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.

Meet the Team: Alejandra Perez

In our ongoing Meet the Teamfeature, 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 Ivette Gomez. Today we’ll shine the spotlight on:

Alejandra Perez

Where is your hometown?  I hail from Cicero, Illinois.

What do you do at Regent RCM? I work as a Revenue Cycle Specialist for one of clients in the Midwest, giving them my focused attention to help enhance their cash-flow process while continuously measuring performance metrics and improving collections.

How long have you been working at Regent RCM? I joined Regent RCM in Spring 2017 after working for Allstate Insurance for six years.

What is your favorite part about working at Regent RCM? When I interviewed for the Revenue Cycle Specialist position there was a lot of talk about how important a positive work environment is to Regent RCM – and it really is true. At Regent RCM, are guided by a values-driven culture that aligns our team in a positive way and helps us stay focused on our goal of leveraging our ASC expertise while providing consistent service and expertise to our clients.

What has been your greatest professional achievement? In our business there will always be hurdles and challenges. I enjoy not only coming up with solutions, but making sure that I stay positive, and I take pride in my approach.  I have always been passionate about dealing with customers and patients and I’ve found that a positive approach allows for an overall pleasant experience, regardless of the situation.  

What is one fun fact about yourself your co-workers don’t know? I love to interact with others on a personal level. I see myself as someone who can help people turn a negative into a positive.  Another passion is cooking; I may not be the world’s greatest chef but my kitchen is certainly the place to be at dinnertime.

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.

Protect Reimbursement 4 Ways as Payers Narrow Payable Diagnosis Codes

For ambulatory surgery centers (ASCs), it’s a “perfect storm” story: the number of Americans with knee osteoarthritis has doubled since the mid-20th century, affecting 19% of those 45 and older, and continues to grow as our population ages. Meanwhile, insurance companies are narrowing payable diagnosis codes for treatment in their drive toward value-based care. Today, surgeons need to prove patients have a very specific diagnosis of knee osteoarthritis before payers will preauthorize surgery, as “knee pain” is no longer an acceptable criterion for approval for many payers.

To help ensure ASCs avoid negative financial consequences of these trends, the experts at Regent Revenue Cycle Management have identified four key steps to protect reimbursement against denied preauthorization and payment when it comes to surgery related to knee osteoarthritis.

  1. Get the Diagnosis Right – As payers narrow the payable diagnosis codes, ASCs need to be aware of payers’ coverage and preauthorization guidelines, ensuring surgeons are aware of and using the acceptable diagnosis codes for each payer to indicate specific diagnoses. Aetna, for example, considers patients with mild-to-moderate osteoarthritis, with knee pain as well as mechanical symptoms, to be candidates for arthroscopic debridement based on medical necessity, but the payer considers the same surgery for persons with osteoarthritis presenting with knee pain only to be experimental. ASCs also should be sure to follow through with claims the physician’s office submits after preapproval so the diagnosis codes match.
  2. Negotiate to Avoid Preauthorization Denial – Since little recourse is possible after a preauthorization is denied, ASCs that include carve-outs for certain diagnosis codes when they negotiate payer contracts are a step ahead. Do this by pulling together evidence-based literature and letters justifying specific procedures and data on their cost and medical necessity to present to the insurance companies during the negotiation. Groups like the American Academy of Orthopedic Surgeons also provide resources on medical necessity and coverage for certain diagnoses. It is also important to stay current on updates to insurance company coverage, and to update your contracts to avoid losing ground.
  3. Track Processed Claims, Audit Payment Patterns — Especially for orthopedic and spine procedures, many orthopedic and spine codes aren’t clearly defined. Know them well, and keep track of processed claims against each. In addition, regular audits can help detect patterns such as minor errors responsible for denials or underpayment, and prevent similar future issues. Be sure to focus on both diagnosis codes used as well as final payment as you audit. Details matter, so consider having a professional revenue cycle management organization like Regent RCM review your contracts and help with the audit.
  4. Bundled payments – As ASCs experiment with new payment models that are directly tied to diagnosis, such as bundled payments, understanding the codes becomes even more important. Recent studies show 80 percent of payers find bundled payments appealing, and providers are beginning to embrace the new model as well. Make sure to stay apprised of any new changes or requirements that occur within the bundles, and the ASC and affiliated physicians are providing the right documentation and verification for the value-based reimbursement — if the diagnosis code is incorrect, the surgery won’t qualify for the bundled payment and the ASC could lose money.

For additional information on protecting reimbursement in today’s evolving healthcare payment environment, call Erin Petrie, Regent’s Director of RCM at (708) 492-0531 or visit www.regentrcm.com.

