3 Advantages to Outsourcing RCM

Streamlined revenue cycle management (RCM) is key to an ambulatory surgery center’s long-term financial success.

The revenue cycle is multifaceted, involving every aspect of coding, billing, claims submissions, and collections. “Because healthcare providers need to expend significant resources to manage the revenue cycle internally, many are choosing to outsource RCM in order to increase efficiency and reduce expenses,” said Regent RCM Director of Revenue Cycle Management Erin Petrie. The RCM market in North America is expected to experience a growth rate of 12% by 2021, according to a MicroMarket Monitor report.

Outsourcing RCM is projected to expand as ASC leaders recognize its benefits:

  • Enhancing quality of care while reducing costs
  • Increasing transparency and accountability
  • Improving cash flow and stabilizing the overall revenue cycle

Ambulatory surgery centers that opt to outsource RCM gain several competitive advantages:

  1. Specialized Expertise

The revenue cycle management landscape is not static; it is changing at a rapid pace. For healthcare providers to keep up with the latest updates to Medicare, Medicaid, the Affordable Care Act, and other guidelines, they must employ RCM specialists on their administrative staff to get optimal results.

Outsourcing RCM is a far more effective and affordable option for many ASCs. A company that specializes in revenue cycle management offers ASCs expertise in developing, executing, and refining billing and collection strategies. “These RCM experts know how to handle the most complicated challenges and plan for any imminent changes,” said Petrie.

  1. Smart Staffing

For ASCs to manage the revenue cycle internally, they must employ an experienced billing and coding staff with built-in redundancies. This costly investment is a necessity for in-house RCM; cutting corners and hiring inexperienced employees can cost ASCs hundreds of thousands of dollars per year.

Outsourced RCM providers are ideally positioned to attract experienced staff with deep knowledge of the revenue cycle. They are RCM specialists, so they know how to recruit and hire the best employees in the industry, often maintaining a pipeline of qualified applicants waiting for a spot to open up. They also offer competitive salaries and benefits, and situate their offices in desirable locations.

  1. Best-in-Class Technology

ASCs often do not have the appropriate tools or resources to manage the revenue cycle in-house. ASC leaders are juggling tight budgets and favoring patient care over improved billing resources, and it’s simply not practical to invest in the most up-to-date RCM software and tools.

By outsourcing RCM, centers can take advantage of economies of scale and gain access to best-in-class technology. The team at Regent RCM uses three powerful technologies to track and automate the revenue cycle process:

  • A Management Information Systems (MIS) platform that helps maximize profitability, lower A/R days, and achieve faster reimbursement
  • Clearinghouse software that makes workflows more efficient, improving patient experiences and reducing outstanding balances
  • A reporting and analytics dashboard that creates real-time customized reports and offers deep insights into an ASC’s operations

Learn more about optimizing your ASCs revenue cycle through outsourcing by conducting a Self-Audit.

Meet the Team: Dacia Aviles

In our ongoing Meet the Team feature, we introduce the many members of our team who make Regent RCM so successful.  In our last post, we learned more about revenue cycle specialists Ariana Cisneros.  Today we shine the spotlight on:

Dacia Aviles

Where is your hometown? Born and raised on the North Side of Chicago near Wrigley Field. So you know what that means…. Go Cubbies!

What do you do at Regent RCM? I’m a Revenue Cycle Specialist. I’m responsible for billing, payment posting and account receivables for a surgery center.

How long have you been working at Regent RCM? I started January 2018, so I’m still new to Regent, but I carry 18 years of revenue cycle experience as well.

Where did you work before joining Regent RCM? Prior to joining the team, I worked for Anne & Robert H. Lurie Children’s Hospital.

What is your favorite part about working at Regent RCM? I love Regent RCM’s friendly and respectful ambience, everyone is willing to help with any question I have. I also like the concept of working for one client because I’m able to see that difficult accounts are resolved almost instantaneously. When several individuals are working the same client account it can get messy. RegentRCM’s method and approach is much more effective!

What has been your greatest professional achievement? When I worked at Loyola I was doing Physician reimbursement for out of state Medicaid. At that time there wasn’t much experience with out of State. so I had to take the initiative to learn the rules of each state and figure out how to generate reimbursement.  It turned out that Indiana was the largest population coming to Loyola’s ER. I was able to create a guide from beginning to end with instructions on how to enroll providers, bill correctly and learn to reach EOB’s. Once I finalized the guide, I was seeing payments come in so that Loyola can continue to succeed. When it was time for me to leave Loyola I felt the guide I created was greatly appreciated by the next person. I know what it feels like to not know and needing to learn a whole new ball game.

