3 strategies

3 Strategies for Getting Your ASC Paid on Time

The financial health of your ambulatory surgery center (ASC) depends on accurate, efficient revenue cycle management – which is difficult to maintain in an increasingly complex insurance environment. Submitting clean claims to payers is an important step in decreasing delays and denials, but it is only one part of the equation. To ensure your ASC is paid properly and promptly, take a proactive approach to streamlining your revenue cycle.

Here are three ways to improve your ASC’s revenue cycle management and work toward your profitability goals.

Evaluate & Update Payer Contracts  

Review all of your current payer contracts and fee schedules. Are payers sending appropriate reimbursements as agreed upon in your contracts? Have any payers updated or waived certain costs or processes because of COVID-19? When was the last time you renegotiated contracts with your most common payers? If you haven’t revised a contract in some time, you may not be receiving the best rates.

Track Key Payer Metrics

To gain a better overall view of your ASC’s financial picture, collect information on claims and reimbursements, and grade major insurance payers on key metrics. Start by asking these questions about each payer:

  • What do they pay for a procedure?
  • How fast do they pay?
  • What percentage of claims do they deny?

Use this data to understand how common denials are and how much time your staff is spending to collect from each payer. Can you pinpoint any trends associated with delays or denials? Are you including all of the information needed for a claim? Are you submitting clean claims and still having to appeal incorrect denials? If you notice that your team frequently battles with a payer over correctly billed claims, resulting in hours of lost staff time, you can use this information to push for changes or contract renegotiations.

Follow Up Quickly

Establish a schedule of follow-up practices for outstanding claims and erroneous denials, and remember not to accept the payer’s first payment. Calculate your ASC’s average days in A/R, and set a goal for following up on claims to reduce that number. If your ASC receives a denial where the payer is at fault, set a timeframe – such as 24 hours – in which your staff must resubmit the claim or file an appeal.

Effective revenue cycle management requires diligence and consistency. Partnering with ASC revenue cycle experts can transform your center’s financial health. Get in touch with Regent RCM to optimize reimbursement and solve problems in your revenue cycle.

quarterly award

Congratulations to our Q1 Award Winners

Regent Revenue Cycle is pleased to present our Distinguished Performance Award recipients for Q1. Each recipient met or exceeded all Regent Gold standard performance benchmarks including:

  • AR follow up
  • Decrease in % of AR over 90 days
  • Highest quality audit results for Q1

Our revenue cycle specialists provide consistent high-value and excellent customer service to our clients and are dedicated to delivering exceptional quality.

“The whole team is proud of this group of employees,” said Vice President of Revenue Cycle Management, Erin Petrie. “These individuals go above and beyond to deliver excellence and exemplify our R.I.S.E Values: Respect, Integrity, Stewardship, and Efficiency.”

Congratulations Rebecca Johnson, Dacia Aviles, Mayra Casco, Lorena Gonzalez, Celia Kulis, Lilia Casas, Maria Murguia, Gabriela Alcaraz, and Angie Valentin.

Updated Gold Standard: A/R over 90 Days

In 2017 we introduced ASC-specific benchmarks. And since then, we have routinely leveraged data and industry trends to review and revise the benchmarks, making updates in order to improve our own processes and approach and ensure our centers capture all the revenue they are entitled to.

In 2020, we’re updating A/R over 90 Days: today, our gold standard is below 25%.

“If a center is getting lower than 25%, it would likely mean that someone is taking write-offs versus exhausting appeals to those claims,” explained Regent RCM Vice President Erin Petrie. “Originally, we were aiming for a gold standard of 20% but when we standardized our data over two years, we saw that the percentage was closer to 30-35%. Since then, we have been digging in to better understand why the percentage is higher and when it might be a sign that the center’s revenue cycle is healthier as a result.”

There are couple of variables that centers should note:

Patient Responsibility & Financial Counseling – Up-front collections are a contributor to A/R over 90 and if a center doesn’t have an up-front collections process in place, it is very unlikely to get to 20% for A/R over 90 Days. Why? Because patients can be responsible for as much as 30% and that takes time to collect.

