Q2 Award Winners Smiling

Congratulations to our Q2 Award Winners

Regent Revenue Cycle is pleased to present our 2019 Distinguished Performance Q2 award winners. Each recipient met or exceeded all Regent gold standard performance benchmarks including:

  • A/R follow up
  • Decrease in % of A/R over 90 days
  • Highest quality audit results for Q2

Our revenue cycle specialists continue to deliver excellent quality service in the industry’s competitive field.  

“Everyone is so proud of this group of employees,” said the RCM Management team. “The Regent gold standard performance benchmarks are extremely difficult to meet, yet alone exceed, and these individuals went above and beyond to deliver excellence. In addition to reaching or surpassing these goals, this group exemplifies our R.I.S.E. values of Respectful Caring, Integrity, Stewardship, and Efficiency that we all strive to reach.” 

Congratulations Gabriela Alcarez, Ariana Treto, Denise Soriano, Lila Casas and Angela Valentin. We look forward to seeing what you all accomplish in Q3.

advance payment collections won’t work

Common Myth Related to ASCs: Advance Collections Won’t Work

There are misunderstandings and outdated beliefs related to ambulatory surgery centers (ASC) upfront financial counseling collections. In this post, the first in a 3-part series, we focus on a common myth: Advance Collections Won’t Work.

Myth: In the healthcare industry, it’s not feasible to collect for procedures not yet completed.

Reality: It’s happening. And it’s helping. Proof abounds that payment only after services are delivered is an outdated mindset, even in healthcare. For example, when leaders at the Glasgow Medical Center in Newark, Delaware, began considering proactive patient financial counseling, they noted a trend in their market of increased patient responsibility, both in terms of deductibles and co-pays.

“Our research suggested collections in advance would be feasible because patients, for the most part, expect to make a payment,” says Mary Kearns, Business Office Manager at Glasgow Medical Center. “Upfront financial counseling helps us help them understand how much they’ll owe, allowing them to budget or apply for credit. As a result, our center has increased upfront money collected. Overall it has been a great experience helping to resolve and minimize our bad debt.”

Glasgow’s results align with an industry statistic that states that more than 90% of patients want to know their payment responsibility prior to a provider visit or scheduled procedure.

Regent RCM is working with leading ASCs to put programs in place that operationalize upfront patient financial counseling and collections, and to dispel outdated myths that keep centers from benefiting from these proactive processes. To learn more, click here to download our white paper, or contact Leslie Favela at lfavela@regentrcm.com.

Three ASC Healthcare Trends

Three Healthcare Trends to Track that Impact ASC Cash Flow and Revenue

Rapid change in the healthcare industry requires that providers cope with a myriad of emerging trends, including increased patient volumes, new reimbursement formulas, an evolving payer mix and a changing regulatory environment. For ambulatory surgery center (ASC) leaders, tracking three key trends in particular is critical to effective cash flow and optimal revenue cycle management. Two of these trends to watch are triggered by changing patient needs, while the third is focused on their employers.

1. Price Transparency

As higher deductible plans drive up the percentage of the healthcare bill that is the patient’s responsibility, consumers are demanding more advance price transparency. Especially for elective procedures but for others as well, prospective patients want to know what their costs will be in advance. In response, earlier this year the Centers for Medicare & Medicaid Services (CMS) implemented new regulations requiring providers to post charges for procedures, and some states have even more demanding requirements.

For ASCs, this trend makes it increasingly important to analyze operational data (such as case costing) as you create a viable fee schedule and estimate costs on a patient-by-patient basis. Click here to learn additional details about upfront patient financial counseling & collections from our newest whitepaper.

2. New Financing Needs

The second patient-driven trend ASCs should track diligently also stems from the shift of more of the healthcare cost burden toward consumers. In spite of the trend making them more financially responsible for their care, many patients simply can’t afford to pay: In fact, A 2018 report by the Federal Reserve revealed that 4 in 10 adults would not be able to cover a $400 emergency expense.

As a result, patients need new ways of paying for surgical procedures, namely payment plans. And ASCs are turning to third-party resources in order to stay out of the consumer loan business. For a fee, these organizations cover the patient’s costs upfront, and then take on the responsibility of collecting the balance over time. ASCs much determine whether the fee involved is worth it, by examining their uncollectible patient debt costs and loss ratio.

