concerns about transition to outsourced RCM

Top concerns about the transition to outsourced RCM

Changes in certain key performance indicators (KPIs), such as increased AR days and decreased revenue, may be negatively impacting your revenue cycle and your ambulatory surgery center’s bottom line. Recognizing the signs that your center may not be financially healthy can help you to take the necessary steps to correct the problems. After examining the situation, you may find that you cannot solve the RCM issues internally and that it’s time to consider outsourcing revenue cycle management.

As you consider working with an external provider, concerns may arise about the transition process. There are two main concerns we frequently come across:

Revenue

One of the biggest concerns that the transition creates the risk of a short term loss of revenue due to the inherent moving parts of the transition itself. Because of this, you might be concerned that revenue will fall short in a specific month.

Staffing

Another major concern is about staffing, which is twofold. You want to support current employees, but you recognize that your center may be experiencing revenue cycle issues because you don’t have the right staff members in the right roles. Additionally, if an integral employee retires, or your center is experiencing a high turnover rate, you may not have the resources to fill these necessary roles in a long-term capacity. Considering transitioning to an external RCM provider may leave you wondering what the future of your center may look like.

We understand that change can be challenging, and even though you recognize that your center could benefit from the transition to outsourced RCM, these concerns may serious hesitation in taking that first step.

Stay tuned for upcoming posts when we address these concerns and look at a case study detailing a successful transition to outsourced RCM services.

Revenue Cycle Analysis

Understanding analytics and reporting

Analytics and reporting empowers you to make educated decisions about your center’s financial and clinical metrics. You can proactively manage the center as well as address any suspicions and employ these tools to drill down to the root cause of the issue. If your suspicion is valid, you’ll have the data needed to determine the necessary modifications.

Though it’s crucial that every ASC analyze key performance indicators (KPIs) and actively monitor any changes, the center may not have the resources and staffing available to study the analytics below a surface level. Further, the billing and coding staff may not have the knowledge and expertise needed to understand the depth of the results of the reports.

Outsourcing may be the solution

If this is the case, it may be in your center’s best interest to evaluate outsourcing revenue cycle management. An external RCM provider had dedicated staff members who not only understand analytics, but can customize reports based on the unique needs of each center. Importantly, the revenue cycle specialists also receive the necessary training to stay on top of any and all changes, address issues efficiently and produce results that will positively impact your center’s revenue cycle.

ASC revenue cycle problems

How to tell if your ASC needs better revenue cycle management: Part 1

Taking a proactive approach in managing your center’s revenue not only provides consistency but also the opportunity for growth. If you’ve identified specific issues or can’t put your finger on exactly what’s impacting financial performance, it may be time to consider revenue cycle management (RCM) resources outside of your ambulatory surgery center (ASC).

The following are a few hard-to-miss changes to key performance indicators (KPI) that might cause your center to need a better RCM solution:

  • Increase in AR days: The gold standard for accounts receivable is 30 days. If your ASC starts to notice an upward trend in this KPI with days expanding to 35, 40 or more, it’s a clear-cut sign that an issue is developing.
  • Decrease in revenue: The second major sign to watch out for is a drop in revenue. Revenue cycle issues can quickly create complexities and delays that directly impact the center’s monthly bottom line.
  • Percentage of clean claims: The third sign is a decreased percentage of clean claims. The gold standard is 90 percent, and Regent RCM sets its standard at 93.3 percent. Your center might experience a drop in its clean claim percentage if claims spend too many days in AR. If they are left too long it may result in the payment being denied all together, which will negatively impact your center’s overall financial performance.

Next week we’ll bring you part two of this revenue cycle management improvement series. In part 2, we’ll look deeper into the less obvious changes happening in you center that could be negatively effecting your bottom line.

Revenue Cycle Dashboard

The Benefits of Outsourcing RCM: Transparent Measurement and Reporting

 Over the course of March, we are diving deep into four key benefits of outsourcing revenue cycle management (RCM) for ambulatory surgery centers.  Last week, we examined how outsourcing RCM provides ASCs with smart staffing solutions and helps them avoid the need for succession planning. This week, we take a closer look at the importance of transparent measurement and reporting, which provides a greater insight into accounts receivable and collection trends.

With the ever-changing landscape of healthcare, including the fast approaching implementation of ICD-10, it’s imperative that ASCs have solid and transparent means of measurement and reporting to understand how the center is performing, where changes need to made and how to improve the bottom line.

Internally, ASCs may not have the necessary expertise, technology and resources – not to mention time – needed to devote to measurement and reporting. To truly track and trend change, these processes can be outsourced to a firm whose employees possess the training and knowledge needed to analyze the data and make a real difference in the center’s financial performance. Outsourcing RCM makes this entire process more efficient with better end results.

Spending time reviewing reports and analytics provides critical insight. Not only does the data offer valuable feedback for the ASC, but having this information can drive change by reducing AR days and tracking collection rate trends. However, internal employees may only have access to canned reports from which they can pull only generalized data. One of the key benefits of outsourcing revenue cycle management is that the RCM provider can develop customized reports and slice-and-dice the most pertinent information for more specified results.

Expertise with third party reporting software allows the RCM provider to pull these specific reports in order to find the root cause of a problem. For example, outsourcing RCM can allow an ASC to determine exactly when and why AR days began increasing so that the center can take steps to reverse this trend.

A management console is a useful tool for seeing various metrics change in real time. The RCM provider can customize each dashboard to display certain key performances indicators (KPIs) that alert the ASC to how well the center is meeting its bottom line.

Some of the top KPIs that can be included in the management console include:

  • Monitoring AR days
  • Collection rate trends
  • Statement lags
  • Charge lags

For each ASC, the RCM provider can set a range that falls between red, yellow and green stages in order to create a visual representation of when issues arise in real time. In some circumstances, it can be useful to compare specific KPIs to industry benchmarks, but success can also depend on the specific center. An RCM provider can determine when it’s best to judge information against these benchmarks and when it is not.