Focusing on Stewardship: Regent RCM’s R.I.S.E. Program

Regent Revenue Cycle Management’s R.I.S.E. program was created to develop a values-driven culture that helps us stay focused on our goal of leveraging our ambulatory surgery center (ASC) expertise, while providing consistent high-value customer service to clients.  While at the same time creating an environment that sets up our employees for successful and rewarding work.

In a four-part series, we’re highlighting our four corporate valuesRespectful Caring, Integrity, Stewardship, and Efficiency.  In part three of our series, we look at Stewardship, the responsibility to properly utilize and develop our people, property and assets while fostering a safe and secure environment.  This approach is a key part of why we can consistently outperform industry benchmarks and allow our clients to focus on high-value activities.

Stewardship is defined by Regent RCM as the ability to excel in five essential skills.  In summary, these skills are:

  1. Mentor others to promote personal and professional growth.
  2. Regularly provide information to create enterprise understanding around the clinical and economic performance of our business.
  3. Communicate difficult information in any direction to improve our business.
  4. Comply with both regulatory requirements and institutional policies and procedures.
  5. Promote and participate in quality improvement initiatives.

Our value based culture is crucial to ensure we consistently provide innovative, cost-effective billing and collection services for surgery centers.  It guides us in all that we do and is fully incorporated into how we effectively lead our employees.

Are you interested in working with Regent RCM?  Contact us today to learn about how you can join our team and make a valuable contribution to our partner centers.

Learn more about our first two parts of our R.I.S.E. Program:  Respectful Caring and Integrity.

Regent RCM Launches New Guide Empowering Surgery Center to Self-Audit Operations

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. Regent Revenue Cycle Management (Regent RCM), a leading provider of innovative, cost-effective revenue cycle management services exclusively for ambulatory surgery centers nationwide, recently published a new self-audit guide to help center administrators audit operations to ensure their ASC stays within compliance while producing maximum revenue.

“Conducting a self-audit is the fastest way for centers to get on track and stay on track,” says Erin Petrie, Director of Revenue Cycle Management at Regent RCM. “A routine audit gives your center the mechanism it needs to ask and answer the questions that lead to stronger financial health.”

Revenue cycle management for a surgery center is complex. In the guide, How to Self-Audit and Improve your ASC’s Financial Health, Regent RCM experts suggest ASC administrators examine four areas affecting the financial function of an ASC: reimbursement, coding and billing, staffing, and observation (workflow and process).

In addition, to bring clarity to surgery center billing, Regent RCM’s Petrie suggests centers monitor ASC-specific benchmarks such as accounts receivable days, net collection rate, statement lag and charge lag, for information to trigger a new audit.

“When you notice negative changes in important benchmarks, a business office audit can be the best course of action,” Petrie contends. “A full business office audit examines both quantitatively and qualitatively all components of the revenue cycle process to determine strengths and weaknesses.”

Click here to download the free guide.

Revenue Cycle Analysis

4 Key Areas Analyzed During a Business Office Audit

Ambulatory surgery center (ASC) administrators are charged with improving their ASC’s financial health and periodic business office audits are key to identifying, both quantitatively and qualitatively, a center’s strengths and opportunities.

On the surface, an audit sounds intimidating. But according to Michael Orseno, VP of Revenue Cycle at Regent RCM, it doesn’t have to be that way.

“We want our centers to maximize revenue and a routine audit is the fastest way to get on track and stay on track,” said Orseno. “The audit identifies issues – then working with our partner centers, we implement strategies and processes to correct them; it’s that simple.”

A Regent RCM audit goes beyond a traditional reimbursement assessment by examining four areas vital to the function of an ASC: reimbursement, coding, staffing and observation (workflow and process).

  1. Reimbursement. Regent RCM conducts a thorough review of a center’s billing and reimbursement procedures, including reviewing payor contracts. “Ensuring that an ASC is being reimbursed the full and correct amount per each procedure code for every case is one of the most important billing practices to maximize revenue for the center,” said Orseno. “Due diligence is crucial and for our partner centers, our team of revenue cycle specialists are intimately familiar with every payor contract.”
  2. Coding and Billing. Whether a center outsources its coding services or employs a certified coder, Regent RCM’s audit evaluates coding, determining if cases are coded correctly and billed properly. “We watch for inaccurate modifiers, which can negate or reduce payment on an otherwise clean claim,” noted Orseno, “and when applicable, we pay particularly close attention to implant coding errors.”
  3. Staffing. More business office staff does not always equal more efficiency, and striking a balance is difficult. Regent RCM’s audit diligently tracks business office FTEs in all of its facilities and compares facilities against the gold standard.
  4. Observation. Regent RCM’s expertise comes from exclusively developing, executing and refining revenue cycle management strategies. “Leveraging our collective experience, our team observes business office functions and processes and looks for inconsistencies and efficiencies,” said Orseno. “For example, a front office employee may be spending vast amounts of time verifying insurance benefits when this can be accomplished more efficiently with the use of technology.”