“When patients lack financial counseling, it often results in the patient being unprepared to pay copayment, deductible and/or co-insurance amounts,” explained Petrie. “This contributes to unsecured debt and drives up days in A/R. We work with our clients to operationalize upfront patient financial counseling and collections and we are seeing dramatic results.”

Quality Auditing – Audits help identify where education is needed among staff and assist in finding gaps and leaks in the revenue cycle. Petrie noted: “By conducting an aggressive appeal the first time, the percent of A/R over 90 Days automatically goes down. High-performing ASCs will inevitably experience claims denials, but during an audit we take an in-depth look at the center’s appeal process, that helps us get to the root of the issue and correct it.”

 

Make the Most of Downtime in order to Reopen Stronger Than Ever

During the COVID-19 crisis, ambulatory surgery centers (ASCs) are pausing non-essential procedures in order to preserve resources for hospitals that are treating an influx of sick patients. In turn, this is leaving ASCs with a reduced or nonexistent case volume. We provide suggestions on how to use this downtime wisely so your center will be prepared to ramp back up as quickly and efficiently as possible.

Payers & Payer Contracts

You should be taking this time to become familiar with what your most common payers are doing now. Some payers may be waiving authorization processes, and some may be waiving certain costs for patients. It’s also important to create a payer fee schedule to reconcile payments as well as review contracts to make sure you have the right fee schedule in place. ASCs also need to establish timely follow up processes and remember – don’t accept what the payer pays the first time.

Continue to Work A/R

Regular monthly A/R reports should be run to streamline follow ups, and billing staff should follow up with every account listed. The gold standard for follow up is at least 95%. This results in improved collections and a decrease in A/R over 90 days.  Running an audit can help identify gaps and leaks in the current revenue cycle. During an audit, you take a deeper look at your center’s appeal process which will help get to the root of the issue and correct it. Download our guide, 3 Revenue Cycle Audits that will Improve Collections & Lower Days in A/R, to get started.

Conduct a Self-Audit

Now may also be an opportune time to conduct a self-audit to ensure you’re collecting every dollar you are entitled to. As ongoing consolidation among healthcare payers squeezes surgery center reimbursements, periodic business office audits can be key to identifying a center’s financial stress points, strengths, and opportunities. We’ve published a guide to help you get started. Click here to download your copy or contact us if we can help.

Vanessa Soto

Meet the Team: Vanessa Soto

We are pleased to welcome Vanessa Soto to the Regent Revenue Cycle Management team. Vanessa brings extensive insurance verification, patient financial counseling and customer service experience to our team.

We sat down with Vanessa to talk about her background.

Tell us about your education and work background.

Prior to joining Regent RCM, I worked as a Medical Records Specialist and as an office coordinator for a physical therapy group. I honed my skills including insurance verification and patient financial counseling while providing high-level customer service.  

What do you like most about working at Regent RCM?

I appreciate that Regent RCM created the R.I.S.E. program to develop a values-driven culture that helps us stay focused on providing consistent high-value and high-touch customer service to our clients. Our office is collaborative and positive and there is never any hesitation to assist a fellow team member and pitch in when needed.

What do you enjoy about your current position?

I enjoy communicating with patients and helping them with any issues they may have. I also enjoy being involved with all the centers and assisting the specialists as needed. I always feel appreciated by the managers and the rest of the leadership team.

What makes you unique?

Need to talk about Keto? I am the unofficial Keto coach for the office. Need a manicure? I have a collection of almost 500 nail polishes. Want to talk about Harry Potter or video games? I can do that as well.

2020 Business Office Manager

2020 Business Office Manager of the Year Announced at Annual Conference

Regent Revenue Cycle Management (RCM) kicked off 2020 by hosting our annual Business Office Manager Conference in South Padre Island, Texas. Ambulatory surgery center (ASC) business office managers from all over the United States were in attendance.

Laina Roberts from Plaza Surgery Center earned the Business Office Manager of the Year award. Stefanie Herrick was also recognized for her achievements at Surgery Center of Wasilla.

Roberts started in 2019 and has made a positive impact from day one. Prior to her start, Plaza Surgery Center had about 3% of the month’s cases unbilled by month end. Through process adjustments, organization, and consistency, Roberts reduced that number to less than 0.5%, essentially eliminating the issue. Roberts has also overhauled some important HR filing and functions, and she is beginning to tackle the credentialing program.

