ASC Billing & Coding

Dispelling ASC Myths: The Transition from Internal Billing and Collections to Outsourced RCM is Challenging

The Myth: It is challenging for an ambulatory surgery center (ASC) to transition from an internal billing and collections team to an outsourced revenue cycle management (RCM) team.

The Truth: ASCs can actually increase the productivity of a center quickly and efficiently if they select to partner with an outsourced RCM team that is proactive and has an orchestrated transition process in place.

The Evidence: Dispelling this ASC myth comes down to the ASC selecting the right outsourced RCM provider. When going through the selection process, ASCs should consider three key qualities to ensure a smooth, efficient transition process:

  1. ASC Policies and Procedures:
    A proactive RCM providers will spend one to three weeks on-site with a transition team to understand the center’s current RCM policies and procedures. Common questions asked at this stage may include: “How does the center handle patients who pay at the time of service?” “How are insurance payments received (via lockbox or sent directly to the facility)?” and “What daily, weekly and month-end reports are necessary to operate your business?” When developing the transition strategy, certain changes to current policies may be recommended to increase efficiency. Since there isn’t a cookie-cutter approach to transitioning to an outsourced RCM provider, this is an essential step that must occur prior to conversion to ensure there is minimal business disruption.
  1. IT Systems:
    The preconceived notion that RCM partners require centers to switch to a specific IT system often fuels this myth. This is not the case with all RCM providers. A good RCM provider will be able to work with any management information system (MIS) in use, while potentially offering recommendations that could increase efficiency for the center. Prior to the transition, an IT assessment should be performed to determine how the RCM provider would connect to the center’s existing MIS. Newer systems can be accessed via the cloud, allowing the RCM provider to make adjustments as quickly as if they were physically in the center. VPN tunnels can be used to access older systems. It’s important that HIPPA/HIGHTECH compliant software should be utilized to always keep data secure.
  1. Contracts:
    Becoming intimate with a center’s contracts prior to transitioning is also essential for a smooth transition. The RCM provider should request updated copies of each contract for extensive review and loading into the system well before conversion. While the transition team is still on-site, a good RCM provider will meet with the managed care team to fully understand the content and avoid any hidden language that could affect bundling, payment methods, or limit the increase of charges. Contracts are an essential part of the billing and collections process and as a result, oversights could cause a center to be operating at only 60 to 80 percent.
Questions About Revenue Cycle Management

Questions to ask if you’re considering outsourcing RCM

We’ve recently explored the transition process from internal billing and collections to outsourced revenue cycle management services. If your center is having issues impacting its financial health, you’re experiencing negative KPIs such as increased AR days and decreased revenue and you don’t have the time and resources to address these pain points, then it might be time to consider working with an external RCM provider. Understanding you most likely have concerns about this transition, it’s important to ask questions in order to get a better understanding of how the transition process works.

What are your areas of expertise?

First and foremost, seek to understand in what areas the external provider excels. Often, it’s a good idea to let an external provider handle all of the back end business office needs from managing payer care contracts to improving AR days, so you want to make sure they are an expert in all parts of billing and collections. You’ll also want to ask detailed follow up questions to ensure the organization’s knowledge and experience align with your needs to optimize the revenue cycle.

Can you describe and demonstrate the technology that you use?

These days it seems like technology advances at the speed of light, so it’s important that your external service provider have a solid understanding of the software and platforms they use. Being tech savvy is now a requirement for successful revenue cycle specialists, and it’s highly recommended that the billing and collections staff undergo regular training to ensure they are up to date on the latest technologies.

What is your hiring process?

To add to the previous question, it’s useful to learn about the outsourced RCM providers hiring process for their billing and collections staff. Regent RCM, for example, takes a well-rounded approach to hiring new employees. Candidates are required to complete a skills assessment in addition to undergoing an interview with the hiring team. Knowing that candidates are fully vetted to ensure they have the necessary experience, knowledge and personality will make any transition process significantly smoother.

Do you leverage reporting and analytics?

In order to measure progress, reporting and analytics tools are essential. Even more effective is a provider with real time management console capabilities that allows them to monitor KPIs against both industry standards and their own benchmarks. Because such a dashboard operates in real time, the revenue cycle specialist can instantly see when a problem arises and begin taking the necessary steps to find a solution.

