Regent RCM Guide Identifies Inefficiencies and Mistakes that Put ASC Financial Performance at Risk

What can surgery center leaders do to ensure an efficient revenue cycle? What processes can be enacted to minimize mistakes in coding, billing and collections? Regent Revenue Cycle Management, a leading provider of innovative, cost-effective revenue cycle management services exclusively for ambulatory surgery centers nationwide, has published 3 Revenue Cycle Audits That will Improve Collections and Lower Days in A/R, a new guide that offers strategies to enhance efficiency and drive growth in 2019.

“No one wants to miss out on revenue due to insufficient revenue cycle management practices,” states Erin Petrie, Regent RCM’s Director of Revenue Cycle Management. “Our new guide illustrates through best practices and case histories that follow simple—yet critical—processes can ensure that when mistakes are made, they are corrected quickly, and new processes can be enacted to make sure you rarely make the same mistake twice.”

This publication outlines the recommended timing and processes for analyzing and improving:

  • Denied claim cause and management
  • Coding accuracy
  • Payer contract adhesion

3 Revenue Cycle Audits that will Improve Collections and Lower Days in A/R will help centers to collect every dollar they are owed and set them up for long-term growth and success,” Petrie states.

The new guide is available for download now.

3 More Advantages to Outsourcing Revenue Cycle

The revenue cycle market is projected to grow at a rate of 12% by 2021, according to a MicroMarket Monitor report. Why? Because administrators recognize they have to fight for every dollar but are stretched thin as revenue cycle is demanding and time consuming.

“ASCs are increasingly focused on delivering value-based care, which aims to improve quality while reducing costs,” said Regent RCM Director of Revenue Cycle Management Erin Petrie. “ASC leaders are also trying to build organizational accountability. Outsourcing revenue cycle aligns with both of these goals; it is the ideal way to increase cash flow, cut costs, and optimize a center’s revenue cycle, while strengthening transparency.”

In a recent blog post, Regent RCM outlined three competitive advantages to outsourcing RCM. Here are three more important ways ASCs benefit when they outsource their revenue cycle.

  1. Transparent Reporting

ASCs often lack the expertise, technology, resources, or time needed to execute transparent measurement and reporting in their finances. Outsourcing to experts gives ASC leaders access to sophisticated financial analysis and tracking tools.

Revenue cycle experts use third-party reporting software to offer deep insight into centers’ financial performance, analyzing and addressing the root causes of problems. For example, by outsourcing revenue cycle, an ASC can receive a thorough audit of its accounts receivable processes. The center can then use this helpful information to reduce days in A/R and improve cash flow.

  1. Staying Ahead of Requirements

Healthcare laws and regulations are constantly changing. ICD-10, for instance, is frequently re-shaping coding, and ASCs must stay ahead of the curve. But centers also have numerous other day-to-day priorities to complete, and new regulations sometimes fall through the cracks.

Outsourcing  solves this challenge seamlessly. Professional revenue cycle vendors must proactively keep tabs on industry laws and regulations, ensuring that their ASC clients remain updated and protected.

  1. Saving Space to Increase Revenue

Outsourcing revenue cycle can free up physical space within an ASC. Because an outside vendor is handling the revenue cycle, the center acquires valuable extra square footage, which opens up new possibilities and opportunities. An ASC can use the available space to enhance value-added aspects of the business; for example, buying more testing equipment or adding new services that will increase the reputation and revenue of the center.

Are you considering outsourcing to optimize your center’s revenue cycle? The experienced team at Regent RCM is available to your answer questions and discuss a revenue cycle evaluation. Contact Regent RCM.

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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.

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.

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 has been a great asset to our team since she began working with us and this promotion is well-deserved,” said Michael Orseno, Vice President of Revenue Cycle at Regent RCM. “As 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. We look forward to her continued contributions and success.”

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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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.

ASC Benchmark Series Video

ASC Revenue Cycle Benchmark Video #4 – Clean Claim Percentage

The Regent Revenue Cycle Management (RCM) team heard from dozens of ambulatory surgery center (ASC) administrators who were struggling to gauge the success of their center’s revenue cycle. They responded by identifying, defining, and interpreting ASC revenue cycle benchmarks and developing a video series that can be used to evaluate the health of any ASC’s revenue cycle.

The fourth video in the series examines clean claims, a stand-alone operating independently of outside influences such as payer mix or case-mix.

While no center can achieve a 100 percent clean claim rate, proper coding and using a robust clearinghouse to scrub claims prior to submission are key. Regent RCM’s gold standard is 98 percent.

Click here to watch the video and learn more about this benchmark including strategies for getting claims out the door with no edits or rejections.

Ready to assess your center’s financial health? Watch Regent RCM’s recent three-part ASC revenue cycle benchmarking webinar series or contact one of Regent RCM’s dedicated revenue cycle specialists today.

ASC Revenue Cycle Analysis

Regent RCM Offers Five Tips for a Healthier Revenue Cycle in 2016

In a recent article published in Becker’s ASC Review, Regent Revenue Cycle Management (RCM) Vice President Michael Orseno details five valuable tips to help ambulatory surgery centers (ASCs) improve financial success for 2016.

Orseno suggests ASCs focus on account follow-up to keep the accounts receivable percentage greater than 90 days to less than 15 percent, and details the best way to do so. He also advises trimming a bloated business office and offers a solution to optimize business office staffing.

Other tips include not procrastinating in areas such as billing, statements, denials, and follow-up, and earning more money by focusing on business office processes. Lastly, Orseno suggests reducing the stress of running an ASC.

“One way to alleviate the stress of RCM is to consider partnering up with an industry-leading RCM partner with proven results,” says Orseno. “With today’s technological advancements, an outsourced RCM employee working the center’s account 1,500 miles away is just as effective as one sitting in the cubicle next door.”

For detailed information on all of Orseno’s tips, click here to read the full Becker’s ASC Review article.