Billing Mistakes and How to Avoid Them: Part 2

An ambulatory surgery center depends on an efficient revenue cycle management process for financial and operational stability. Because the revenue cycle involves complex and overlapping processes, an ASC needs a revenue cycle solution that can manage everything from billing and collections and payer contract negotiating to measurement and reporting and automated workflow tasks.

Billing mistakes can cause serious problems for an ASC, interfering with its immediate cash flow and long-term financial health. In a recent post, Regent RCM outlined prevention tactics for four common ASC billing errors. The second part of this series will examine four additional billing mistakes and how to avoid them.

  1. Not Reconciling Billing

It is crucial for ASCs to monitor patient files carefully, making sure that all performed procedures are billed and followed up on. Unbilled procedures result in lost revenue, damaging a center’s revenue cycle. Similarly, cases that are denied or rejected by the payer must be properly appealed or processed.

Solution: Utilize a system that tracks all performed cases and ensures that they are billed out within a certain timeframe. Use automated tools as much as possible, setting up notifications and reminders to follow up on claims or make edits as necessary.

  1. Neglecting to Appeal Claims

Inaccurate payments are unfortunately commonplace within the revenue cycle. The real problem arises when ASCs fail to appeal incorrect or incomplete payments in a timely manner. If a center doesn’t maintain a quick and streamlined appeals process, it can fall into harmful patterns and struggle to meet its financial goals.

Solution: Address flawed payments right away, setting a specific turnaround for sending out appeals. Regent RCM’s standard is to appeal all under- and no-pay claims within 24 hours.

  1. Not Measuring Performance

Unidentified problems can’t be fixed. Kept busy with day-to-day responsibilities, ASCs often neglect to monitor key performance metrics of their revenue cycle – and any problems with net collection rates, A/R days, or statement, charge, or claim lags remain unresolved.

Solution: Implement measurement and reporting software to track specific benchmarks in the revenue cycle. Gauge the current health of the ASC’s performance, and set goals going forward. For example, the Regent RCM gold standard net collection rate is a minimum of 97%.

  1. Errors in Payment Posting

Erroneous payment posting can lead to confusion and financial losses for an ASC. A simple mistake, such as a typo in a payment amount, has a domino effect: an incorrect patient responsibility and billing statement, back-and-forth communication with the patient, a statement adjustment, and so on.

Solution: Check that all billing, payment, and collection information reconcile properly. If it is a challenge to manage the process with in-house staff, outsource it to a company with expertise in revenue cycle management. Regent RCM uses sophisticated software to post payments, ensure that they are paid according to contract, and turn over bad debts to collections.

Need expert assistance in improving your revenue cycle management? Contact Regent RCM

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.

What is Regent RCM’s RISE Program?

Regent Revenue Cycle Management (RCM) is a values-driven company. We are committed to upholding our high industry standards and providing essential services to our ASC clients, all while staying true to our fundamental ideals.

We created the RISE program as a way to integrate our core values into every aspect of Regent RCM’s corporate culture, including how we lead our employees, how we nurture our client relationships, and how we meet and exceed our shared goals.

RISE stands for:

  • Respectful Caring
  • Integrity
  • Stewardship
  • Efficiency

Our team strives to leverage these principles to deliver exceptional service and value to our ambulatory surgery center clients. Here’s a little more about each of the RISE values.

Respectful Caring

Compassion is central to Regent RCM’s mission, and our employees exercise it consistently with clients, patients, and other team members. Regent RCM’s revenue cycle professionals are friendly, responsive, and helpful in communicating with all stakeholders. They supply information, answer questions, listen to feedback, and act promptly to serve patient and client needs.

Integrity

We cultivate an environment of commitment, accountability, and honesty – reflecting our beliefs through our actions and words. All of our employees take pride in their work, striving to perform their responsibilities reliably, and go above and beyond expectations. Regent RCM welcomes open communication, celebrating successes and resolving challenges with transparency.

