Revenue Cycle Analysis

4 Key Areas Analyzed During a Business Office Audit

Ambulatory surgery center (ASC) administrators are charged with improving their ASC’s financial health and periodic business office audits are key to identifying, both quantitatively and qualitatively, a center’s strengths and opportunities.

On the surface, an audit sounds intimidating. But according to Michael Orseno, VP of Revenue Cycle at Regent RCM, it doesn’t have to be that way.

“We want our centers to maximize revenue and a routine audit is the fastest way to get on track and stay on track,” said Orseno. “The audit identifies issues – then working with our partner centers, we implement strategies and processes to correct them; it’s that simple.”

A Regent RCM audit goes beyond a traditional reimbursement assessment by examining four areas vital to the function of an ASC: reimbursement, coding, staffing and observation (workflow and process).

  1. Reimbursement. Regent RCM conducts a thorough review of a center’s billing and reimbursement procedures, including reviewing payor contracts. “Ensuring that an ASC is being reimbursed the full and correct amount per each procedure code for every case is one of the most important billing practices to maximize revenue for the center,” said Orseno. “Due diligence is crucial and for our partner centers, our team of revenue cycle specialists are intimately familiar with every payor contract.”
  2. Coding and Billing. Whether a center outsources its coding services or employs a certified coder, Regent RCM’s audit evaluates coding, determining if cases are coded correctly and billed properly. “We watch for inaccurate modifiers, which can negate or reduce payment on an otherwise clean claim,” noted Orseno, “and when applicable, we pay particularly close attention to implant coding errors.”
  3. Staffing. More business office staff does not always equal more efficiency, and striking a balance is difficult. Regent RCM’s audit diligently tracks business office FTEs in all of its facilities and compares facilities against the gold standard.
  4. Observation. Regent RCM’s expertise comes from exclusively developing, executing and refining revenue cycle management strategies. “Leveraging our collective experience, our team observes business office functions and processes and looks for inconsistencies and efficiencies,” said Orseno. “For example, a front office employee may be spending vast amounts of time verifying insurance benefits when this can be accomplished more efficiently with the use of technology.”

To learn more, read a case study revealing how an audit uncovered coding errors which led to recouping more than $590,000 in additional funds.

A recent blog highlighted what to expect from a business office audit, including Regent RCM’s methodology. Ready to schedule an audit for your center? Call (312) 882-7228 today.

Regent RCM’s Michael Orseno to Speak at MASA 2016 Education Day

Regent Revenue Cycle Management (Regent RCM) is again proud to support this year’s Michigan Ambulatory Surgery Association (MASA) Education Day conference.

Michael Orseno, VP of Revenue Cycle at Regent RCM, will present, ASC Benchmarking – Business Office Staffing & Revenue Cycle, on Friday, Oct. 21 at 9:45 a.m.

“One of the toughest challenges for any surgery center is determining if your revenue cycle is performing well,” says Orseno. “Until now, there wasn’t a comprehensive list of ASC-specific benchmarks, and how they should work together. We solved that challenge for our industry and we’re looking forward to a great exchange with center leadership teams. Not only will we focus on the nine benchmarks themselves, we’ll go deeper and discuss  how outside forces impact the numbers, how the benchmarks work together, and when the numbers lie.”

The conference takes place Oct. 20 and 21 at the Soaring Eagle Resort in Mount Pleasant, Mich. Attendees can sit in on a variety of sessions, with four breakout tracks: Administrative, Clinical, Billing and Coding, and Materials Management. For more information on the conference and registration, click here.

To learn more about ASC-specific revenue cycle benchmarks, stop by Regent RCM’s booth during the show. Click here to access Regent RCM’s video and webinar series, including instructions on how to calculate and measure what Orseno refers to as “the great lie detector,” the net collection rate.

To download your copy of Regent RCM’s white paper, Using ASC-Specific Benchmarks to Assess Revenue Cycle Health, click here.

