revenue cycle management

Top Revenue KPIs for ASC Stakeholders

Ambulatory surgery center administrators are often asked by stakeholders to evaluate their center’s revenue cycle management (RCM) process for strengths and weaknesses. As every administrator knows, this can be easier said than done. Key Performance Indicators (KPIs) are used as a scorecard to highlight issues and determine how well an ASC is performing compared to other ASCs. For example, wild swings month-to-month in Days in Accounts Receivable Outstanding could highlight billing and collections process problems, while a high percent of AR greater than 90 days may emphasize an issue with patient collections processes and/or insurance denials.

In an effort to lighten the load for administrators, here are six KPIs to track against goals set for ourselves internally:

  • Days Outstanding or Days in A/R – Regent RCM standard is less than 30 days
  • Claim Lag and Charge Lag – Regent RCM standard is less than 3 days
  • % of A/R Greater than 90 Days – Regent RCM standard is less than 15%
  • Net Collection Rate – Regent RCM standard is greater than 97%
  • Denial % and Clean Claim % – Regent RCM standard is 98% clean/less than 5% denial rate
  • Business Office Staff per 1,000 Cases – Regent RCM standard is 1.5 FTEs per 1,000 cases

“A number of our clients sought our services after an internal KPI audit identified gaps and weaknesses in their RCM process,” stated Vice President Michael Orseno. “We understand the intricacies of the ASC revenue cycle, where problems commonly occur and how to fix them, as well as how to optimize reimbursement. Measurement and reporting will always be key to helping our clients achieve success.”

Over the coming weeks we will break down each of these metrics, explain how we set our internal standards, and share with you common issues and how to overcome them.

If your KPI audit reveals more weaknesses than strengths, Regent RCM can perform a free business audit. To schedule an audit or learn more call 312-882-7228.

Becker's ASC Review

Regent RCM Comments on the Ultimate ASC Revenue Cycle Management Dashboard

In a recent article from Becker’s ASC Review, Michael Orseno, Director of Regent Revenue Cycle Management, and Ed Tschan, Director of Business Development, identify revenue cycle management (RCM) metrics to track on a daily, weekly, monthly and quarterly basis. Chosen metrics and data points should be tracked by ASC leaders to maintain an effective RCM process and a healthy revenue cycle.

Once specific RCM data points and associated intervals are identified, ASC leaders traditionally run reports to track each key performance indicator (KPI). Optimally, They are able to monitor their KPI’s on a real-time dashboard.

“You can set up these dashboards with your top KPIs, both financial and clinical,” says Mr. Tschan. “Picture that dashboard as a central console. You can customize the parameters that make up these KPIs.”

When an ASC leader sets a RCM standard, it can be watched over time to ensure performance is met. To gain an even deeper understanding of the health of your ASC, look for a Partner that offers a free business office audit service.

“Aside from identifying potential RCM deficiencies, these audits may also compare your facility to national averages and gold standards,” says Mr. Orseno. “Many centers don’t realize this option is available to them free of charge.”

Click here to read the full Becker’s article.

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.

Regent RCM front desk billing

Proper follow up procedures can reduce the number of A/R days

In addition to proper charge entry, follow up is an essential part of an ambulatory surgery center’s billing practice, and this step alone can involve up to 60 percent of the billing staff’s time. Though it can be time consuming, taking the proper steps to ensure that claims are being processed correctly, and thereby optimizing revenue, will directly impact the center’s revenue cycle as a whole.

Contact payers to check on claim status

Billing specialists should dedicate time to call each payer and check on the status of each claim every 30 days. This assists the center in determining if the claims are clean or if the payer needs any additional information to approve the claim. Payer follow up can help prevent issues and delays in payment as these can ultimately lead to non-payment. If an appeal is needed, it’s best to begin working on that immediately. If a biller appeals a claim right away and uses the correct verbiage in correspondence, the payer shouldn’t hesitate to pay.

Run A/R reports to streamline follow up process

Regular monthly A/R reports should be run to streamline follow ups, and billing staff should follow up with every account listed. Using a software management information system (MIS), such as HST Pathways, provides a platform for an efficient workflow. With an MIS, tasks can be automatically assigned to each billing specialist. For example, one specific specialist can be assigned to follow up on accounts that are 45 days past due. This will help prevent problematic claims from falling through the gap.

Don’t forget patient follow up

It’s also necessary to follow up with patients every 30 days to make sure that payments due are fully accounted for as part of the ASC’s financial projections. After 90 days, it’s time to send the patient a final notice and determine if the bill will be sent to collections. To avoid reaching this point, early patient follow up allows the center to collect the full payment or set up a payment plan to ensure the center is maximizing revenue given individual patient circumstances.

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.