Stewardship

Regent RCM isn’t satisfied to maintain the status quo; our team aims to foster growth and advancement throughout the company. We develop new procedures, educational programs, and quality improvement initiatives to move toward our long-term goals. We also treat our employees as our most valuable asset, hiring people who are passionate about Regent RCM’s work, and offering ongoing mentorship and professional development opportunities to elevate their capabilities.

Efficiency

We identify, select, and manage our company’s resources to achieve the most affordable and effective results for our stakeholders. Regent RCM utilizes a proactive approach to determine the technology, systems, and equipment that will improve processes while lowering costs. We are always looking for innovative solutions to help us manage our time and complete our tasks more efficiently.

Learn more about Regent RCM.

Internal Auditing for ASCs: Are You Receiving Maximum Revenue?

How would you rate the overall financial health of your ambulatory surgery center?

Are you producing maximum revenue – or are you running into obstacles that interfere with your profitability?

As an ASC administrator, you have an extensive to-do list on any given day. However, it’s important to make time to step back and look at your big-picture financial goals and processes.

Conducting an internal revenue cycle audit is an effective way to evaluate your ASC’s operations, identifying financial stress points, strengths, and opportunities. An internal audit examines, quantitatively and qualitatively, all components of the revenue cycle process. It helps you ask the right questions to reveal what is working and what can be improved, helping your center get on track and stay on track.

If you’ve noticed negative changes in important benchmarks, such as accounts receivable days, net collection rates, or statement and charge lags, a revenue cycle audit may be the best course of action.

According to Regent RCM’s Director of Revenue Cycle Management Erin Petrie, a successful self-audit focuses on four main financial areas of an ASC:

Reimbursement

Do a thorough examination of your center’s billing and reimbursement procedures, paying close attention to payer contracts and total revenue collected.

Coding and Billing

Evaluate coding procedures, whether your ASC has a certified coder on staff or outsources services. Determine if cases are coded and billed correctly, identifying inaccuracies that could delay, reduce, or invalidate claims.

Staffing

Assess how administrative employees spend their time and what causes their pain points. What

facilitates smooth operations? What requires excessive time or effort to accomplish?

Observation

Scrutinize business office functions over time, noting recurring inconsistencies or inefficiencies. Look for solutions, through technology or processes, that could address these problems.

To help you get started, the experts at Regent Revenue Cycle Management have developed a free guide, “How to Self-Audit and Improve Your ASC’s Financial Health.” It takes an in-depth look at key revenue cycle functions, giving you the information you need to keep your ASC within compliance while producing maximum revenue. Download the full guide here.

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.

3 Tips to Maximize Surgery Center Billing and Coding

Regent RCM’s gold standard for days outstanding is 30 days or less, although the right number for a center could range from the mid- to high teens all the way up to 50, depending on payer mix and case mix. In this blog post, we’ve summarized 3 ways to keep days outstanding in check.

Manage Lags and Turnaround Time

Claims should always be sent the same day charges are entered, so the claim lag should be the same as the charge lag. If centers are experiencing a significant difference between the two, this is an indication that your billing department may be holding claims or that they’re entering charges prior to receiving the operative report. Managing lags and turnaround time is one of the easiest ways to decrease your days outstanding. “The charge entry lag is measured from the date of service to the date charges are entered. The charge entry lag should be less than five days, with the gold standard being less than two and a half days.” Said Erin Petrie, Regent RCM’s Director of Revenue Cycle Management.

Conduct Periodic Coding Audits

It is extremely important to conduct periodic coding audits by an outside coding company, whether your center outsources its coding services or employs a certified coder. “Regent coordinates bi-annual audits on all of our centers using an outside firm. By doing so, we eliminate the conflict of interest a regular coding company may have in finding coding errors in the hopes of gaining additional clients. All centers should be held to an acceptable standard above 90 percent accuracy but be given a chance to rebut coding inaccuracies found during an audit,” said Petrie.

Some disparities found during our coding audits center around what was performed during the procedure and what was dictated. Sound coding practice is to always code from the operative report and not from the procedure.

