benefits of outsourcing rcm

Whitepaper: Top 4 Benefits of Outsourcing RCM for ASC’s

As Scott Becker recently pointed out in his article on top ASC trends, revenue cycle is getting more attention from center leadership as they look for new ways to improve financial health.

If there’s an opportunity to improve revenue cycle, one of the first and most important decisions to be made will be whether to insource or outsource.

So when you make your list of pros and cons, we wanted to make sure you have the right information to include in the outsourced column.

Look for the following 4 key benefits to outsourcing your RCM:

  1. Leveraging expertise in billing and collections, especially with coding changes brought on by ICD-10
  2. Workflow and process optimization that utilizes best-in-class technologies
  3. Smart staffing and avoiding the need for succession planning
  4. Real-time monitoring and reporting, giving actionable insight into AR days and collection rate trends

Click here to sign up and read the detailed white paper on the Top 4 Benefits Of Outsourcing RCM For ASC’s.

ASC revenue cycle benchmarking

Comparison: Insourcing vs. Outsourcing Revenue Cycle Management

Deciding on whether to manage revenue cycle operations internally or to outsource your revenue cycle management (RCM) is a tough decision. ASCs have to balance supporting local jobs and staff who may have been with the organization for many years while ensuring the overall financial health of the center. Here are some of the pros and cons to insourcing versus outsourcing RCM:

Insourcing

If you choose to keep your revenue cycle management internal, your ASC maintains hands-on control of the financial operations. Should problems arise, you have immediate access to your RCM staff since they are most likely located right down the hall.

Internal RCM could be a viable option if your ASC has experienced employees performing revenue cycle functions, or your ASC is in geographic proximity to a broader talent pool with the skill set necessary to manage these duties.

On the flip side, your ASC must invest in recruiting and training medical billers, purchasing revenue cycle technology and analytic tools to avoid employee mistakes or neglect. In addition, finding and retaining the right staff with the appropriate knowledge and expertise required for developing a successful revenue cycle management system can be difficult especially in remote areas.

Other potential problems include a lack of quality information technology, ineffective management information systems, and limited knowledge of reporting and analytic tools to measure success.

Outsourcing

The biggest advantage to outsourcing RCM is the ability to leverage expertise in billing and collections. This expertise crosses many areas including maintaining regulatory compliance, understanding payer contracts and staying abreast with changes in coding, the latest being ICD-10.

In addition, outsourcing provides ASCs with access to best-in-class technologies for workflow management, process automation and measurement and reporting. ASCs can also avoid the need for succession planning due to staff redundancy and access to a larger talent pool of talented RCM staff.

Outsourcing, however, is not risk-free. When considering a vendor, it’s crucial to develop a good line of communication and ensure that as questions or issues arise, they will be prioritized and addressed accordingly. Information security and maintaining high standards of integrity can also be risk factors that should not be taken lightly.

While the cost for outsourcing can appear to be an expensive option, the added expense should be offset by increased efficiency and improved cash flow. Click here to download Regent RCM’s latest white paper on the Top 4 Benefits of Outsourcing RCM for ASCs to learn more.

 

Meet the Team | Lorena Gonzalez

In our ongoing Meet the Team feature, we introduce the many members of our team who make Regent RCM so successful. Today we’ll find out more about:

Name: Lorena Gonzalez

Hometown: Chicago, Illinois

What do you do at Regent RCM? I am a revenue cycle specialist. I handle all of the billing, payment posting and collections for a center in Colorado.

How long have you been working at Regent RCM? I have been working at Regent RCM since February 2015.

What is your favorite part about working here? It is both a professional and friendly environment.

What has been your greatest professional achievement? My greatest professional achievement is having more than 15 years of experience in the healthcare industry.

What is one fun fact about yourself your co-workers don’t know? I love to travel, and the beach is definitely my favorite place to be.

Revenue Cycle Analysis

Case study: Undergoing the transition to outsourced RCM services

In 2012, a West Coast multispecialty ambulatory surgery center began working with Regent Surgical Health to manage and take minority equity in the center, but they chose to keep billing and collections in-house. However, the center was experiencing financial unhealthiness with key performance indicator (KPIs) metrics moving in the wrong direction, specifically high AR days and low net revenue.

In February 2013, the center realized its struggle with cash, revenue per case and proper business office staffing could not be righted internally so they made the decision to transition to outsourced revenue cycle management. They selected Regent RCM, an independent division of Regent Surgical Health, for a one-year contract to help turnaround their revenue cycle operations. During the contract period, Regent RCM was able to significantly reduce the center’s AR while increasing cash and net revenue.

