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.

Meet the Team: Kristina Bahula

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 specialist  Ana Hernandez. Today we’ll shine the spotlight on:

Kristina Bahula

Hometown: I grew up in Downers Grove, a western suburb of Chicago.

What do you do at Regent RCM?

As a Revenue Cycle Specialist, I leverage my industry knowledge and ASC-specific training to lead all aspects of billing, payment posting and accounts receivable for a surgery center located in the Midwest. I diligently monitor ASC-specific benchmarks to ensure revenue cycle efficiency.

How long have you been working at Regent RCM?

Prior to joining Regent RCM in May 2016, I worked in the business office at North Central College in Naperville, Ill. for 10 years. I enjoyed working with students and helping them navigate complicated tuition payments, tax forms and reporting. In that role, I was able to hone my financial counseling and customer service skills which I use every day at Regent RCM.

What is your favorite part about working at Regent RCM?

Regent RCM encourages continuous learning for all employees, and challenges us to delve into all aspects of the healthcare industry in order to understand its intricacies. In particular, I’ve learned so much about the ever-changing field of health insurance, and I am grateful for that opportunity. Additionally, our corporate values RISE program teaches our team respectful caring, integrity, stewardship, and efficiency; these values benefit not only our team, but our partner centers and their patients.

What has been your greatest professional achievement?

In my career, I have always strived to be a committed, reliable and positive employee who goes above and beyond what is expected. My financial expertise has garnered many successful outcomes for clients and I look forward to learning and achieving even more as I continue to grow here at Regent RCM.

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

I have a slight obsession with sea otters! Not only are they adorable, but they are able to live in the ocean and walk on land. The life lesson that I’ve learned from the otters: It is important to be versatile!

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ICD-10, One Year Later: What’s the Impact on Revenue Cycle Management?

Healthcare providers went through a massive change in billing operations last year, as the shift from ICD-9 to ICD-10 went into effect on Oct. 1, 2015.

The new coding system brought with it not only an increase in diagnostic codes (from about 14,000 to over 68,000) and procedure codes (from 4,000 to 87,000), but also an increase in operational concerns for providers. Even though the ultimate goal of ICD-10 was to improve quality reporting and outcomes measurement, and also to bring efficiency to reimbursement processes, providers around the country feared the shift would cause productivity to plummet, as well as increased denials and reduced revenue.

Other developed countries such as Canada, Australia and various countries throughout Europe transitioned to ICD-10 years before the United States, and had a rough go of it. Canada’s healthcare system, for instance, reported a 50% drop in coder activity after the implementation of ICD-10 in 2001. 

But in the United States, the numbers did not suffer nearly as much. Initially, the industry reported a decrease of only 25% in charts coded per hour. And a year after implementation, coding productivity has stabilized and now providers report only a 10-15% decrease.

Optimally-trained billing staffs reduced the chance of negative impact on healthcare facilities. To that end, Regent Revenue Cycle Management (Regent RCM) provides tenured, proven revenue cycle management to ambulatory surgery centers (ASCs) with the skills to handle ICD-10 efficiently.

“Our team understands how ICD-10 can impact each segment of the revenue cycle from claim denials to days outstanding/days in A/R,” said Michael Orseno, VP of Revenue Cycle at Regent RCM. “It has been a year since ICD-10 implementation and our team has mastered the changes and updates. Your center may have a solid business office in-house who can sufficiently handle RCM; but if not, consider transitioning to outsourced RCM services with an external provider that is fully prepared.”

If you’re considering outsourcing to optimize your center’s revenue cycle, Ed Tschan and the experienced team at Regent RCM are available to your answer questions, explore a revenue cycle audit or discuss a cost benefit analysis. Ed can be reached directly at 312-882-7228.

Meet the Team | Ana Hernandez

In our ongoing Meet the Team feature, we introduce the many members of our team who make Regent RCM so successful. Today we’ll shine the spotlight on:

Ana Hernandez

Hometown:

I was born in Central Mexico, in a little town called Jerez, Zacatecas. It is very rustic and beautiful, and the food is amazing! I came to the United States when I was 3-years-old, and was raised right here in Chicago.  I am proud to say that I became a U.S. citizen last year!

What do you do at Regent RCM?

I am a Revenue Cycle Specialist for a center in the Pacific Northwest. I leverage my industry expertise and ASC-specific training as I manage all aspects of billing, payment posting and accounts receivable. Like all of my team members, I keep a watchful eye on RCM benchmarks, carefully measuring the health of my center’s revenue cycle.

Where did you work before joining Regent RCM?

I am passionate about healthcare, and have been fortunate enough to have worked in that sector for over 20 years, gaining expertise on payer regulations on the provider side. Prior to joining Regent RCM, I worked as a Reimbursement Specialist for Midwest Orthopedics at Rush University Medical Center for six years. My duties consisted of working on accounts receivable for any state-funded or commercial insurance, and I negotiated with non-contracted insurance companies. Additionally, I would appeal claims that were denied. Before that, I spent 15 years at Neurologic and Orthopedic Institute of Chicago, also working in accounts receivable.  I was also a benefits coordinator, working closely with patients prior to their surgeries/services in case the services were not covered or there was a high patient responsibility. I am so grateful for these previous experiences, as they have given me the extensive knowledge that I have today.

