM Client Makes a Case for Outsourcing Billing Services in an Interview with Becker’s ASC Review

Larry Parrish, administrator of Illinois Sports Medicine & Orthopedic Surgery Center (ISMOSC), explained why his center decided to outsource revenue cycle management (RCM) during a recent Q&A session with Becker’s Healthcare. He listed space and expertise as the main factors.
 
“If we had the physical space to accommodate the billing activity, we might have seriously considered it. However, accurate and effective billing is a very complex process, and you want to make sure you have very capable individuals providing those services.”
 
Parrish also lists eliminating the headaches of staffing, training, managing, and covering for sick leave/vacation as reasons he decided to outsource. 
 
Naturally, the big question was, “In retrospect, was this the right decision for your ASC?”  For the answer, read the full interview in Becker’s ASC Review. Spoiler Alert: The answer is “Yes.”
 
Are you an ASC administrator and ready to learn more about outsourcing RCM? Register for an upcoming webinar, “Gaining More Control and Efficiency by Outsourcing RCM.”
Maria Murguia Regent RCM

Meet the Team | Maria Murguia

Over the next few months, we will be introducing the many members of our team who make Regent RCM so successful. In our last post we met Revenue Cycle Specialist Gabriela Alcaraz. Today, let’s get to know:

Name: Maria Murguia

Hometown: Chicago, IL

What do you do at Regent RCM? Revenue Cycle Specialist

How long have you been working at Regent RCM? 9 years

What is your favorite part about working here? I work with a great team of people. Performing the multiple revenue cycle functions is always easier when you have their support, enthusiasm and commitment. Collaboration is key!

What has been your greatest professional achievement? I have been awarded several RISE awards for my exceptional customer service.

What is one fun fact about yourself your co-workers don’t know? Well this is no secret; I’m a big Disney fan!

ASC Physician looking for revenue

ICD-10: Top 3 myths and facts for ASCs

It’s no secret that the use of ICD-10, the 10th addition of the International Classification of Diseases by the World Health Organization (WHO), will commence in approximately six months, and ambulatory surgery centers should be taking the required steps to prepare for as seamless of a transition as possible.

The start of ICD-10 has been delayed more than once, and this has blurred the lines between myth and fact:

Myth 1

ASCs should continue to plan to implement ICD-10 under the assumption that the Department of Health and Human Services (HHS) will grant another extension.

Fact 1

The HSS has no plans to extend or delay the implementation of ICD-10 for all HIPAA-compliant entities, so ASCs need to continue taking the necessary steps to officially make the switch ICD-10 on October 1, 2015.

Myth 2

Since ICD-10 was actually developed and implemented around the world years ago, it’s probably out of date already.

Fact 2

ICD-10 codes have been updated annually prior to a partial code freeze to stay on pace with advances in technology and the healthcare environment. The partial freeze was implemented by the ICD-9 Coordination and Maintenance Committee, and only codes capturing new technologies and diseases were added to ICD-9 and ICD-10. No ICD-9 updates will be made past October 1, 2015, and regular updates to ICD-10 will resume on October 1, 2016, according to the Centers for Medicare & Medicaid Services.

Myth 3

The increased amount of available codes will make ICD-10 more challenging to use.

Fact 3

ICD-10 will have almost five times the number of diagnostic codes and will require greater specificity and detail, but that doesn’t mean it will be necessarily more complex. Almost half of the new codes are simply to differentiate between the two sides of a patient’s body. Having a greater selection of codes will actually make it easier to find the proper code because they will be more precise. Additionally, ICD-10 will have an alphabetic index and electronic coding tools to help billing and coding staff find the correct option.

With these facts in mind, ensuring that an ASC’s billing and coding staff receive optimal training should reduce the chance of negative impact on the financial health of the center. If the staff is not as prepared as needed, it might be the time to consider outsourcing RCM to a provider whose employees have been adequately trained to handle ICD-10 efficiently.

ASC Business Office

How does proper charge entry affect an ASC’s financial performance?

Charge entry is considered one of the most critical stages in an ambulatory surgery center’s billing process. Best practices, including using modifiers correctly and performing regular business audits, should be followed and executed by knowledgeable experts to maximize revenue potential for the ASC.

Using modifiers correctly

Billers must confirm that not only the correct codes are inputted for each procedure performed, but also the correct modifiers are used. The two most common modifiers are 50, which is used for bilateral procedures performed during the same surgery, and 59, which indicates a procedure that is independent from other services performed on the same day. Inputting the correct modifier directly affects reimbursement so it is imperative to an ASC’s financial health that the biller gets it right the first time.

Performing regular business audits

Many billing and coding staff members are unaware of the importance of reading the full payer contract and how charge entry errors can affect the ASC’s financial performance. Performing a business office audit can help point out if there has been any lost revenue due to errors during the charge entry process. Audits should be performed regularly and errors should be reviewed so future revenue is not lost.

