Three ASC Healthcare Trends

Three Healthcare Trends to Track that Impact ASC Cash Flow and Revenue

Rapid change in the healthcare industry requires that providers cope with a myriad of emerging trends, including increased patient volumes, new reimbursement formulas, an evolving payer mix and a changing regulatory environment. For ambulatory surgery center (ASC) leaders, tracking three key trends in particular is critical to effective cash flow and optimal revenue cycle management. Two of these trends to watch are triggered by changing patient needs, while the third is focused on their employers.

1. Price Transparency

As higher deductible plans drive up the percentage of the healthcare bill that is the patient’s responsibility, consumers are demanding more advance price transparency. Especially for elective procedures but for others as well, prospective patients want to know what their costs will be in advance. In response, earlier this year the Centers for Medicare & Medicaid Services (CMS) implemented new regulations requiring providers to post charges for procedures, and some states have even more demanding requirements.

For ASCs, this trend makes it increasingly important to analyze operational data (such as case costing) as you create a viable fee schedule and estimate costs on a patient-by-patient basis. Click here to learn additional details about upfront patient financial counseling & collections from our newest whitepaper.

2. New Financing Needs

The second patient-driven trend ASCs should track diligently also stems from the shift of more of the healthcare cost burden toward consumers. In spite of the trend making them more financially responsible for their care, many patients simply can’t afford to pay: In fact, A 2018 report by the Federal Reserve revealed that 4 in 10 adults would not be able to cover a $400 emergency expense.

As a result, patients need new ways of paying for surgical procedures, namely payment plans. And ASCs are turning to third-party resources in order to stay out of the consumer loan business. For a fee, these organizations cover the patient’s costs upfront, and then take on the responsibility of collecting the balance over time. ASCs much determine whether the fee involved is worth it, by examining their uncollectible patient debt costs and loss ratio.

3. New Ways of Contracting

Employers are impacted by rising healthcare premiums as well, and some have attempted to contain rising premium costs by contracting directly with providers (a form of self-insurance). For ASCs, this trend creates another reason to truly understand the drivers of a center’s revenue and case volume.

Again, having the information technology and analytics in place to get the answers is critical. ASCs need data in order to ask and answer the right questions about their profitability. Only with the ability to analyze how these healthcare trends are impacting their revenues and cash flow can they proactively manage revenue to avoid potential adverse financial outcomes.

Regent Revenue Cycle Management (RCM) provides turnkey billing and collections services focused only on ambulatory surgery centers in the United States, approaching revenue cycle in a unique way that consistently outperform industry benchmarks and allows ASC managers to focus on what they do best: providing high quality care. For more information on how Regent RCM can help ASCs manage these key trends, click here.

Becker’s 25th Annual Meeting: What we Heard on the Tradeshow Floor

Regent RCM’s leadership team recently attended the Becker’s 25th Annual Meeting: The Business and Operations of ASCs.

While there was a plethora of great information to take away from the show, Director of Revenue Cycle Management Erin Petrie  picked up on a few common pain points among center leadership, including:

  • The increasing difficulty of negotiating payer contracts
  • The need for ASC-specific revenue cycle benchmarking data
  • The rise of bundled payments – and the race to execute successfully

We drilled down on two of those issues in our latest guide,  3 Revenue Cycle Audits That will Improve Collections and Lower Days in A/R, where we identified inefficiencies and mistakes that put ASC financial performance at risk and shared best practices around denied claims, improving coding accuracy and payer contract adhesion.

If you’re interested in learning more, click here to stay abreast of ASC news via our blog.

ASC Billing & Coding

Dispelling ASC Myths: The Transition from Internal Billing and Collections to Outsourced RCM is Challenging

The Myth: It is challenging for an ambulatory surgery center (ASC) to transition from an internal billing and collections team to an outsourced revenue cycle management (RCM) team.

The Truth: ASCs can actually increase the productivity of a center quickly and efficiently if they select to partner with an outsourced RCM team that is proactive and has an orchestrated transition process in place.

The Evidence: Dispelling this ASC myth comes down to the ASC selecting the right outsourced RCM provider. When going through the selection process, ASCs should consider three key qualities to ensure a smooth, efficient transition process:

  1. ASC Policies and Procedures:
    A proactive RCM providers will spend one to three weeks on-site with a transition team to understand the center’s current RCM policies and procedures. Common questions asked at this stage may include: “How does the center handle patients who pay at the time of service?” “How are insurance payments received (via lockbox or sent directly to the facility)?” and “What daily, weekly and month-end reports are necessary to operate your business?” When developing the transition strategy, certain changes to current policies may be recommended to increase efficiency. Since there isn’t a cookie-cutter approach to transitioning to an outsourced RCM provider, this is an essential step that must occur prior to conversion to ensure there is minimal business disruption.
  1. IT Systems:
    The preconceived notion that RCM partners require centers to switch to a specific IT system often fuels this myth. This is not the case with all RCM providers. A good RCM provider will be able to work with any management information system (MIS) in use, while potentially offering recommendations that could increase efficiency for the center. Prior to the transition, an IT assessment should be performed to determine how the RCM provider would connect to the center’s existing MIS. Newer systems can be accessed via the cloud, allowing the RCM provider to make adjustments as quickly as if they were physically in the center. VPN tunnels can be used to access older systems. It’s important that HIPPA/HIGHTECH compliant software should be utilized to always keep data secure.
  1. Contracts:
    Becoming intimate with a center’s contracts prior to transitioning is also essential for a smooth transition. The RCM provider should request updated copies of each contract for extensive review and loading into the system well before conversion. While the transition team is still on-site, a good RCM provider will meet with the managed care team to fully understand the content and avoid any hidden language that could affect bundling, payment methods, or limit the increase of charges. Contracts are an essential part of the billing and collections process and as a result, oversights could cause a center to be operating at only 60 to 80 percent.