Payer Contract Adhesion – And What They Can Do For Your Revenue Cycle Audit

Every ambulatory surgery center (ASC) strives to manage its revenue cycle as efficiently as possible. Mistakes or delays in coding, billing, and collections can lead to financial challenges. No center wants to show a loss in revenue because of flawed revenue cycle management practices.

Regent Revenue Cycle Management encourages ASCs to perform three regular audits to detect and correct errors before they become larger problems. Regent RCM has created a new guide that details how centers can take simple, concrete steps to track and improve their revenue cycles:

  • Denied claim cause and management
  • Coding accuracy
  • Payer contract adhesion

Payer Contract Adhesion

In our third and final blog of our three-part series, we focus on why negotiating fair payer contracts – and making sure that all terms are met – is a critical part of revenue cycle management.  Your revenue cycle team needs to know every detail of their contracts, so they can fight for every dollar.

Regent RCM advises centers to conduct an audit on each of their payer contracts to understand what the contract says, what their center is allowed to bill, and how they can avoid over- or under-payments. The ultimate goal is for ASCs to receive exactly what they are owed – no more and no less.

When negotiating a contract, Regent RCM recommends following these five steps:

  • Start at least four months before the anniversary of the contract
  • Check the terms of the contract carefully
  • Build relationships with payers
  • Be aware of evergreen contracts that roll forward without renegotiation or a termination date
  • Keep all contracts current to make sure they aren’t falling behind

Learn how to perform our three audits to enhance your ASC’s financial performance. Download the guide here.

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.