What is one fun fact about yourself your co-workers don’t know? I love crafting and the kid in me loves Roller-Skating…two of my happy places.

ASC Physicians in Operating Room

Physicians are Key to Revenue Cycle Success

While they may feel more comfortable managing matters related directly to patient care, physicians also have an important role to play in the overall financial sustainability of the ambulatory surgery center (ASC) where they practice. Whether their compensation is tied directly to productivity or collections or not, understanding the ins and outs of revenue cycle management is important.

But often, revenue cycle management isn’t a memorable lesson from medical school. The experts a Regent Revenue Cycle Management (Regent RCM) understand the importance of educating physicians on the financial aspects of providing quality healthcare.

“In many cases, surgeons do not understand all the interrelated aspects of how the organization bills and collects for services,” says Erin Petrie, Regent RCM’s Director of Revenue Cycle Management, “so they often need help understanding how the revenue cycle works and the key areas that require physician involvement.”

Petrie outlines three areas where physician involvement in RCM is critical:

  1. Coding

To facilitate insurance company payment, it is critical for physicians to facilitate proper coding for their procedures. While in some academic settings a staff person may select the specific ICD-10 and CPT codes for cases, under most circumstances it is the physicians who must own code selection. If they don’t, the case may remain unbilled or risk non-payment due to timely-filing limits, which can be as short as 20 days. Need help learning coding specifics? The American Academy of Orthopedic Surgeons offers a coding and reimbursement course.

  1. Documentation

Documenting what was done in a specific and detailed way is a critical part of the surgeon’s role in any ASC procedure, and using CPT language is the most efficient way to link the service to the correct CPT codes for appropriate reimbursement. For example, Petrie explains, it is no longer enough to specify “joint pain.” Instead, specifying the joint and the laterality in detail enables specific coding and increases the likelihood of timely reimbursement.

  1. Reviewing Accounts Receivable

Finally, Petrie suggests surgeons take active interest in understanding the ASC’s accounts receivable. Ask for a monthly A/R report and review it, she advises. Watch out for any increase in the number of accounts more than 90 days old, and ask for details about accounts in the 60-day column. When surgeons begin to take an active interest in the billing process, chances are the staff will, too.

 

 

For more information about understanding the ins and outs of revenue cycle management, contact Petrie or a member of her team at (708) 492-0531.

Reasons to Outsource

4 Steps of a Regent RCM Business Office Audit

A Regent Revenue Cycle Management (Regent RCM) audit goes beyond a traditional reimbursement assessment. “The benefits of an audit are clear,” said Michael Orseno, VP of Revenue Cycle at Regent RCM, “and we ensure that facility time commitment is minimal. Our ASC-specific expertise allows us to complete the process in about two weeks.”

This is a quick turnaround, particularly considering the potential upside. In the case of one client, a business office audit uncovered coding errors which led to recouping more than $590,000 in additional funds.

An audit is comprised of four steps:

  • Initial Data Request*. Access to information is vital, and centers will provide a variety of data including but not limited to year-to-date case count and payer mix.
  • Initial Analysis. After collecting and reviewing initial data, Regent RCM selects multiple cases for a more detailed review and analysis.
  • Full Analysis. Pinpointing a number of cases, the Regent RCM team dives deeper using an internal audit tool set.
  • Once the audit is complete, Regent RCM will present findings on-site and provide detailed, strategic recommendations to ASC leadership.

In an upcoming blog, Regent RCM will further define the four key components of an audit including reimbursement, coding, staffing and observation (workflow and process).

Ready to get started? Call Regent RCM’s dedicated team today (312) 882-7228 to schedule an audit for your center.

Reasons to Outsource

Top 6 Reasons to Outsource RCM – Part Two

Why is the revenue cycle management (RCM) market projected to experience a 12 percent uptick in growth through 2021? Two primary forces are at play: 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 see the need to achieve real transparency, predictability, and performance, and outsourcing RCM is the ideal way to increase cash flow, cut costs and optimize 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 blog>> focused on expertise, technology and staffing. This second installment focuses on transparent reporting, legalities and location-specific savings.