What’s the best part about working at Regent RCM?

I have several favorite things about Regent RCM! Regent RCM treats employees very well and as a result, we arrive at work with a positive attitude, ready to help each other reach our goals. I have received extensive training and after I was assigned to the ASC I’m responsible for, I traveled with Leslie Favela and Michael Orseno to the center to meet the facility team, learn their policies and procedures, and determine how we could best serve them and help them be successful. I grateful for the opportunity to meet and observe the business office staff at the center, which ultimately helped ensure that all of our processes were efficient and in place.

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

I love to smile! I truly believe life is too short to be angry or upset, and it’s important to stay positive and make every day count. I think our partner centers appreciate my attitude, and it helps us work together to achieve the ultimate in patient satisfaction.

Regent Revenue Cycle Management Names Luz Renteria to Revenue Cycle Supervisor

After a year as Revenue Cycle Specialist, Renteria to assume Revenue Cycle Supervisor Position

Regent Revenue Cycle Management (Regent RCM), a leading provider of cost-effective billing and collection services for ambulatory surgery centers in the United States, today announced Luz Renteria has been promoted to Revenue Cycle Supervisor.

Luz is a 15-year veteran of the healthcare industry, she brings a wealth of experience to her role and she continues to move the needle and add value to our surgery center partners.

Renteria joined Regent RCM in 2015 as a Revenue Cycle Specialist, and was responsible for the charge entry, billing, and collections for a surgery center in the Southeast.  While she served in this role, the center’s days in accounts receivable dropped to the lowest in its history. In addition, she collected over $1 million during August 2016, which is the highest amount ever collected during the ASC’s history. As a supervisor, Renteria will lead a team of specialists who are each responsible for a center of their own.  Additionally, she will be conducting business office audits for current and prospective clients.

“I am pleased to serve in this new role alongside my fantastic team, and look forward to contributing to the growth of Regent RCM,” said Renteria. “My goals for this position are to exceed the metrics for our team, and to maintain the high standard of excellence that our company is known for.”

Renteria began her career on the payer side as a data entry specialist for a Blue Cross and Blue Shield of Illinois fund office. She then transitioned to the provider side a decade ago, and most recently managed a patient accounts office for University of Illinois Hospital & Health Sciences System in Chicago.

revenue cycle management

3 Secrets to Successful ASC Revenue Cycle Management

Effective ambulatory surgery center (ASC) revenue cycle management can be hard to achieve, particularly as internal and external forces exercise their influence. According to Regent RCM’s Director of Revenue Cycle Management Erin Petrie, ASCs that pay attention to three key success factors are well-suited for the challenge.

“The first key success factor is driven by the healthcare industry’s shift toward value-based care,” Petrie says. “While assuming reimbursement risk from payers along with the responsibility to provide quality care has created some uncertainty and challenges for ASCs, managed care is in better hands. ASCs are equipped to both deliver quality care and manage costs more effectively than insurance companies ever were. But to be successful in revenue cycle management (RCM), ASCs need to become more adept at both managing costs and collecting additional revenue directly from patients, many of whom have selected healthcare insurance plans with lower premiums but higher deductibles.”

Another factor is also closely related to the evolution of value-based care. While many ASCs are succeeding at streamlining procedures and costs for procedures new to out-patient treatment, such as total joint replacement, payment bundling and reimbursement declines introduce new pressures. For example, payers are beginning to scrutinize payment of high-cost implant procedures and are driving a hard bargain when it comes to bundled payment agreements. As ASCs assume leadership of these bundles, a second key success factor is careful negotiation along the way. “You need to be diligent – check your costs, factor in economies of scale but also account for patient-driven variation, and renegotiate contracts annually,” Petrie suggests.

A third way to ensure successful RCM is to optimize business office staffing. “The best-run ASCs make sure their RCM staff is motivated and incentivized to aggressively pursue revenue, rather than just remaining content with the status quo,” Petrie says. “If an ASC’s staff is accepting only what the insurer pays and not fighting for what the center is contractually entitled to or higher than ‘usual and customary,’ that particular facility may be leaving a lot of money on the table.”

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ASC Revenue Cycle August Industry News Wrap-Up

Each month Regent Revenue Cycle Management (Regent RCM) explores the top news and headlines affecting the health care industry. This month in the news: An editorial discusses the importance of effective infection and outcome metrics for ASCs; North Carolina attempts to repeal its certificate of need legislation; and a Regent Surgical Health Vice President of Managed Care reveals fundamentals for day-to-day payer negotiations.