Billing and collections analysis

Addressing concerns about transitioning to outsourced RCM services

Last week, we discussed concerns you might experience as you consider transitioning from internal revenue cycle management to outsourced RCM services. Now we’ll address some of the most pressing concerns that you may be facing.

Decreased revenue

One of the most prominent concerns is that the transition process may lead to decreased revenue. Importantly, choosing to outsource RCM not only adds consistency and predictability, it offers the ability to increase monthly revenue. An external provider, such as Regent RCM, reviews and takes the time to understand all of your center’s payer contracts as the foundation for success. Once the initial review is complete, a targeted assessment is done, and any outstanding payments are collected.

The external provider also looks at past reimbursements per each contact, and if money has been left on the table, they will help you recoup the lost revenue for your center. For example, if your ASC was owed a $1,000 reimbursement but you were only paid $800, the external provider will help you get that lost money. Whenever possible, they will renegotiate a better rate and increase revenue per case.

The outsourced RCM provider will also examine your out-of-network revenue. In cases where negotiations have not been pursued, pursuit of available monies becomes paramount to bring in money left on the table in these situations as well.

It requires the diligence of a dedicated team who has the time and resources to focus on optimizing and increasing revenue coming into your center. Additionally, a provider like Regent RCM has the proper process and workflow in place to make the transition to outsourcing an effective one and ultimately bring more revenue into your ASC.

Supporting staff

The other major concern with the transition process relates to staffing, whether it’s supporting current internal business office staff members or wondering what to do when there is a billing and collections gap.

Centers that have long-term employees don’t have to let them go just because you choose to outsource. If you have good people working in your ASC, they can simply be redeployed within the center to fulfill the front end of the business office or to take on roles that also match their skillsets. Transitioning to outsourced RCM services take the complex billing and collections piece off the table, allowing the internal staff to focus on core priorities and optimize the center as a whole.

In situations where an internal role is left unfulfilled because of high turnover or a senior billing a collections staff member retires, an external RCM provider can help maintain continuity to keep the business office running. External RCM providers offer contingency plans that allow you to engage in succession planning. You won’t have to ask yourself what will happen down the road, and how you’ll stay ahead of it to avoid a revenue drop. At the end of the day, you need planning and strategies in place because predictability keeps the process running smoothly.

Next up, we’ll provide a real-world example using a case study that details the transition process and the success an ASC can find by outsourcing RCM services.

Becker's ASC Review Conference

Regent RCM’s recap of the Becker’s ASC conference

Last week, Regent RCM’s leadership team headed to Chicago, Ill., to the Becker’s 13th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference & the Future of the Spine.

The Becker’s conference was a great opportunity for Regent RCM’s Director, Michael Orseno and Director of Business Development, Ed Tschan to network with other industry professionals and provide useful insight on how the benefits of outsourcing RCM can have positive long-term effects on a center’s financial health. Steve Taylor from ASCInsight was also on site to provide demonstrations of a real-time dashboard that monitors KPIs and assists with reporting and analytics.

There were certainly some conversational themes our team has noticed throughout the conference. Some of the key discussion points included:

  • Managed care contracting
  • Coding audits
  • How Regent RCM sets itself apart in the marketplace
  • Short-term revenue cycle needs and the flexibility and integrity needed to satisfy these needs
  • Constraints within an ASC that lead to a need for outsourced RCM, especially with AR days that are greater than 90 days

Becker’s proved to be a success for the Regent RCM team as we were able to provide valuable insight into how outsourcing RCM might be the right decision for your ASC’s billing and collections needs and the importance of reporting and analytics to your center’s financial health.

ASCA 2015 Conference Regent RCM

Regent RCM is Live from ASCA 2015

This week, Regent RCM’s leadership team headed down to Orlando, Fla. to participate in ASCA 2015, the premier meeting for those in the ambulatory surgery center (ASC) industry.

ASCA 2015 has been a great opportunity for Regent RCM’s Director, Michael Orseno, Director of Business Development, Ed Tschan and Revenue Cycle Coordinator Leslie Favela to network with other industry professionals and provide useful insight on how the benefits of outsourcing RCM can have positive long-term effects on a center’s financial health.

There have certainly been some conversational themes our team has noticed since they arrived at the conference. Some of the key discussion points have included:

Regent RCM will be exhibiting at ASCA 2015 through the end of the conference so be sure to stop by booth #413 to say hello and learn more about how outsourcing RCM might be the right decision for your ASC’s billing and collections needs.