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.”

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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.

New Case Study: A/R Follow-Up Increases Collections in Ft. Myers

The Center for Specialized Surgery in Ft. Myers (TCSSFM), Florida is growing rapidly, in part because the center leverages Regent RCM benchmarks to gauge performance across all functions of the revenue cycle.  A new case study outlines the center’s positive experience with the benchmark for Accounts Receivable Follow-Up.

The A/R follow-up benchmark tracks how many of the cases a center has with an open balance are being followed up on each month. The gold standard expectation is that biller/collectors follow up with the payer for at least 95% of all the open claims every month.

The case study outlines steps TCSSFM has taken to achieve an amazing result: increasing collections by $125,000 per month in the past year. While center growth and the addition of high reimbursement procedures have contributed as well, efforts to follow up with payers on at least 95% of claims every month have been a big part of that success.

Erin Petrie, Regent RCM’s Director of Revenue Cycle Management says: “This metric allows us to drill down into the actual collector’s performance, versus just the center’s performance. A center might have a great month and collections are up through the roof, but that’s not necessarily a reflection of the efforts of that collector. Whereas your follow up, how many claims you’re touching every month, reflects your work.”

Want to learn more? Read the full case study here.

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Case Study: Regent RCM Nearly Doubles Monthly Revenue Collections for High-Volume ASC

When the Andrews Institute Ambulatory Surgery Center (AIASC) sought to address challenges impacting its monthly collections, the high-volume surgery center turned to Regent RCM for help. The specialized facility, based in Gulf Breeze, Fla., is a joint venture between Baptist Health Care and area physicians, offering orthopaedic and sports medicine services.

After identifying coding and A/R process & workflow challenges leading to lost revenue for the center, the AIASC signed with Regent RCM in May of 2015. By December 2015, just eight months later, AIASC nearly doubled its monthly collections without significant changes in volume or case mix.

Regent RCM worked with the center to achieve this success by leveraging coding expertise to code claims accurately. Regent RCM also brought the center up to a clean claim submission of 97 percent – the industry gold standard, and addressed the center’s A/R process & workflow issues. Regent RCM’s primary goal was tailoring effective solutions to AIASC’s specific needs.

For more information on how Regent RCM nearly doubled the monthly collections for AIASC, read the case study here or call 312-882-7228 to find out how Regent RCM can help your ASC.

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Regent RCM’s Partner Centers

Case Study: A Comprehensive RCM Solution Shortens Revenue Cycle For ASC Joint Venture


The Robert Wood Johnson Endosurgical Center, located in East Brunswick, NJ, is a 6,800 square foot, state-of-the-art ambulatory surgery center offering the highest quality of care with the most advanced medical technology and equipment. A joint venture among Regent RCM, local physicians and Robert Wood Johnson University Hospital, the center offers fully equipped operating rooms, a recovery room, a post recovery room and a spacious waiting room.

Regent’s Solution

Working with its joint venture partners, Regent in 2013 began developing a comprehensive revenue cycle management solution that would arrange for payment prior to the date of service. Using Regent’s management information system, the solution would allow staff to instantly verify benefits before procedures are performed. It also would allow the ASC to capture important patient documents such as drivers’ licenses and insurance cards in one central database.


Once Regent’s RCM recommended solutions were implemented, the results were almost immediate, RWJ ASC Business Manager Linda Reid said. After a review by Regent’s RCM experts, several existing claims were immediately resubmitted, including a $12,000 initial payment that was later reimbursed for $30,000.

Click here to read the detailed case study on the comprehensive RCM solution that shortened the revenue cycle for an ASC joint venture.

Regent RCM

Case Study: RCM Audit Provides Pivotal Step to Greater Financial Performance


Regent RCM conducted a revenue cycle audit of one of Regent Surgical Health’s partner centers where a representative sample of cases was selected according to the specialty and payer mix of this particular center. A full review of the ASC’s billing and reimbursement procedures and practices was conducted, providing a comprehensive snapshot of the ASC’s overall billing, collections and reimbursement performance.

Regent’s Solution

Regent discovered a claim that included a modifier billing error that not only impacted the reimbursement of the specific case in question, but had the potential to impact many more.

Based on these preliminary findings, Regent developed and executed a strategy for universally identifying the issue including a contract review, RCM process review, expanded incidence review, educating staff and reviewing previous cases.


Within two business days, the ASC’s staff corrected and rebilled for the cases that included the error – all during the course of regular working hours.

Click here to read the detailed case study on the improvement of financial performance during an RCM audit.