Editorial: The need for effective infection & outcome metrics to propel the ASC industry forward

As healthcare continues to move to the outpatient setting, the ASC industry needs to have systems in place to measure quality outcomes in order to thrive, writes Dr. Donald Fry, executive vice president for clinic outcomes management for MPA Healthcare Solutions and an adjunct surgery professor at Chicago-based Northwestern University Feinberg School of Medicine. Click here to read more.

North Carolina moves to repeal CON legislation

A North Carolina state senator has added a CON repeal proposal to House Bill 161, which would repeal North Carolina’s controversial certificate-of-need legislation. Experts say the state’s CON law for ambulatory surgery centers has costly repercussions for patients and insurers, and that repealing the CON laws would give patients more treatment options, thereby improving quality of care. Click here to read more.

Managed Care ABCs for Day-to-Day Payer Negotiations

As new payment models continue to emerge, one of the critical mistakes that ambulatory surgery centers (ASCs) make is not paying attention to the day-to-day management of payer contracts. Andrea Woodell, Vice President of Managed Care at Regent Surgical Health, says that even as MACRA (Medicare Access & CHIP Reauthorization Act) drives healthcare to performance targets, it will take some time for those changes to take full effect. Click here to read more.

revenue cycle dashboard

Managed Care ABCs for Day-to-Day Payer Negotiations

While Medicare’s recent changes and emerging alternate payment models are top-of-mind for many in the healthcare industry today, it is equally important to pay attention to the day-to-day management of payer contracts.

According to Andrea Woodell, Vice President of Managed Care at Regent Surgical Health, even as MACRA (Medicare Access & CHIP Reauthorization Act) drives healthcare to performance targets it will take some time for those changes to take full effect. Meanwhile, healthcare facilities can’t lose sight of their routine negotiations. “It’s not magic, it just takes constant attention,” Woodell says. “One of the biggest mistakes that many centers make is not renegotiating contracts annually, or entering into multi-year contracts without factoring in incremental increases each year.”

Many ambulatory surgery centers in the industry do not revisit and renegotiate their managed care contracts annually to maximize their payments. Keeping reimbursement contracts current is critical for ongoing financial health of most centers. “If you’re not getting at least a 3% increase each year, you’re probably falling behind,” Woodell explains. “We advise centers to look at contracts annually. Identify the facility team member with the correct skill set and align their incentive plan to reward annual payer negotiations and go get those increases!”

Even for standalone surgery centers in saturated markets with no hospital partners, Woodell says, it is possible – and important – to negotiate minimum annual increases of 3%. SWB, new technologies and medical instrumentation, and implants drive up the cost of surgery every year. “I am working on a new project with development reviewing a center’s agreements for the lift I can bring; one of the contracts was last negotiated in 2002 and pays well below Medicare. If the agreement had been touched annually their payments could be 40% higher for that payer.”

Woodell outlines two key steps for centers looking to do a better job in this important area:

“One strategy we’ve found to be effective, is to involve a surgeon in the negotiations. Elevating the negotiation beyond your financial counterpart at the payer organization changes the dynamic. If you have your surgeon contact the VP over ancillaries on the payer side, it can completely change the conversation and may have the power to take you from a 3% increase in a contract year to 10 or 15%.”

Another of Woodell’s recommendations is to pay attention to your facility’s relationships with payers. “These relationships are more important than ever,” she says. “If they don’t like you, not only will they not help you, they will hurt you. – A good relationship with a payer means you understand their challenges as much as you want them to understand yours, and you help them help you by giving them good, objective data that they can take on to their interior team to help you achieve what you’re asking for.”

The bottom line in these contract negotiations, according to Woodell, is to demonstrate the value and cost savings that you’re providing to payer organization. Focused attention, surgeon involvement and strong relationships within the infrastructure of payer organizations can improve results beyond the standard response of “No, all I can do is 2%.”

To learn more about payer negotiations and how Regent RCM can help, contact 312-882-7228.

Revenue Cycle

Regent RCM and ZirMed Partner to Improve Revenue Performance

Authored by Vice President of Revenue Cycle Michael Orseno, Regent Revenue Cycle Management (RCM) this week released an article that outlines five ways in which Regent RCM and ZirMed combine to improve revenue performance.

“The ASC revenue cycle is complex and we both know that. Through our partnership, we leverage our expertise and provide ASCs with the support and technology needed to effectively manage the revenue cycle,” said Orseno. “With this article we drill down on five keys to getting paid quickly and efficiently.” Strategies include:

  1. Verify insurance coverage.
  2. Code claims correctly the first time.
  3. Minimize claim denials.
  4. Act quickly against denials.
  5. Arrange for/Collect patient out-of-pocket expense up front.

“Surgery centers need revenue cycle strategies that work and together with ZirMed, we deliver breakthrough revenue cycle management solutions that enable partner centers to collect every dollar they are entitled to,” added Orseno.

The article, Regent RCM, ZirMed Work Together to Solve ASC Revenue Issues, appears exclusively online at Becker’s ASC Review. Click here to read the full article.

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