Choose the Right Clearinghouse

Choosing the right clearinghouse can make a significant difference in the efficiency of your business office. Most clearinghouses can send electronic claims and receive electronic remittance (ERA). ZirMed and others set themselves apart by performing electronic eligibility in either batch or individual mode, providing real-time statuses and having the ability to setup center-defined, custom claim edits. In addition, ZirMed rolled out a new enhancement recently which allows some of our centers to send worker’s comp claims, traditionally sent on paper, electronically by matching up a scanned operative report to the electronic claim. This has caused a decrease in our A/R greater than 90 days for worker’s comp, which is habitually one of the more challenging financial classes.

Keeping days outstanding to a minimum is a worthy task for all ASCs, one that requires constant diligence and strong organizational efforts from everyone involved in the process. The fruits of this labor can lead to steadier collections, a more organized business office, and more integrity in your reporting data

Learn more about Regent RCM’s expert billing and coding services for ASCs

Meet the Team: Ariana Cisneros

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 Gina Rice-Hill.  Today we shine the spotlight on:

Ariana Cisneros

Where is your hometown? Born and raised in Chicago

What do you do at Regent RCM? As a revenue cycle specialist, I help with self-pay for a couple of centers, calling patients to resolve their balances, and help with any billing questions they might have. I’m also training for insurance verification. After that I will hopefully take over responsibility to do billing, posting, and a little bit of everything for a center. I’m looking forward to learning lots of new things!

How long have you been working at Regent RCM? I’ve been with Regent RCM for about a month and a half now.

Where did you work before joining Regent RCM? Before making my way to Regent, I was working at Loyola University Medical Center in the billing customer service area.

What is your favorite part about working at Regent RCM? So far, my favorite part is having great coworkers that who’ve welcomed me onto their team. They’ve been very accommodating and have offered their help more times than I can count. It is always great to feel welcomed and see that at the end everyone works as a big team.

What has been your greatest professional achievement? I’m not sure what has been my greatest professional achievement as of yet, my mindset is to work hard every day and continue to out do my greatest achievement on a consistent basis. My goals are to be a great employee, work hard and be a good team member in order to help Regent RCM achieve its goals.

What is one fun fact about yourself your co-workers don’t know? A fun fact about myself is I love doing crafts, I like baking and I also enjoy decorating around my house or even helping decorate special events. I like being creative!

4 Reasons ASCs Fail and How to Manage for Success

While many trends in healthcare today point to the value of outpatient care, ambulatory surgery centers can still falter if they fail to actively manage risk in critical areas. The experts at Regent Revenue Cycle Management have observed four common mistakes, and together with Regent Surgical Health, can help centers turn each challenge into an opportunity for growth.

  1. Poorly Managed Contracts
    ASC administrators face a variety of challenges when it comes to successfully managing their payor contract negotiations. One common problem is that often hard-working and well-intentioned administrators and office managers are too busy balancing numerous job responsibilities to dedicate the needed persistence and focus required to successfully negotiate expiring payor contracts. But with careful preparation, ASC administrators can keep more money to reward and fuel center growth by negotiating payor contracts that will adequately cover the full cost of services and ultimately streamline healthcare costs for all. Key strategies include: incorporating Centers for Medicare & Medicaid Services (CMS) changes into contracting, planning for future case mix changes and updated procedures, building in annual increases and multi-year contract increases, and overall caution/careful attention to terms when it comes to preferred provider organizations (PPO) and third-party administrators (TPA).
  2. Skyrocketing Costs
    Monitoring expenses and tracking trends are essential to managing costs. For example, if a center is losing money on unprofitable cases and inefficient supply management, tools that help keep administrators in the know can help immensely. To address this problem, Regent has spearheaded solutions like the use of electronic preference cards to replace old, less precise metrics. Electronic preference cards provide a wide swath of data, as information is collected and compared across member facilities to get a clear picture of supply expenditures. This allows surgery centers to discern which physician items are driving up costs, and find out where real savings can be captured. In addition, Regent has found that integrating the information with the help of electronic procurement systems like Inventory Optimization Solutions (IOS) helps ASCs better manage costs throughout a single center as well as throughout the entire organization.
  3. Failure to Bring in High-Reimbursement Cases
    To succeed in an era of tightening reimbursement practices, an ASC needs to stay ahead of the competition by adding profitable procedures that may not be available elsewhere, or risk losing such cases to the competition. Procedures with potential to deliver strong profits include (among others) major spine cases and total joint replacements (TJR). Moving TJR surgeries to an ASC makes sense for many reasons, both clinical and financial. It is important to first assess outcomes on an inpatient versus outpatient basis to see whether the results vary by setting type or provider.
  4. Revenue Cycle Management
    The way an ASC manages the revenue cycle can make or break its profitability. And with the Affordable Care Act, Medicare and Medicaid payment bundling, and updated ICD-10 guidelines looming, the revenue cycle landscape is changing at a rapid pace. Specialized expertise is required to ensure optimal results while anticipating new opportunities, and revenue cycle management can’t be an afterthought. The team Regent RCM understands the intricacies of the ASC revenue cycle, where problems commonly occur and how to fix them, as well as how to optimize reimbursement.

