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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.

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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.

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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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ASC Revenue Cycle July 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: A new infographic details changes that the U.S. Department of Health and Human Services has implemented for payment models; A pair of funding opportunities that will establish an Information Sharing and Analysis Organization; Becker’s Hospital Review has chosen 15 revenue cycle management leaders to know; And the release of the 2017 proposed Medicare payment rates for ASCs by the Centers for Medicare & Medicaid Services.

Changes come to revenue cycle management in new value-based environment

The healthcare landscape continues to shift from volume to a value-based healthcare model. A new infographic details changes that the U.S. Department of Health and Human Services has implemented for payment models. Click here to read more.

HHS to fund cybersecurity information sharing organization

To provide more threat and information sharing and improve cybersecurity awareness, HHS, ONC and the Assistant Secretary for Preparedness and Response announced a pair of funding opportunity announcements to establish an Information Sharing and Analysis Organization. Click here to read more.

15 Revenue Cycle Management leaders to know

The importance of fiscal responsibility is at an all-time high in healthcare, and thought leadership is critical. With that in mind, Becker’s Hospital Review chose 15 revenue cycle management (RCM) leaders to know. Regent RCM VP of Revenue Cycle Michael Orseno made the list and adds key insights from the ASC community. Click here to view the list.

2017 Proposed Medicare Payment Rates Released

The Centers for Medicare & Medicaid Services (CMS) on July 7 released the 2017 proposed payment rule for ASCs. In the proposed rule, ASCs would see an effective update of 1.2 percent—a combination of a 1.7 percent inflation update based on CMS’s estimation of the change in Consumer Price Index for All Urban Consumers (CPI-U) and a productivity reduction mandated by the Affordable Care Act of 0.5 percentage points. Also, the agency has proposed to add eight new procedures to the ASC list of payable procedures for 2017. Click here to read more.

The Importance of Regent RCM’s Dedicated Staffing Model

Part one of a four-part series examines Regent RCM’s mission to improve the ASC revenue cycle service model

Dedicated exclusively to ambulatory surgery centers, Regent Revenue Cycle Management (Regent RCM) has built an innovative engagement model that leverages the latest industry technology and workflows. “Because we are in the trenches with our partner centers, we know their pain points and we know how to solve them,” said Michael Orseno, Vice President of Revenue Cycle. “Our unique revenue cycle management (RCM) model successfully lowers RCM costs, improves results, and increases patient satisfaction.”

The model is defined by four components:

  1. Dedicated Staffing
  2. Efficient Automation
  3. Real-time Reporting
  4. Industry Expertise

This first of a four-part series reviews the importance of Regent RCM’s dedicated staffing model designed to provide consistency, transparency and accountability.

“In order to provide the highest level of patient satisfaction, we knew we had to have a dedicated team that possessed an all-inclusive knowledge of the revenue cycle,” said Orseno. “Regent RCM understands that one action in the revenue cycle affects all others.”

Regent RCM’s dedicated team includes a revenue cycle supervisor who manages the revenue cycle specialists. Supervisors have expertise across the entire spectrum of ASC revenue cycle from payment posting and billing, to patient and payer follow-up.

Only revenue cycle veterans are hired by Regent RCM, and each supervisor has 10+ years of industry-specific experience. These supervisors leverage their industry acumen to become an integral part of Regent RCM’s business office team – monitoring and reporting on revenue cycle health for each ASC client, and using a series of benchmarks and KPIs in order to ensure optimal results.

Regent RCM implements thorough development and training programs to make sure the team stays ahead of ongoing industry changes and updates. “In addition to having dedicated professionals assigned to each account, we have redundancies in place including succession and contingency plans,” said Vianca Bautista, Revenue Cycle Supervisor. “Our staffing model ensures the financial health of a center, no matter what happens.”

Contact us to learn more about dedicated staffing or to speak with a revenue cycle team member, and stay tuned for the next blog in our four-part series: Efficient Automation.

Regent RCM’s Michael Orseno to Speak at Becker’s Second Annual CIO/HIT + Revenue Cycle Conference

Regent Revenue Cycle Management (Regent RCM) has been selected to participate in this year’s CIO/HIT + Revenue Cycle Conference hosted by Becker’s.

Michael Orseno, Vice President of Revenue Cycle at Regent RCM, will contribute to a timely panel discussion, Addressing High Deductible Patient Plans and the Evolving Role of Patients Becoming Payers, from 1:00 p.m. – 1:45 p.m. on Thursday, July 28.

“More and more, patients are responsible for handling most of the financial responsibility for their medical care,” said Orseno. “Moving forward, it is critical for revenue cycle leaders to focus on high deductible patient plans, and understand how these plans impact the revenue cycle.”

The conference takes place July 27-28 at the Fairmont Hotel in Chicago. Attendees can sit in on a variety of sessions, featuring 175 experts and revenue cycle leaders. Overall, there will be nearly 100 sessions over the two-day conference, with three full CIO/Health IT tracks, as well as three full revenue cycle tracks. Topics include:

  • The Transformation from Volume to Value and the Constant Movement and Impact on the Revenue Cycle—Wednesday, July 27, 8:05 a.m. to 8:45 a.m.
  • Adapting Best Practices for the Revenue Cycle– Wednesday, July 27, 8:50 a.m.-9:30 a.m.
  • Key Thoughts on Improving Revenue Cycle– Wednesday July 27, 9:50 a.m.-10:30 a.m.
  • The Biggest RCM Pitfalls– Thursday, July 28, 9:45 a.m.-10:25 a.m.
  • Post ICD-10—How is the Revenue Cycle Performing? – Thursday, July 28, 1:00 p.m.-1:45 p.m.

For more information on the conference and registration, download the brochure here.

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