3. New Ways of Contracting

Employers are impacted by rising healthcare premiums as well, and some have attempted to contain rising premium costs by contracting directly with providers (a form of self-insurance). For ASCs, this trend creates another reason to truly understand the drivers of a center’s revenue and case volume.

Again, having the information technology and analytics in place to get the answers is critical. ASCs need data in order to ask and answer the right questions about their profitability. Only with the ability to analyze how these healthcare trends are impacting their revenues and cash flow can they proactively manage revenue to avoid potential adverse financial outcomes.

Regent Revenue Cycle Management (RCM) provides turnkey billing and collections services focused only on ambulatory surgery centers in the United States, approaching revenue cycle in a unique way that consistently outperform industry benchmarks and allows ASC managers to focus on what they do best: providing high quality care. For more information on how Regent RCM can help ASCs manage these key trends, click here.

Doctor smiling - three myths whitepaper

New Whitepaper Debunks Three Myths about Upfront Patient Financial Counseling and Collections

To combat climbing health insurance deductibles and co-pays that push a larger portion of the cost of surgery from insurers to patients increasing collections risk, ambulatory surgery centers (ASCs) have responded with more robust financial pre-registration processes to maintain efficiency and profitability. A new whitepaper offers insights into this trend, while separating myth from reality regarding implementation.

Regent RCM’s Erin Petrie, Director of Revenue Cycle Management, says while there was resistance in the marketplace to upfront patient financial counseling and collections just a few years ago, the practice is rapidly gaining acceptance today. More than 90% of patients want to know their payment responsibility prior to a provider visit or scheduled procedure.

“In response to the trend, we’re making sure to include in our financial planning process an upfront review of the patient’s benefits,” she says. “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.”

Regent RCM, a leading provider of innovative and cost-effective revenue cycle management services exclusively for ASCs, is working with leading ASCs to put programs in place that operationalize upfront patient financial counseling and collections, and to dispel outdated myths that keep centers from benefiting from these proactive processes. The new whitepaper, available for free download here, addresses three common myths:

  • Myth #1: Advance collections won’t work.
    Reality: It’s happening. And it’s helping.

  • Myth #2: The practice lacks physician support.
    Reality:
    Physicians understand that healthcare providers must embrace good business practices in order to stay solvent and continue to provide quality care.

  • Myth #3: Attempting advance collections might prompt surgery cancellations.
    Reality: Patients appreciate transparency around what charges they’ll be accountable for and understand that high deductibles are the new norm.

The white paper offers proof that payment only after services are delivered is an outdated mindset in healthcare, citing the advance collections experiences of two leading ASCs, Glasgow Medical Center in Newark, Delaware, and Palos Surgicenter in Palos Heights, Illinois. The paper also offers four suggestions for ASC leaders interested in implementing advance collections.

To learn more about Regent RCM’s work with ASCs to implement upfront patient financial counseling and collections, contact Favela at lfavela@regentrcm.com.

How Do You Measure ASC Revenue Cycle Health? HINT: Use ASC-Specific Benchmarks

Prior to Regent RCM’s development of revenue cycle management benchmarks specifically for ambulatory surgery centers (ASCs) in 2017, leadership leaned on hospital or physician practice metrics. But those “borrowed” metrics caused confusion and failed to provide the assessment tools ASCs needed to compete successfully in the healthcare marketplace.

A new white paper updates the nine ASC-specific benchmarks based on two years of learning, adding an essential new metric to help surgery centers accurately measure their revenue cycle health. The new benchmark tracks Net Collections Rate: the percentage of eligible money that was actually collected. The Regent RCM gold standard is to collect greater than 97% from contracted payers.

According to Erin Petrie, Regent RCM’s Director of Revenue Cycle Management, while striving for an efficient revenue cycle if a center’s net collections percentage is low, it may be a sign that the business office is accepting whatever the third-party pays and not fighting for what is contractually owed.

With reimbursement dollars continuing to be stretched, Regent RCM’s gold standard benchmarks assist ASCs around the country in receiving the most revenue possible for the care they provide. In addition to Net Collections Rate, the white paper provides insights on the advantages of tracking:

  • Claim and Charge Lag: The Regent RCM gold standard for both the number of days from date of service until the billing date, and from the date of service until charge entry, is 48 hours.
  • Statement Lag: According to the Regent RCM benchmarks, the lag between the date a balance becomes a patient’s responsibility to the time the statement is sent should be less than 5 days.
  • Clean Claims %: Proper coding, a knowledgeable billing staff, and the use of a robust clearinghouse to scrub claims prior to submission are paramount for achieving the Regent RCM gold standard of a 98% clean claims rate.
  • Denials: The Regent RCM gold standard for denied claims is less than 10% denials.