Are you interested in auditing your operations to ensure your ASC is maximizing revenue? A self-audit guide is available download here and will help identify your center’s financial stress points, strengths, and opportunities.

Meet the Team: Gina Rice-Hill

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 Lisa Thomas.  Today we shine the spotlight on:

Gina Rice-Hill

Where is your hometown?

Born and raised in Downers Grove, IL, just outside Chicago.

What do you do at Regent RCM?

As a revenue cycle specialist, I work with a surgery center to handle their billing, payment posting, and accounts receivable. This allows me to focus my efforts to a single client, giving them 100% of my expertise and attention.

How long have you been working at Regent RCM?

I’ve been with Regent RCM for about a year now.  Preceding my work here at Regent RCM I worked with ATI physical therapy as an accounts receivable specialist.  Before that I worked as a patient account representative and financial analyst for a national operator of surgical facilities.

What is your favorite part about working at Regent RCM?

We’re a team here a Regent RCM and our team has a willingness to help each other; that’s hard to find in most workplaces, not here. It’s part of our culture, defined by our R.I.S.E. program. This has helped me to grow as a professional and as a person.

What has been your greatest professional achievement?

I don’t know if I can point to a single event that has been my greatest professional achievement, but I can point to my main motivator as an accounts receivable specialist – my drive to exceed clients’ expectations. I like knowing that I am preforming my job at the highest level possible and I am always trying to grow and improve, I take great pride in this.

What is one fun fact about yourself your co-workers don’t know?

Like a lot of people in Chicago, I’m a huge sports fan!

4 Coding & Billing Best Practices

Erin Petrie, Director of Revenue Cycle Management at Regent RCM, has worked in the medical field for nearly a decade, specializing in hospital administration and revenue cycle management. She draws from her experience to share best practices to help billers and coders manage a successful revenue flow.

  1. Verify patient information.

Prepare or update patient files in advance of their appointments. Check benefits and eligibility, making sure you have accurate information on factors such as copayments, deductibles, and balances due. Patients aren’t always aware of details related to their medical insurance – for example, if their employer has switched insurance companies, or if they need a referral from their general practitioner before seeing a specialist. Verify that the procedure code is billable under the patient’s insurance plan.

  1. Clarify patient financial responsibility.

Train your staff to communicate with patients about what payments they are responsible for. Make your ASC’s payment policies clear; ask front desk staff to confirm them when scheduling appointments, and post them in a visible area near check-in. Collect copay or co-insurance from patients at the time of service, and require payments toward past balances before scheduling new procedures.

  1. Submit correct claims the first time.

Be meticulous in producing error-free claims. Submitting an insurance claim, only to have it rejected, fixed, and resubmitted, can delay a payment by weeks or months. Avoid this frustrating cycle by double-checking claims for any errors in patient, provider, insurance, or billing information.

  1. Use proper codes and modifiers.

Go through each claim with a fine-tooth comb to confirm that you are using the appropriate codes for the services provided. Follow a standardized process to check information and minimize errors. Have you included all the necessary procedure and diagnosis documentation? Are you using the correct modifier for a procedure’s specific circumstances? Attention to detail in coding is critical for fast and accurate claims processing.

Learn more about Regent RCM’s expert billing services for ASCs.

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