reimbursement

Three Revenue Cycle Trends to Watch

An increasing need for timely insurance claims processing and reimbursement in a rapidly changed healthcare market is sparking a growing need in the industry for more — and better — revenue cycle management support.

A recent report from Global Market Insights shows the healthcare revenue cycle management market reached $39 billion in 2015, and is expected to continue to grow at a rate of 11 percent annually between 2016 and 2024. The report highlights three trends underlying that growth and impacting revenue cycle professionals and the healthcare provider organizations they serve:

  1. The medical coding process is becoming more complex even as the need for efficient claims processing increases, underscoring the critical role of professional revenue cycle management solutions to reduce billing errors.
  2. The significant growth in revenue cycle spending in the healthcare sector through 2024 could lead to the government implementing cost-cutting measures.
  3. Physician billing organizations are a major end user of revenue cycle: they comprised 40 percent of the overall healthcare revenue cycle management market in 2015, and that percentage is expected to grow at a rate of 12.3 percent through 2024.

Parallel growth in revenue cycle technology and products underscores the increasingly important role of healthcare revenue cycle in the healthcare market of the future.

In response to these trends, Regent Revenue Cycle Management (Regent RCM) continues to pioneer strategies for ambulatory surgery centers, developing, executing, and refining ASC-specific revenue cycle management solutions as well as investing time and resources in the technology, training and staffing to help ASC leaders stay profitable in the changing healthcare marketplace.

To learn about Regent RCM’s expanding services to support this growth, contact a member of our team.

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.

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Regent Revenue Cycle Management Expands Service Infrastructure; Ensures Dedicated Staffing

Regent Revenue Cycle Management (Regent RCM), a leading provider of innovative, cost-effective revenue cycle management services exclusively for Ambulatory Surgery Centers (ASC) in the U.S., announced today that the company is investing in new talent to provide seamless service delivery to a growing customer base.

The company has hired Ivette Gomez to serve as Revenue Cycle Specialist.  In this role, Gomez will handle billing, payment posting, and accounts receivable for her surgery center, while delivering high-value and high-touch customer service to ASCs.

“Dedicated staffing is essential to achieving patient satisfaction and revolves around a team that possesses an all-inclusive knowledge of the revenue cycle,” said Michael Orseno, Regent RCM Vice President. “Ivette is a wonderful addition to our team and I’m certain her contribution will benefit our clients and enable us to continue to outperform industry benchmarks.”

Gomez will be responsible for a center in the Southeast. She previously served as Senior Reimbursement Specialist at Midwest Orthopaedics at Rush. In this position, Gomez followed-up on outstanding claims and performed reimbursement audits to ensure payments matched contracts and fee schedules.

“I am pleased to begin my new career at Regent RCM,” said Gomez. “There is an incredible team in place, and I’m truly excited to share ideas with them. Together, we will continue to provide the best solutions for our centers and their patients.”

Regent RCM’s services optimize ASC workflow and processes, and generate real-time analytical dashboards that are critical to assessing an ASC’s financial health. Regent RCM consistently outperforms industry benchmarks allowing ASC managers to focus on high-value activities.

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, we identify 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.

Are you considering outsourcing to optimize your center’s revenue cycle? We 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.

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ASC Revenue Cycle July 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: A new infographic details changes that the U.S. Department of Health and Human Services has implemented for payment models; A pair of funding opportunities that will establish an Information Sharing and Analysis Organization; Becker’s Hospital Review has chosen 15 revenue cycle management leaders to know; And the release of the 2017 proposed Medicare payment rates for ASCs by the Centers for Medicare & Medicaid Services.

Changes come to revenue cycle management in new value-based environment

The healthcare landscape continues to shift from volume to a value-based healthcare model. A new infographic details changes that the U.S. Department of Health and Human Services has implemented for payment models. Click here to read more.

HHS to fund cybersecurity information sharing organization

To provide more threat and information sharing and improve cybersecurity awareness, HHS, ONC and the Assistant Secretary for Preparedness and Response announced a pair of funding opportunity announcements to establish an Information Sharing and Analysis Organization. Click here to read more.