Challenges of bringing RCM back in house

Once the center was financially healthy and back on track, administration opted to bring billing and collections back in-house by hiring a local revenue cycle specialist. Ultimately, the center was unable to handle the full extent of revenue cycle management on its own, and the KPI metrics almost immediately began to move in the wrong direction – revenue dropped while AR days were back on the rise.

Recognizing the need to permanently transition to outsourced RCM services

In February 2015, Regent RCM was brought back into the fold to investigate what went wrong and what steps could be taken to correct the issues. Regent RCM performed a business office audit and discovered that there was virtually no claim follow up. The center has never performed its own internal audits so they were somewhat surprised to learn that this was the case. Without the necessary training, experience and expertise, payer short pays and/or denials were not being appealed and follow-up either wasn’t happening or not following best practices, which ultimately left money on the table.

Benefits of working with an external RCM provider

When the center transitioned back to working with Regent RCM, the same revenue cycle specialist they had worked with previously was assigned. As a bilingual, seasoned specialist with experience working with this center, the Regent RCM specialist was a logical and natural fit to jump back into the position she formerly held.  Additionally, the Regent RCM revenue cycle specialist had a strong understanding of payers, contracts and California law likely to impact the center’s revenue cycle. Specially, she had significant experience working with Blue Cross and Blue Shield in California as well as California MediCal.

The transition back to outsourced RCM was smooth given Regent RCM familiarity of the nuances of the center. The center’s management information system (MIS) was cloud-based so Regent RCM was able to gain access seamlessly. Additionally, there was an accessible coding system in place, which allowed Regent RCM to receive timely notifications so the specialist can send out bills in a timely manner.

Since taking back over, Regent RCM has regularly scheduled internal audits to ensure timely and complete claim follow up, claims are billed appropriately and their revenue cycle specialist uses reporting and analytics tools that allow for customized reports to track progress.

Regent RCM has once again been able to drop AR days  – from 43 to 33 over the course of just two months! During this period, cash collections have also increased by 47 percent from $366,000 to $538,000 monthly.

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 benchmarking

What does it take to get your center healthy?

For an ambulatory surgery center to be financially healthy, it requires that data, analytics and reporting tools be set in place to monitor the success of certain key performance indicators (KPIs) that allow the center to be in total control of the revenue cycle.

If an ASC does not have visibility of these KPIs via a real-time management console or analytics tools, no one might realize that there is a problem within the revenue cycle, which could ultimately cause significant revenue and timing challenges.

Signs an ASC is not financially healthy

There are a few tell-tale beacons to watch for to determine your center’s financial health:

  • A monthly decline in revenue
  • A monthly increase in A/R days

If these changes occur, a center must immediately begin to examine the root cause of the issues and formulate a plan of attack to regain consistent performance and overall financial health.

Improving an ASC’s financial health

Ultimately, successful financial health comes down to this: Revenues exceeding expenses. On the cost side, you should examine business office staffing costs to determine if they’re optimized with the right people in the right roles. On the revenue side, you should look at revenue per case as well as the revenue per contract. Each contract should be uploaded into the management information system (MIS), and every revenue cycle specialist should have an intimate understanding of each contract. This ensures that the correct reimbursement is being received.

To begin to understand your center’s financial health status, you can take a proactive first step and complete a business office audit to determine what issues exist, where the issues are and where changes need to occur.

Once you recognize the need to improve your ASC’s financial health, the center has two options: Keep RCM internal or outsource RCM.

To make this decision, it’s best to objectively analyze your center’s capabilities and strategies. If your center has the resources, expertise, technology and performance to not only sustain a healthy revenue cycle but improve upon it, you can implement internal changes. However, if this is not the case, then outsourcing RCM to an organization that’s dedicated to each piece of the revenue cycle may be the best top line and bottom line approach.

Ambulatory Surgery Center facility building

Regent Revenue Cycle Management selected by the Andrews Institute ASC to provide turnkey solution to optimize financial health

Chicago-based RCM provider to help navigate changes brought on by impending ICD-10 implementation

Chicago, IL – May 12, 2015 – Regent Revenue Cycle Management (Regent RCM), an independent division of Regent Surgical Health and a leading provider of quality, cost-effective revenue cycle management services exclusively for ambulatory surgery centers in the U.S., was recently selected by the Andrews Institute ASC, LLC to provide full-service long-term outsourced revenue cycle management. Regent RCM will provide billing and collections, process automation and performance measurement to optimize the center’s financial health and performance.

“We looked around, and what I took back to the Board was that we wanted a company with a proven record of success that focused specifically on the ASC community,” said Terri Gatton, RN, CNOR, CASC, administrator at Andrews Institute ASC. “Regent RCM offers that, and the fact that they spun their revenue cycle management services off from Regent Surgical Health was also a very attractive feature. We didn’t need the management aspect [that Regent Surgical Health provides] but certainly need the oversight and expertise that’s unique to ASCs so we can continue to optimize our revenue stream.”