  1. Transparent Reporting. While ASCs often lack the necessary expertise, technology and resources, or time needed to devote to transparent measurement and reporting, outsourcing these processes offers access to the tools and expertise needed to analyze the data and track changes in financial performance. Expertise with third party reporting software allows revenue cycle experts to pull specific reports to find the root cause of a problem. For example, outsourcing RCM can help determine what it means if an ASC has either a very low or very high percentage of A/R over 90 days. The center can then take steps to correct course.
  2. Keep up with rules and regulations. Never has it been so important to stay abreast of healthcare laws and regulations. ICD-10, for example, is constantly re-shaping coding, and ASCs must stay ahead of the curve. But centers also have numerous otherpriorities that must be completed, and new regulations can fall through the cracks. Outsourced RCM vendors, by the nature of their business, proactively keep tabs on industry laws and regulations.
  3. Save space to enhance revenue. Outsourcing RCM can create added space within a facility, and the extra square footage can be used to enhance value added aspects of the business. More testing equipment can be brought in for example, enabling services that create an increase in revenue. “Outsourcing RCM frees up physical space in an ASC, and that can give centers the opportunity to add new services, which can be beneficial financially,” said Orseno.

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. 312-882-7228.

If you missed part one, read it 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.

Meet the Team: Vernon Gill

Meet the Team | Vernon Gill

In our ongoing Meet the Team feature, we introduce the many members of our team who make Regent RCM so successful. In our last post, we learned more about revenue cycle specialist Anabel Navarro. Today we’ll shine the spotlight on:

Vernon Gill

Hometown:  I was born and raised in the beautiful city of Chicago.

What do you do at Regent RCM?  As a New Market Specialist, I promote our revenue cycle services to surgery centers across the country. I am passionate about healthcare, and in a landscape where reimbursements are shrinking, surgery centers need to be in a position of financial strength. By outsourcing RCM, we help centers focus on what they do best – caring for patients.

What is your favorite part about working at Regent RCM? I work with great people who are willing to help not only our clients but also fellow team members any way they can. It really is a collaborative atmosphere; the more experienced team members are always willing to provide guidance for newer employees and everyone is committed to serving our clients with excellence.

What has been your greatest professional achievement? Over the course of my career, I’ve been fortunate to work with strong leaders and veteran salespeople. They’ve taught me that there’s no substitute to rolling up your sleeves and going to work. That can-do attitude impacts everything I do and underscores my dedication to helping partner centers succeed.

What is one fun fact about yourself your co-workers don’t know?  I love the art of photography. It’s relaxing, but more than that, it also teaches you to appreciate great moments in time.

asc revenue cycle management solution

ASC Revenue Cycle August Industry News Wrap-Up

Each month Regent Revenue Cycle Management (Regent RCM) explores the top news and headlines affecting the health care industry. This month in the news: An editorial discusses the importance of effective infection and outcome metrics for ASCs; North Carolina attempts to repeal its certificate of need legislation; and a Regent Surgical Health Vice President of Managed Care reveals fundamentals for day-to-day payer negotiations.

Editorial: The need for effective infection & outcome metrics to propel the ASC industry forward

As healthcare continues to move to the outpatient setting, the ASC industry needs to have systems in place to measure quality outcomes in order to thrive, writes Dr. Donald Fry, executive vice president for clinic outcomes management for MPA Healthcare Solutions and an adjunct surgery professor at Chicago-based Northwestern University Feinberg School of Medicine. Click here to read more.

North Carolina moves to repeal CON legislation

A North Carolina state senator has added a CON repeal proposal to House Bill 161, which would repeal North Carolina’s controversial certificate-of-need legislation. Experts say the state’s CON law for ambulatory surgery centers has costly repercussions for patients and insurers, and that repealing the CON laws would give patients more treatment options, thereby improving quality of care. Click here to read more.

Managed Care ABCs for Day-to-Day Payer Negotiations

As new payment models continue to emerge, one of the critical mistakes that ambulatory surgery centers (ASCs) make is not paying attention to the day-to-day management of payer contracts. Andrea Woodell, Vice President of Managed Care at Regent Surgical Health, says that even as MACRA (Medicare Access & CHIP Reauthorization Act) drives healthcare to performance targets, it will take some time for those changes to take full effect. Click here to read more.

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.

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