Impact on financial performance

Charge entry requires full understanding of payer contracts and billing s and is particularly important for ASCs with specialties like orthopedics, spine cases and pain management. Errors in the charge entry process can lead to lost revenue and directly impact an ASC’s overall financial performance.

revenue cycle benchmark

How to Get a Clean Claim the First Time, Every Time

Ensuring that a claim is clean the first time it is submitted can save your ASC a lot of time, and potentially money. It may take 30 days or longer to get a denial response back, and then you’ll have to start the billing process over again. Clean claims will reduce your AR days and increase your cash flow.

Here are some foolproof ways to get you a clean claim every time:

  • It is imperative to provide front-office staff with training and regular feedback to prevent unnecessary errors. The road to a clean claim starts with the front-office staff getting the right demographics, verifying insurance, and generally ensuring there aren’t any administrative errors going into the claim.
  • Doctors must take great care in dictating information correctly in terms of what procedures were done. Coders must then properly research and identify the right diagnosis and procedure codes before claims are submitted. Attention to detail is key here – one incorrect or imprecise code can result in a denial.
  • Billers must properly append the correct modifier to the procedure code if applicable, submit the claim to the right insurer, and confirm that the procedure is billable for that specific payer. It can be tempting for a biller to go on autopilot and make assumptions about what is and is not billable, but that can lead to avoidable errors.
  • Utilize RCM technologies to provide feedback on denials for each set of users within the claim submittal process. Then build custom edits within the clearinghouse that will kick a claim back before it is submitted if it does not meet certain standards. This will ensure you don’t spend precious time in the denial process and risk not getting paid.
ASC Physician

Advice for ASCs Hiring a Billing Services Company

When selecting a billing services, or revenue cycle management, company, it is essential to make the right choice. Doing so will save you money and further headaches down the road. We’ve come up with a few things to keep in mind when making this important decision:

  • Make sure they understand the ASC industry. The ASC revenue cycle is very different from that of a physician’s office or hospital, and you want a partner that understands that and is attuned to your specific needs. An RCM partner that has experience in your exact specialty is even better.
  • Capitalize on their knowledge. Now that you have chosen someone with experience in this field, it will be useful to learn from that experience. Ask them for best practices, templates, anything that can help you get started quickly.
  • Get reports. You will want to stay up to date with your RCM provider, and be able to monitor the things that are important to your ASC. If you can get these reports customized, all the better.
  • Always communicate. The more you communicate, the better your billing services will be. It is important to ask questions, and be available for them to ask you questions. Work together as a team and you will be successful.
ASC Billing Staff Meets With Physician

Overcome the 4 Most Common Pitfalls in ASC Revenue Cycle

A different version of this article first appeared in Becker’s ASC Review

By Carrie Pallardy

Michael Orseno, revenue cycle director at Regent RCM, identifies four common areas that translate into lost income and the policies ambulatory surgery center leaders can put in place to overcome these revenue cycle issues.

Insurance verification. Insurance verification is a simple process, but when overlooked it translates into lost revenue. If insurance is not verified, ASCs may lose money on uninsured patients or those who recently lost their benefits. “At Regent centers, 100 percent of cases need to go through the insurance verification process. This has alleviated past issues of performing cases for free,” says Mr. Orseno.

A policy for regular insurance verification is easily implemented. With software, such as HST Pathways and ZirMed, verification can be instantly obtained and viewed in a patient’s chart. ASC leaders are able to see whether a patient’s insurance is active, their co-pay, co-insurance, deductible and remaining deductible. Pre-operative authorizations still require manual staff time, but the entire process serves as a way to prevent lost revenue.

Scheduling. Proper scheduling is key to ASC efficiency and operational success. But, scheduling is not only about maximizing operating room time. The types of cases scheduled are equally important. Effective schedulers will have a grasp how profitable cases are based on case cost and payer reimbursement. “Perform case costing and know your margins,” says Mr. Orseno.

Scheduling is of particular importance in centers that rely on a high volume of out-of-network cases. “In out-of-network facilities you want to avoid scheduling cases with patients that have a high out-of-network deductible or no out-of-network benefits ,” says Mr. Orseno. Insurance verification is the first step in understanding which cases make sense to schedule and which do not.

As a number of ASCs begin to take on higher acuity cases, such as joint replacement, the implant price becomes an important consideration during scheduling. A single implant can cost $20,000. Perform a return on investment analysis and determine whether or not reimbursement for the procedure will cover its costs. Consider implementing a protocol requiring administrator approval before scheduling a high-price implant case.

Insurance follow-up. Thorough follow-up ensures ASCs capture as many dollars as possible for the cases performed. “Know your contracts and don’t accept anything less than what you are contractually owed,” says Mr. Orseno. In the case of out-of-network centers, payers will often attempt to settle for 20 percent or less of a procedure’s gross charges.

Policies need to be put in place to verify that the center is receiving maximum reimbursement. If a payer is not meeting contractual levels, appeal the underpayment immediately. In out-of-network centers, create a threshold for reimbursement and if that threshold is not met, escalate the issue with payers.