In addition to overall revenue cycle management, Regent RCM’s team of experts will help develop a strategy for the deployment of the new ICD-10 coding system.

“The impending implementation of ICD-10 has people nervous across the board,” continued Gatton. She added that it’s becoming more challenging to balance a successful revenue cycle strategy with planning for the new coding system. The Andrews Institute ASC has also experienced consistent increments of growth and developed a need to outsource revenue cycle management to stay financially healthy and continue with their success.

“We’re excited to work with such a prominent center in the ASC community,” said Regent RCM Director Michael Orseno. “The work that Dr. Andrews and the team does is known worldwide, and we’re excited to join their team to help them increase long-term profitability.”

About Regent Revenue Cycle Management

Regent Revenue Cycle Management (Regent RCM), an independent division of Regent Surgical Health, is a leading provider of quality, cost-effective revenue cycle management services exclusively for ambulatory surgery centers throughout the United States. Regent RCM harnesses Regent Surgical Health’s strong ASC industry expertise, allowing Regent RCM to consistently outperform industry benchmarks. To learn more about Regent RCM, visit http://regentrcm.com/.

About Andrews Institute ASC, LLC

The Andrews Institute Ambulatory Surgery Center (ASC) is a joint venture between Baptist Health Care and local area physicians. It’s a specialized facility designed and optimized for outpatient procedures with eight operating rooms complete with digital equipment and state-of-the-art technology, lending to the Patients First philosophy encompassed by the professional staff, some of the top-rated Florida surgeons and caring nurses. The ASC uses innovative anesthesia and pain management techniques to make surgery a more pleasant experience and a more comfortable procedure and recovery. To learn more about the Andrews Institute ASC, visit http://www.andrewsinstitute.com/Surgery/.

ASC staff meeting revenue management

Regent RCM provides 3 ways ASCS can reduce costs for a stronger RCM strategy

Regent RCM recently spoke to Becker’s ASC Review to provide insight on how to reduce the costs related to an ambulatory surgery center’s business office. This includes everything from smart staffing practice management, which can become expensive quickly.

1. ASCs should invest in IT as information technology can lead to major cost savings over time. For example, electronic insurance verification and payment posting reduce the number of business office employees needed as well as lower one of the highest ASC expenses.

2. Another suggestion is to invest in a solid business office staff and hiring the best of the best for the job. Instead of hiring multiple people, an ASC can capitalize on one employee who can successfully wear more than one hat and manage numerous business office functions.

3. The third way to cut business office costs is to consider outsourcing RCM.

ASCs run on lean resources. Staff members wear multiple hats and revenue cycle management can easily slip through the cracks. The right RCM outsourcing provider can handle coding, billing and all of essential tasks related to revenue cycle to bring more money to the table.

To read the full story in Becker’s ASC Review, click here.

ASC revenue cycle benchmarking

How to tell if your ASC needs better revenue cycle management: Part 2

In part one of this series, we discussed the foundational changes in key performance indicators (KPIs) that might signal that your ambulatory surgery center is in need of a better revenue cycle management. Today, we’re going to take a closer look at the less obvious changes that could negatively affect the financial health of your center.

Changes in AR, revenue and clean claims percentage should be fairly visible to the center, but many other essential performance indicators may not be as apparent.

The need for a real-time dashboard
Access to a real-time management console that aggregates all KPIs can provide a competitive edge. Even if the employees have a suspicion that there’s an issue, having the time and resources interally to perform an evaluation and substantiate a concern may be challenging at best.

Patient dissatisfaction
Perhaps most poignantly, billing issues can also lead directly to patient dissatisfaction. Lengthy delays in billing can create situations where a past due notice is received even before the original bill.

The need for a full business office audit
When a center is experiencing a rise in AR days, a drop in revenue, and struggling clean claims percentage, a business office audit may be the best course of action. While some centers may request just a coding audit, especially with the impending ICD-10 changes, it is more beneficial to perform a full business office audit including all components of the revenue cycle process. Importantly, finding an RCM firm that offers a no-cost business office audit is the first key step in benchmarking center performance and building a strong foundation for growth.

A lack of regular measurement and reporting
Internally, billing employees can and should be running reports to determine the root cause of financial problems. It’s important to note that an ASC needs to have the right staff, time and tools in place in order to identify and take the appropriate steps to find and resolve financial challenges.

ASCs that can’t dedicate the time and resources or don’t have the expertise may be better off outsourcing billing and coding to a firm with highly skilled employees whose sole focus is on revenue cycle management. The right provider has the necessary reporting and analytical capabilities to pinpoint AR, revenue and clean claim percentage challenges to ensure not only revenue consistency but revenue growth.

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