15 Revenue Cycle Management leaders to know

The importance of fiscal responsibility is at an all-time high in healthcare, and thought leadership is critical. With that in mind, Becker’s Hospital Review chose 15 revenue cycle management (RCM) leaders to know. Regent RCM VP of Revenue Cycle Michael Orseno made the list and adds key insights from the ASC community. Click here to view the list.

2017 Proposed Medicare Payment Rates Released

The Centers for Medicare & Medicaid Services (CMS) on July 7 released the 2017 proposed payment rule for ASCs. In the proposed rule, ASCs would see an effective update of 1.2 percent—a combination of a 1.7 percent inflation update based on CMS’s estimation of the change in Consumer Price Index for All Urban Consumers (CPI-U) and a productivity reduction mandated by the Affordable Care Act of 0.5 percentage points. Also, the agency has proposed to add eight new procedures to the ASC list of payable procedures for 2017. Click here to read more.

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ASC Revenue Cycle May Industry News Wrap-Up

Each month Regent Revenue Cycle Management (RCM) explores the top news and headlines affecting the health care industry. This month in the news: Managing overpayments from insurance companies, a new app for cataract surgeons, and tools to streamline patient handoff at health care facilities.

Expert Advice on Handling Overpayments

Regent RCM Vice President of Managed Care Andrea Woodell advises ambulatory surgery centers (ASCs) to avoid racking up overpayments from insurance companies. In a recent article addressing the burden this places on billings and collections, Woodell details the steps centers should take to deal with overpayments. Click here to read her helpful tips and click here for a blog post that further examines this issue.

New App Puts Information at Surgeons’ Fingertips

Cataract surgeon pre-op notes to go digital with new iOS app under development by Bausch & Lomb and IBM. The iPhone and iPad app enables surgeons to access information before, during and after procedures, organizing essential information. Pilot testing on the cloud-based app is scheduled to begin later this year. Click here for details on how the app can help with more efficient planning and follow-through for surgeons.

Top Tools Streamline Patient Handoff

Health care facilities can utilize a host of tools aimed at improving and streamlining patient handoff. A recent article lists ten tools that are currently available, including Digital Nurse Assistant, which automates tasks nurses commonly perform by hand, and a patient handover toolkit that looks at all aspects of patient handovers including common problems experienced and recommended standard protocols. Click here for all 12 helpful tools.

Contact Regent RCM at 312-882-7228 to learn more about cost-effective billing and collection services for ASCs.

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.
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Regent RCM Healthcare Industry News | August 2015

Each month Regent RCM explores the top news and headlines affecting the healthcare industry. 

This month in the news: States with high percentages of uninsured people drop this year, many physicians lack confidence in ICD-10 with the deadline approaching, and ASC Focus magazine reminds ASC’s to confront their financial and management concerns.

States With the Highest Percent of Uninsured Population Drop in 2015

In the U.S., the amount of people who are uninsured continues to drop in most states. The ten states with the most uninsured people in 2013, many around 20%, have dropped significantly with the percent of uninsured in 2015 ranging from 6% to 11%. Arkansas and Kentucky continue to have the sharpest decrease in uninsured rates since new healthcare laws in 2014. Most states have expanded Medicaid and established a state-based or state-federal partnership and the states that have embraced the multiple parts of health law continue to see the most improvement. To read more on the uninsured rates, click here.

Physicians Lack Confidence in ICD-10 with Deadline Approaching

With the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) deadline approaching, new data suggests that many physicians lack confidence in ICD-10. ICD-10 is anticipated to be severely damaging with claims disruptions, claim denials, etc. This may cause physicians to use personal funds to keep their practices running or go into early retirement. A small 10% of physicians state that they are “very confident” that their practice is ready for the ICD-10 deadline. Click here to read more on the lack of confidence in ICD-10 or click here for tips to accelerate your ASC’s ICD-10 preparation.

Overcome your ASC’s Biggest Financial and Management Challenges

ASC Focus magazine reminds ASC’s to confront their elephants, or the financial and management concerns that go along with providing the highest quality care for patients. These concerns include reimbursement, cost containment, increased regulations, management and patient education on ASC benefits. Quality care and expense monitoring for cost containment are just two of the ways ASC’s can confront their biggest challenges. Click here to read more on confronting ASC concerns or click here for tips to ensure an accurate and timely billing process for your ASC.