Reasons to Outsource

Top 6 Reasons to Outsource RCM – Part One

Revenue cycle management (RCM) is one of the functions healthcare providers outsource the most. In fact, the RCM market is projected to experience a 12 percent uptick in growth through 2021, according to a MicroMarket Monitor report.

Outsourcing is projected to expand due to two primary market forces: Value-based care’s emphasis on improving quality while reducing costs, and the increased complexity that comes with a more accountable organization. Ambulatory surgery center (ASC) leaders are recognizing the need to make RCM more transparent and predictable, and outsourcing RCM is the optimal way to increase cash flow, cut costs and stabilize their centers’ revenue cycle.

In a two-part series, Regent RCM’s VP of Revenue Cycle Michael Orseno identifies the top six reasons for outsourcing RCM. The first installment focuses on expertise, technology and staffing.

  1. Expertise. With the Affordable Care Act, Medicare and Medicaid payment bundling, and updated ICD-10 guidelines looming, the RCM landscape is changing at a rapid pace. Ensuring optimal results while keeping up with the latest opportunities related to RCM requires specialized expertise. The team at Regent RCM specializes in developing, executing and refining billing and collection strategies, and invests in the most up-to-date tools and technologies. “Revenue cycle management can no longer be an afterthought,” said Orseno. “With the vast overhaul that the healthcare industry continues to undergo, business office managers at surgery centers must employ RCM experts that have seen it all, and can not only roll with the changes, but anticipate what’s around the bend.”
  2. Best-in-class technology. With tighter margins, and priorities favoring patient care over improved billing resources, ASCs are often not equipped to excel at managing the revenue cycle in-house. By outsourcing RCM, centers can take advantage of economies of scale and gain access to best-in-class technology. At Regent RCM, staff use a trio of technologies: ASC Management Information Systems (MIS platform), clearinghouse software, and next generation dashboard and real-time monitoring and management. “RCM providers have a deep knowledge of which tools work well together and which work in silos,” said Orseno. “We have enterprise dictionaries already built for one MIS platform, so that only facility-specific information needs to be inputted. This makes implementing new technology easier, too. At an ASC, implementation typically takes more than three months, but for our partner centers, we can cut that time in half.”
  3. Smart staffing/no succession planning. For ASCs, an experienced billing and coding staff with built in redundancies is now a necessity. Cutting corners by hiring inexperienced staff can cost an ASC hundreds of thousands of dollars per year, not to mention direct impact on workflow and efficiencies. Outsourced RCM providers have the resources to attract experienced staff because they can pay well, provide good benefits, and situate themselves in desirable locations. In addition, because outsourcing RCM is what they do, these specialists know how to find and hire the best of the best, and often have a pipeline of qualified applicants waiting for a spot to open up.

Are you considering outsourcing to optimize your center’s revenue cycle? Ed Tschan and the experienced team at Regent RCM are available to your answer questions and discuss if a revenue cycle evaluation makes sense for you. Please call 312-882-7228.

Click here to continue to Part Two.

Revenue Cycle

Regent RCM and ZirMed Partner to Improve Revenue Performance

Authored by Vice President of Revenue Cycle Michael Orseno, Regent Revenue Cycle Management (RCM) this week released an article that outlines five ways in which Regent RCM and ZirMed combine to improve revenue performance.

“The ASC revenue cycle is complex and we both know that. Through our partnership, we leverage our expertise and provide ASCs with the support and technology needed to effectively manage the revenue cycle,” said Orseno. “With this article we drill down on five keys to getting paid quickly and efficiently.” Strategies include:

  1. Verify insurance coverage.
  2. Code claims correctly the first time.
  3. Minimize claim denials.
  4. Act quickly against denials.
  5. Arrange for/Collect patient out-of-pocket expense up front.

“Surgery centers need revenue cycle strategies that work and together with ZirMed, we deliver breakthrough revenue cycle management solutions that enable partner centers to collect every dollar they are entitled to,” added Orseno.