“Laina is doing exceptional work and she exemplifies the best qualities in an ASC business office manager,” said Regent RCM Vice President Erin Petrie. “Her tenacity, attention to detail, and willingness to dig in and make a difference contributes to the success of her facility. We’re thrilled to recognize her as this year’s winner.”

In her role at Surgery Center of Wasilla, Herrick has positively impacted the morale of the center, improved employee engagement, and has revamped all of the business office functions.

“We congratulate Stefanie and Laina; we are so pleased to have them leading our centers, training others, and exemplifying excellence,” added Petrie.

If you’re interested in joining our team, click here.

financials

Going Deep to Understand Surgery Center Financials Helps Minimize Issues

Part 1 of a 2-part Q&A series with Leslie Favela

Getting a good handle on revenue cycle management can make a big difference for ambulatory surgery center (ASC) leaders when it comes to achieving profitability goals.

“What it comes down to is really understanding and knowing your center,” says Leslie Favela, manager of the business development team at Regent Revenue Cycle Management. “It’s all about being aware of all of your payer contracts and tracking your center’s trends. It’s important to be ahead of the game with the payers. If you know your center’s contracts, and the overall health of your revenue cycle, you know where you stand with the payers. And that helps you catch issues in the beginning so you’re able to minimize them as they come up in the future.”

Favela recently sat down to answer some of the most frequently asked questions she and her team receive from ASC professionals:

Question:

Our center would like to increase revenues this year and we have an aggressive goal of 8-10%. Is that doable?


Answer:

Yes, that level of improvement is doable. Whenever we bring on a new client, because of our best practices and our work quality, our statistics show that our team increases center revenues a minimum of 10% or more in that first year, and then we help our centers maintain that level or improve in the ensuing years. We start by reviewing the existing overall health of a center, and then help them improve by adopting the correct focus, making sure that we’re looking at the correct benchmarks, the correct business office processes and workflow, and making sure that we’re maintaining our expected net revenue of at least 97%. On a high level, it’s about having that mindset on how to improve revenue, that’s number one. And two, it’s efficiencies – making sure that you have the correct resources to ensure you’re auditing and managing your revenue cycle the right way.

Question:

Our surgery center is having issues with outstanding claims going well past 30 days. Do you know how we can improve on this metric?


Answer:

Yes, there are several steps centers can take to minimize past due claims. One way to start is to begin tracking all of the payers that are having that delay and look for trends. Then, start asking yourself some questions: What’s the source of the delay? Are you submitting the claims correctly, with all of the claim form values that need to be added for successful claim processing? Is there additional information that needs to go out with the claim, such as a medical record or a copy of the implant invoices? The goal is to identify how the payer likes to receive their claims and to be ahead of game. If you can identify payer trends, then you’ve got that data on your side and you can improve on-time reimbursement. 

For more information on efficiently managing your center’s revenue cycle, contact the Regent RCM team or contact Leslie Favela directly at lfavela@regentrcm.com.

lilia casas

Meet the Team: Lilia Casas

We are excited to introduce the newest member of our team, Lilia Casas. Lilia brings a wide range of financial skills to the Regent RCM team through her many years in the healthcare industry. Most recently, Lilia worked as a Cash Applications Specialist.  

We sat down with Lilia to ask about her background.

Where did you work before?

I spent the last 11 years of my career at Midwest Orthopedics at Rush as a Cash Applications Specialist.

What is your education/work background?

Beginning in 1998, I’ve built my versatility within the industry by working in a variety of departments including posting, charge entry and collections.

What do you like most about working at Regent?

I’ve spent most of my career working in one segment of the billing cycle. At Regent, I am getting the chance to gain experience with the entire billing cycle. I also appreciate that we have a values-driven culture that helps us stay focused on our goal of leveraging our ASC expertise while providing consistent, high-value and high-touch customer service to our clients.

What is something unique about you?

I am rarely in a bad mood. I use my sense of humor and ability to laugh at most things to get me through challenging assignments and situations.

What do you enjoy about your current position at Regent?

I really enjoy working with one center because I get to develop relationships with patients and colleagues. Also, since I work with one center, the success of that business is personal to me.