Patient collections. Rising patient deductibles and out-of-pocket costs are a well-known issue in healthcare. ASCs will lose money unless they make an effort to discuss this fact with patients prior to the procedure. “The chance of collection drops 50 percent after the procedure is done and it continues to drop every 30 days without payment,” says Mr. Orseno.

After insurance has been verified, ASC leaders can sketch an estimate of what a patient’s financial responsibility will be based on the deductible and co-insurance. Review a patient’s benefits with them and explain the cost. Determine a set amount that is due before the procedure and explain payment options for any amount remaining after the payer has adjudicated the claim. Open communication prepares patients for their financial responsibility and mitigates the risk of ASCs losing on collections.

Interested in ensuring your center is receiving maximum reimbursements? Contact Mike Orseno, Revenue Cycle Director of Regent RCM for a revenue cycle audit.

ASCs take control of billing and coding

Automate Your Revenue Cycle

In today’s world of shrinking reimbursements, centers are looking for ways to decrease costs without sacrificing efficiency. By automating functions and tasks in the business office, facilities can reduce staff costs while also increasing efficiency. The list below represents a list of functions that Regent centers employ to achieve gold-standard revenue cycle metrics:

Insurance Verification. Automating insurance verification is nothing new – more than a decade ago facilities were accessing payer websites to verify patients’ benefits. Today with the integration of clearinghouses and management information systems, it’s possible to obtain up-to-date insurance information in seconds. At our centers, employees are able to obtain instantaneous, up-to-date insurance benefits populated right into patients’ charts in HST Pathways via ZirMed. This can be done either in batch mode or individually.

Scheduling. Several Regent centers use an automated scheduling system, decreasing the number of registration errors and increasing efficiency. SCOR Technologies offers a product that allows physician offices to view the ASC’s OR schedule and request appointments. Once accepted by the ASC, the patient information automatically populates in HST. Other home-grown electronic scheduling systems are in place at other Regent centers as well.

Claims Processing. Today nearly all facilities send their claims electronically, however, gold standard facilities setup customized edits with their clearinghouse to catch erroneous claims at the time of submission instead of waiting 30 days for an insurance denial. This process will help reduce Days Outstanding.

Payments. Most payers are able to send electronic payments directly to a facility’s bank account through electronic funds transfer (EFT). Your funds will be available more quickly and the chances for fraud are reduced.

Remittance/Payment Posting. Along with EFT, the majority of payers are able to send patient remittance electronically (ERA). Once centers have setup ERA, they can begin posting their payments electronically via Auto-Post. Auto-Post eliminates the timely keying of each individual payment thereby reducing key-stroke errors and increasing efficiency. HST allows the payment poster to approve each individual payment prior to auto-posting payments. This allows for greater flexibility with incorrect payments.

Contract Upload. Regent centers upload all payer contracts into HST. So at the time of posting, the payment poster can instantaneously verify whether the payment is correct and if not, flag it for follow-up. The uploading of the contracts also allows management to run an end-of-month Contract Variance Report to track insurance underpayments and determine if trends exists. These trends can lead to developing clearinghouse edits to prevent insurance denials.

Statement Generation. Gone are the days where centers take an entire day or half-day to print statements, stuff envelopes, affix postage and mail statements. Regent centers upload the patient statement files weekly from HST to ZirMed, which processes the patient statements for a price less than the centers could do it themselves. ZirMed statements look professional and can contain the facility’s information and/or logo.

Reports. For centers without a customized reporting package, some of the canned reports from the management information system may need to be modified from time to time. If you’re constantly performing the same modifications to reports in Microsoft Excel such as formatting and calculations, you can automate this process in Excel by developing macros. Macros have saved staff time at our facilities. For example, one facility was spending an inordinate amount of time each morning formatting scheduling reports for specific doctors. We developed a macro that reduced the time to format a report from 20 minutes to just one key-stroke.

Along with automating functions, the working of revenue cycle tasks can be automated, provided you have a robust management information system such as HST. Worklogs can be used as a type of “checks-and-balances” system for revenue cycle staff. For example, by setting up a task for CHARGES NOT ENTERED, a biller will be able to check his/her worklog daily to ensure all charges were entered. Utilizing a worklog will also make staff more efficient and cut down on the amount of paper an office uses. Most Regent centers utilize the Accounts Receivable tasks such as NO PAYMENT RECEIVED FROM PAYER, and PATIENT HAS NOT PAID FOR 30, 60, 90…DAYS SINCE LAST STATEMENT. Standard operating procedure is to print out an A/R report and work it line by line. The problem is that the report is out-of-date by the time the staff member gets to the bottom of the first page due to payers and/or patients paying subsequent to the report being run. The worklog is updated nightly so it is never out-of-date – staff will always be working receivables due. Management is also able to run worklog reports to track staff efficiency.

By automating both revenue cycle functions and tasks, facilities can improve their bottom lines without negatively impacting productivity.