The article, Regent RCM, ZirMed Work Together to Solve ASC Revenue Issues, appears exclusively online at Becker’s ASC Review. Click here to read the full article.

Regent RCM’s Michael Orseno to Speak at Becker’s Second Annual CIO/HIT + Revenue Cycle Conference

Regent Revenue Cycle Management (Regent RCM) has been selected to participate in this year’s CIO/HIT + Revenue Cycle Conference hosted by Becker’s.

Michael Orseno, Vice President of Revenue Cycle at Regent RCM, will contribute to a timely panel discussion, Addressing High Deductible Patient Plans and the Evolving Role of Patients Becoming Payers, from 1:00 p.m. – 1:45 p.m. on Thursday, July 28.

“More and more, patients are responsible for handling most of the financial responsibility for their medical care,” said Orseno. “Moving forward, it is critical for revenue cycle leaders to focus on high deductible patient plans, and understand how these plans impact the revenue cycle.”

The conference takes place July 27-28 at the Fairmont Hotel in Chicago. Attendees can sit in on a variety of sessions, featuring 175 experts and revenue cycle leaders. Overall, there will be nearly 100 sessions over the two-day conference, with three full CIO/Health IT tracks, as well as three full revenue cycle tracks. Topics include:

  • The Transformation from Volume to Value and the Constant Movement and Impact on the Revenue Cycle—Wednesday, July 27, 8:05 a.m. to 8:45 a.m.
  • Adapting Best Practices for the Revenue Cycle– Wednesday, July 27, 8:50 a.m.-9:30 a.m.
  • Key Thoughts on Improving Revenue Cycle– Wednesday July 27, 9:50 a.m.-10:30 a.m.
  • The Biggest RCM Pitfalls– Thursday, July 28, 9:45 a.m.-10:25 a.m.
  • Post ICD-10—How is the Revenue Cycle Performing? – Thursday, July 28, 1:00 p.m.-1:45 p.m.

For more information on the conference and registration, download the brochure here.

Mike Orseno VP Revenue Cycle

ASC Revenue Cycle Benchmark Video Series–Number Nine: Business Office Audit

With reimbursement rates for ambulatory surgery centers (ASCs) shrinking, it is now more important than ever to know that every dollar available is being collected. Revenue cycle firms across the country offer business office audits, but Regent RCM’s audit is unique: it examines reimbursement, implants, coding, staffing and process flow, and is offered free of charge.

Regent RCM Vice President Michael Orseno recently hosted a series of videos examining nine benchmarks he and his team utilize to determine the health of an ASC’s revenue cycle. The ninth of these industry specific benchmarks is the business office audit, and provides an inside glimpse into where your surgery center stands with reimbursements.

“We’ll take a percentage of claims and determine if you’re being reimbursed properly,” said Orseno.

Not only that, Regent RCM also conducts a full coding audit and ensures all the cases are coded and billed correctly.

Click here to watch the video and learn more about this meaningful tool and the other measurements a Regent RCM business office audit looks at besides reimbursement, such as correct coding, implant revenue, staffing and business office processes.

Regent RCM recently released a white paper describing in detail nine ASC-specific benchmarks to accurately and consistently assess the health of a surgery center’s revenue cycle. Download the white paper here.

 

ASC Revenue Cycle Benchmarks

ASC Revenue Cycle Benchmark Video #8 – Staffing

With ambulatory surgery centers (ASCs) focused on collecting every dollar they are entitled to, the center’s business office staff operations must run as smoothly as possible.

But, more business office staff does not always equal more efficiency, and striking a balance is difficult. Regent Revenue Cycle Management (Regent RCM) Vice President Michael Orseno and his team acknowledged this problem, as well as other issues that ASCs face, and have developed a series of videos series that can be used to evaluate the health of any ASC’s revenue cycle.

The eighth video addresses staffing, and how to maximize efficiency of the business office staff. To accomplish this, Regent RCM has developed and adopted a gold standard of 1.5 FTEs per 1,000 cases. The metric is unique, and was derived after Regent RCM pored over ASC data for several years. The company found that busier ASCs generally operated more efficiently in terms of staffing. On the other hand, business office staff at less busy centers were actually underutilized.