 

Celia Kulis

Meet the Team: Celia Kulis

Introducing our new revenue cycle specialist, Celia Kulis. Celia brings great value to the team with 20 years of revenue cycle experience, and will leverage that knowledge to help manage all aspects of billing, payment posting and accounts receivable.

Here are some more fun facts about Celia:

Where did you work before? 

Before joining Regent RCM, I had a similar position at Enhanced Medical Revenue, a professional services firm, as an account specialist. I have been working in the healthcare billing and records space for 20 years.

What is your education/work background? 

I began my career in healthcare working as a file clerk. I gained exposure to revenue cycle and honed my skills and gained experience that has prepared me for my current role.

What do you enjoy about your current position at Regent?  

I enjoy the opportunities for growth that are offered at Regent. I have always sought out new projects and opportunities to enhance my knowledge and Regent offers great opportunities through the R.I.S.E. program to learn and improve both personally and professionally. I love the challenge of learning something new, and I hope to be able to mentor other new employees to improve their professional growth in the future.

2019

2019 Greatest Hits: Managing Growth and Profitability for ASCs in 2019

Looking back on 2019, it’s clear that managing growth and profitability is a key challenge facing ambulatory surgery centers (ASCs). The Regent Revenue Cycle Management (Regent RCM) team kept ASC leaders on top of the trends throughout the year with blog posts and white papers developed to inform and educate. Following are links to the articles that proved to be this year’s greatest hits:

How ASC Revenue Cycle Benchmarks Are Transforming Center Performance: An Update on Regent RCM’s Exclusive Metrics

The Regent RCM ASC Revenue Cycle Benchmarks are a critical measurement tool to help surgery centers accurately measure revenue cycle health and ultimately, account for every dollar they are entitled to. In this white paper updating the benchmarks introduced in 2017, Regent RCM Vice President of Revenue Cycle Management Erin Petrie says:

“Having the tools and intel to gauge performance across all functions of the revenue cycle has been a game changer for center leadership. Implementing benchmarks gives you a baseline to understand what process changes you need to make to get to your goal.”

Click here to continue reading about Regent Benchmarks.

Debunking Three Myths Related to ASC Upfront Financial Counseling & Collections

A second Regent RCM white paper explores the trend toward upfront patient counseling and collections. In response to climbing health insurance deductibles and co-pays that push a larger portion of the cost of surgery from insurers to patients, leading centers are responding with robust financial pre-registration processes to maintain efficiency and profitability. And, patients and physicians’ offices alike are supporting these proactive steps.  Says Petrie:

“Taking this step helps ensure transparency about out-of-pocket expense, so costs can be estimated, explained, and ideally, collected in advance of services being rendered. It makes patients more comfortable about their financial commitment and reduces our risk on the backend.”

 Click here to continue reading about Three Myths.

New Case Study: A/R Follow-Up Increases Collections in Ft. Myers

In addition to providing profitability management help on the front end, Regent RCM’s benchmarks help ASCs with Accounts Receivable (A/R) as well. One 2019 case study features the efforts of The Center for Specialized Surgery in Ft. Myers (TCSSFM), Florida, to implement the A/R Follow-Up benchmark. The blog outlines steps TCSSFM has taken to achieve an amazing result: increasing collections by $125,000 per month in the past year. While center growth and more high reimbursement procedures contributed as well, efforts to follow up with payers on at least 95% of claims every month have been a big part of that success. Click here to read the full blog.

Adding a Specialty? Make Sure Contracts Support Profitable Reimbursement

As ambulatory surgery centers change and grow, they add new specialties, creating another challenge to profitability: making sure contracts keep up with the changes. In another well-received blog post, Regent RCM’s Vice President of Managed Care Andrea Woodell says centers should analyze their contracts to evaluate how new specialty cases will be reimbursed when evaluating the addition of new lines of business. For example, she says, “If you’re locked into 2-3-year contracts with your top three payers and you’re adding a new specialty that is not reimbursed, adding that specialty is not a profitable option until the contracts can be renegotiated.” Click here to read the full blog.

Want to learn more about optimizing your center’s revenue cycle management? The Regent RCM News & Insights page will continue to report on trends, success stories and new developments in 2020.

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