Click here to download the full white paper on using Regent RCM’s benchmarks to assess the health of your revenue cycle.

See You at ASCA in Nashville!

The Regent RCM team will be at the ASCA 2019 Conference and Expo, the largest and most diverse conference of the ambulatory surgery industry. Scheduled for May 15-18 in Nashville, TN, at the Gaylord Opryland Resort & Convention Center, the conference is presented by the Ambulatory Surgery Center Association (ASCA.)

ASCA 2019 offers top notch educational programming and networking opportunities, along with the ASC industry’s largest exhibit hall featuring hundreds of new products, services and technologies representing nearly 200 vendors.

In addition to more than 50 ASC-specific educational sessions, two keynote speakers promise to be motivational highlights of the conference: Alex Sheen, CEO and founder of the international social movement and nonprofit because I said I would, dedicated to bettering humanity through promises made and kept; and Scott Hamilton, Olympic gold medalist in figure skating, best-selling author of “Finish First: Winning Changes Everything,” and cancer survivor-turned-activist.

Want to schedule an appointment to connect with Regent RCM at the conference? Contact us here.

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

The Center for Specialized Surgery in Ft. Myers (TCSSFM), Florida is growing rapidly, in part because the center leverages Regent RCM benchmarks to gauge performance across all functions of the revenue cycle.  A new case study outlines the center’s positive experience with the benchmark for Accounts Receivable Follow-Up.

The A/R follow-up benchmark tracks how many of the cases a center has with an open balance are being followed up on each month. The gold standard expectation is that biller/collectors follow up with the payer for at least 95% of all the open claims every month.

The case study 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 the addition of high reimbursement procedures have 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.

Erin Petrie, Regent RCM’s Director of Revenue Cycle Management says: “This metric allows us to drill down into the actual collector’s performance, versus just the center’s performance. A center might have a great month and collections are up through the roof, but that’s not necessarily a reflection of the efforts of that collector. Whereas your follow up, how many claims you’re touching every month, reflects your work.”

Want to learn more? Read the full case study here.

Adding a Specialty? Make Sure Contracts Support Profitable Reimbursement

As ambulatory surgery centers (ASCs) change and grow, they add new specialties. Making sure contracts keep up with these changes is critical to ongoing success. Andrea Woodell, Regent’s vice president of managed care, has extensive experience negotiating payer contracts – and helping ASCs keep them current. In this final blog in a 3-part series, she shares tips for specialty-specific contracts.

“As surgery centers age, physician partners come and go, and new specialties are frequently introduced,” Woodell says. “Many ASCs are actively recruiting new partners to replace physicians who have relocated or retired. When evaluating the addition of new lines of business, centers should analyze their contracts to evaluate how the new specialty cases will be reimbursed. For example, 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.”

When it is time to negotiate, Woodell advises ASCs build contracts for current specialties and consider how the contract would support added new business lines as well. Below are tips for two popular specialties, ENT and TJR:

Expanding into ENT

Adding an ear/eye, nose, and throat (ENT) specialty to your ASC can be a challenge, Woodell says, due to payer payment on multiples. She cites United Healthcare’s (UHC’s) preference to contract at 100/50/25, rolling implants into their groupers and carve outs.

“Sinus cases often bill out 6-8 CPTs (Current Procedural Terminologies) when repriced through UHC’s enhanced groupers and multiple methodology,” she says, “so these cases often end up south of Medicare payment, which is unacceptable. While the ENT CPTs are not on UHC’s standard carve out list, they will carve them out if you negotiate wisely. It is important to respect their position and take the time to build a thoughtful quantified response.”

Taking on TJR

Total Joint Reconstruction (TJR) is a specialty many ASCs would love to add, as acceptance grows for outpatients handling of these procedures. Woodell says the challenge typically faced is how to get paid fairly – rewarding the partners and facility for the additional risk they assume providing TJR in an ASC.

“What often happens is a GI (gastroenterology) center down the street will have language in a payer contract agreeing to TJR reimbursement at $12,000. They don’t think about it, because they don’t see joints. But then that payer tells the next provider that $12,000 is the market rate, proving it with the contracts they have in place.”