Click here to watch the video and learn more about this valuable staffing metric, and why it works.

Regent RCM recently released a white paper describing in detail nine ASC-specific benchmarks to accurately and consistently assess the health of a surgery center’s revenue cycle. Download the white paper here.

ASC Revenue Cycle Statement Lag

ASC Revenue Cycle Benchmark Video #7 – Statement Lag

Regent Revenue Cycle Management (Regent RCM) Vice President Michael Orseno and his team developed nine industry-specific benchmarks to gauge the health of an ambulatory surgery center’s (ASC) revenue cycle in answer to an ongoing need to better manage billing and collections. A series of videos discussing these metrics explains how each is utilized to improve revenue cycle processes.

The seventh video focuses on statement lag, which is the time between the balance becoming the patient’s responsibility and the time the statement goes out the door. The Regent RCM gold standard is less than five days. Although it is recommended that patients be put on a 30-day cycle, statements should be run at least once per week.

With the probability of collecting patient balances decreasing every day since the procedure was performed, it is paramount for facilities to send statements out to patients as soon as their payment portion is known.

Click here to watch the video and learn more about this meaningful metric and what it means when a facility has a high statement lag.

Find more detailed information on this metric and others that will help your center monitor and manage its revenue cycle by watching the three-part webinar series that explores the topic in-depth. Regent RCM revenue cycle specialists are also available to answer further questions. Click here to contact the team.

ASC Revenue Cycle Benchmarks Claim Lag and Charge Lag

ASC Revenue Cycle Benchmark Video #6 – Claim Lag/Charge Lag

Gauging the health of a surgery center’s revenue cycle is challenging. Regent Revenue Cycle Management (Regent RCM) Vice President Michael Orseno and his team recognized the struggle and responded by identifying, defining, and interpreting ASC-specific revenue cycle benchmarks and developing a series of videos series that can be used to evaluate the health of any ASC’s revenue cycle.

The sixth video examines claim lag and charge lag. Charge lag is measured from the date of service until the charge entry date, while the claim lag is the number of days from the date of service until the billing date. Claims should be sent out the same day as charges are entered and coded.

“If centers are experiencing a difference between the two lags, this is an indication that the billing department may be holding claims or entering charges but not sending them out in a timely manner,” said Orseno. “Transcription and coding for each should be completed in 24 hours or less – that is the gold standard – which still leaves 24 hours to get the claims out the door.”

Click here to watch the video and learn more about this valuable metric, and why there should be no difference between the two lags.

Are you ready to use this key performance indicator to improve your revenue cycle? Gain information on this and the other ASC benchmarks by watching the three-part webinar that goes into further detail on the topic, or have your questions answered by contacting one of Regent RCM’s revenue cycle specialists.

Revenue Cycle management webinar

ASC Revenue Cycle Benchmark Video #3 – Claim Denials

Regent Revenue Cycle Management’s (RCM’s) video series features nine industry-specific videos that can be used to evaluate the health of an ambulatory surgery center’s (ASC’s) revenue cycle. The third video examines claim denial rate, the percentage of claims that are rejected by payers.

The Regent RCM gold standard for claim denials is five percent – half the industry standard. Regent RCM Vice President Michael Orseno discusses this benchmark and how keeping this percentage low will keep the number of days outstanding low and the percent of days in accounts receivable (A/R) low as well.

Common reasons for potential claim denials include:

  • Missing pre-authorization or referral
  • Medically unnecessary procedures
  • Incorrect payer selected
  • Wrong format

Click here to watch the video and learn a variety of tactics aimed at helping centers achieve the Regent RCM gold standard.

Looking for more ways to gauge your center’s financial health? Watch Regent RCM’s three-part ASC revenue cycle benchmarking webinar series or contact one of Regent RCM’s dedicated revenue cycle specialists today.

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