To learn more, read a case study revealing how an audit uncovered coding errors which led to recouping more than $590,000 in additional funds.

A recent blog highlighted what to expect from a business office audit, including Regent RCM’s methodology. Ready to schedule an audit for your center? Call (312) 882-7228 today.

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.

Revenue Cycle Management Solution

4 ASC Revenue Cycle Things to Know This Month

Each month Regent Revenue Cycle Management (Regent RCM) explores the top news and headlines affecting the ambulatory surgery center (ASC) industry. This month in the news: St. George Surgical Center in Utah is committing to price transparency; The number of anterior cervical discectomy and fusion (ACDF) surgeries is rising as a result of the growing elderly population in the country; Four important legislative changes that impact ASCs; and a trio of ways to maximize reimbursement through anesthesia.

St. George Surgical Center is Appealing to Consumers through Price Transparency

As consumers seek low-cost, high-quality care, St. George (Utah) Surgical Center tells patients how much a procedure will cost before it is performed, which may be a trend that takes hold during healthcare’s continuing shift toward value. Click here to learn more.

Outcomes of Spine Surgery in an ASC

According to Dr. Anthony Asher, ASCA board member, director of the Neuroscience Institute at Carolinas HealthCare System and a senior partner at Carolina Neurosurgery and Spine Associates in Charlotte, North Carolina, the number of anterior cervical discectomy and fusion (ACDF) surgeries continues to rise as a result of the growing elderly population in the country and can be performed as safely as in an inpatient hospital setting . Click here to read more.  

Four Legislative Changes Impacting ASCs

CMS is bringing forth some changes that ASC leaders should note including an increase in ASC payment and 10 codes added to the ASC payable procedure list. Click here to read more.

Three Ways to Maximize Reimbursement through Anesthesia

As healthcare continues down the path of value-based care, ASCs take on more financial risk and must find ways to maximize reimbursements by improving performance regarding CMS’ ASCQR measures. Here are a trio of aspects of anesthesia to assess for quality. Click here to read more.

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ASC Revenue Cycle October Industry News Wrap-Up

Each month Regent Revenue Cycle Management (Regent RCM) explores the top news and headlines affecting the healthcare industry. This month in the news: The new MACRA final rule released by the Centers for Medicare and Medicaid Services (CMS) contains aspects that will impact ASCs; A new editorial weighs the pros and cons of “condiminiumizing” ASCs; Key specialties coming for ASCs next year; And a Deloitte survey reveals that a large number of physicians are still paid under fee-for-service payment model.

MACRA Final Rule Released

On Friday, October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) released its final rule that established the new Medicare payment methodology for physician services furnished under Medicare Part B, known as the Quality Payment Program (QPP). The rule contains many components that will impact ASCs. The QPP was enacted in 2015 as part of the Medicare Access and CHIP Reauthorization Act (MACRA) and has two participation options for physicians: The Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). Reporting for the first year of the QPP begins in 2017. Click here to read more.

ASCs: To Be or Not To Be “Condominiumized”

In an editorial, Stephen Sheppard, CPA, COE, reveals the pluses and minuses around the concept of “condominiumizing” ambulatory surgery centers (ASCs). This model involves separating a single physical ASC plant temporally among two distinct legal entities. For example, ASC-A could operate on Monday, Wednesday, and Friday, while ASC-B could operate on Tuesday and Thursday. Sheppard outlines the opportunities and obstacles. Click here to read more.

Key Specialties Coming for ASCs in 2017 

Ambulatory surgery centers are performing higher acuity cases and presenting opportunities for the healthcare system to provide quality care for patients at a lower cost. Paul Eiseman, vice president of business development at Regent Surgical Health, shares insights into specialties that have fared well in the ASC space and what is in store for 2017. Click here to read more.

Deloitte Survey: 86% of Physicians Are Still Paid Under Fee-For-Service Payment Model

Deloitte’s “2016 Survey of U.S. Physicians” survey has revealed that many physicians are reimbursed under a fee-for-service model instead of the value-based system in which providers are paid according to outcomes. Click here to read more.

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