If it happens to you, Woodell suggests asking what TJR volume was successfully pulled from hospitals by those contracted centers who agreed to accept $12000-. Even better, know your competition and who is performing TJR. If there are no centers in your vicinity that objection can easily be overcome.

“If you have obtained EOBs (Explanation of Benefits) and know the surgeon’s current hospital site of service is paid $30,000 and the payer is only offering $15,000, ask the payer ‘Why is 20% savings not enough?’” she advises. “My argument is, ‘You are underrating the value of our service, disincentivizing surgeons from bringing cases here, and ensuring our center won’t invest in capital equipment to encourage the migration of TJR cases.’”

In addition, she suggests ASCs should not overlook tools payers themselves provide online for their members. For example, Blue Cross and Blue Shield recently published an article highlighting the variance in hospital payments within a city – this is very useful information for negotiating fair rates for outpatient joints.

“Those carriers posting rates at different venues will guide you to what the market bears, and often include the volume tied to a specific type of case. So, if you spot a lowball rate, it may be that the facility does not even provide the service,” she explains.

More Quick Contract Tips

Woodell offers additional specialty-specific contract considerations:

  • Podiatry is a specialty likely impacted by multiples – increases in hammertoe payment by Medicare within the last couple years have helped support the ASC’s position.
  • New technology in orthopedics continues to mitigate margins – rotator cuff implant costs have jumped $1000-1200 per case, taking a bite out of margins.

For more help and other tips on demystifying contract negotiations, contact Woodell here.

ASC Nurse evaluating revenue cycle

Decreasing Days Outstanding by Managing Charge and Claims Lag

Building on our latest guide where Regent RCM updated is established Key Performance Indicators (KPIs) to highlight issues and determine how well an ASC is performing compared to other ASCs, the following post examines charge and claims lag.

Managing a financially successful ambulatory surgery center (ASC) hinges on efficient revenue cycle management (RCM), yet many center administrators struggle with charge lags leading to delayed claims submissions and ultimately delayed reimbursement. Lag days contribute to an uncertain revenue cycle. One of the most effective ways to decrease days outstanding is to manage lags and turnaround time.

Charge entry lag is calculated by the number of days from the date of service to the date charges are entered. Claim lag is defined as the date of service to the charge billing date. The best practice for ASCs for both lags together is less than three days. Charges should be entered as soon as they are coded and claims should be sent the same day, so there should be no difference between the claim lag and the charge lag.

“If centers are experiencing a difference between the two lags, this is an indication that the billing department may be holding claims or entering charges but not sending them out,” stated Erin Petrie, Director of Revenue Cycle Management. “Transcription should each be completed in 24 hours – that is the gold standard.”

Coding and physician dictation may also be contributing to slow turnaround times, and those are more complicated problems to solve. “At Regent RCM we get to the root of the lag problem by running daily reports on unbilled cases and from there, our staff will begin the research to understand the source of the problem,” explained Petrie. “Whether it is coding, transcription or dictation, we arm center staff with the necessary information to put processes in place to correct the problem.”

If your center is struggling with high charge and claims lag, click here to download our latest guide, and learn how to gain more control and efficiency.

Congratulations to our Q4 Award Winners

Regent Revenue Cycle Management announced individual and team 2018 award winners for the fourth quarter recently, honoring recipients for stellar performance in accordance with the Departments’ Key Performance Indicators and company’s RISE values .

Casey Eazell was the individual winner for the fourth quarter of 2018, meeting or exceeding benchmark metrics for the quarter for Cash Collection, AR Follow-Up, and Decrease in % of AR over 90 days. Eazell was also part of the group that took fourth quarter team honors. That team, led by Manager Vianca Bautista , also included Windy Cortez, Dacia Aviles and Lorena Gonzalez. All involved were honored earlier this year for their outstanding achievements.

“We’re so proud of this group of employees,” said Leslie Favela , RCM Manager Business Development “The fourth quarter is a tough time of year in our business, and each and every one of these folks went above and beyond to deliver excellence. They truly embody team spirit and the RISE values we stand for.”

Regent RCM’s RISE values are: Respectful Caring, Integrity, Stewardship, and Efficiency.
Our team strives to leverage these principles to deliver exceptional service and value to our ambulatory surgery center clients.

Congratulations!

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