missteps

ASCs Can Avoid Revenue Missteps with the Right Business Office Structure

Pat 2 of a 2-part Q&A series with Leslie Favela

With some strategic advanced planning, ambulatory surgery centers (ASCs) can put policies and procedures in place, along with tracking mechanisms, to effectively manage their revenue cycle.

For this second blog in a two-part series, Leslie Favela, an eight-year veteran of Regent Revenue Cycle Management (RRCM) and manager of the RRCM Business Development team, sat down to answer some of the most frequently asked questions that RRCM receives from ASC professionals around the country:

Question:

My colleagues and I are trying to find ways to improve our collections and are considering asking for upfront collections from patients. How can we do this without irritating our clientele?

Answer:

There are several ways to sustain the goal of improving collections overall, and we have had several successes with centers starting to do the upfront collections. In another recent blog, we addressed some of the myths out there, but on a high level, before you start upfront collections, education is key. It is critical that you begin by educating your surgeons, educating the center staff, and educating the patients on exactly what it means and why collecting upfront is the right thing to do. For us, a big focus has been advising the patient and educating them on their financial liability for their healthcare. Once they understand that piece of it, I think that definitely takes away the irritation.

Within our industry, times have changed. Now, we have the capability to really know how much a patient is estimated to pay for a given procedure. So, step one is making sure the patient understands that information: what their deductibles are, what their liability is. The same thing is true for the surgeons: they can prep the patients on their end by telling them “Hey, we can save you time and money by doing the surgery you need at the surgery center instead of at a hospital. We’ll help you understand your deductible and the percentage of the total cost you’ll need to pay, and we collect that upfront.”

Question:

Last year my center merged with two other surgery centers and it has been so hectic that I am worried some administrative chores may be falling through the cracks. Do you have any suggestions on how we can ensure nothing gets missed?

Answer:
Yes, merging two surgery centers can definitely be hectic, but establishing standard policy and procedure helps. At RRCM, we follow a check list that details what reports we should be running on a monthly basis and helps ensure that all of the critical work of revenue cycle management gets done. Self-audit is really key here, whether it’s you who’s completing the tasks or managing someone else who is implementing. It’s all about making sure that once you have the process in place, you follow through on all of your business office policies and procedures, and that you tend to them each month.

“It all comes down to advance planning,” Favela says. “Overall, the secret is really focusing on revenue cycle management and working to ensure that you have an effective structure in place within your business office. In addition, centers should educate everyone from the staff to the surgeons to the patients on standard operating procedures for the center and overall expectations. With those things in place, it’s all about doing regular self-audits to make sure you’re doing everything right and catching any issues early.”

For more information about effective revenue cycle management, contact Favela.

Beckers

Join Regent RCM at Becker’s Annual Meeting: The Business and Operations of ASCs

Regent Revenue Cycle Management is counting down to the 23rd Annual Meeting: The Business and Operations of ASCs hosted by Becker’s ASC Review.

Taking place Oct 27-29 at Chicago’s Swissotel, the conference offers attendees over 100 sessions, and features over 200 total speakers including physicians and ASC administrators speaking on a variety of topics. All told, more than 1,000 attendees are expected at the event, which focuses on business, clinical and legal issues faced by ASCs.

Our own Michael Orseno, VP of Revenue Cycle at Regent RCM, will present “Regent RCM’s Nine ASC Revenue Cycle Benchmarks to Know and How to Improve Each of Them,” on Friday, Oct. 28, at 4:05 p.m.

“Now more than ever, it is crucial for ASCs to optimize their revenue cycle,” says Orseno. “And until now, there wasn’t a comprehensive list of ASC-specific benchmarks, and how they should work in unison. We solved that challenge for our industry and we’re looking forward to a great exchange with center leadership. We will focus on the nine benchmarks themselves, and we’ll also go deeper and discuss how outside forces impact the numbers, how the benchmarks work together, and when the numbers lie.”

Please stop by booth 27S to receive your conference gift. We look forward to seeing you!

For more information on the conference and registration, click here. To learn more about ASC-specific revenue cycle benchmarks, click here to access Regent RCM’s video and webinar series, including instructions on how to calculate and measure what Orseno refers to as “the great lie detector,” the net collection rate.

To download your copy of Regent RCM’s white paper, Using ASC-Specific Benchmarks to Assess Revenue Cycle Healthclick here.

revenue cycle analysis

Case Study: Regent RCM Nearly Doubles Monthly Revenue Collections for High-Volume ASC

When the Andrews Institute Ambulatory Surgery Center (AIASC) sought to address challenges impacting its monthly collections, the high-volume surgery center turned to Regent RCM for help. The specialized facility, based in Gulf Breeze, Fla., is a joint venture between Baptist Health Care and area physicians, offering orthopaedic and sports medicine services.

After identifying coding and A/R process & workflow challenges leading to lost revenue for the center, the AIASC signed with Regent RCM in May of 2015. By December 2015, just eight months later, AIASC nearly doubled its monthly collections without significant changes in volume or case mix.

Regent RCM worked with the center to achieve this success by leveraging coding expertise to code claims accurately. Regent RCM also brought the center up to a clean claim submission of 97 percent – the industry gold standard, and addressed the center’s A/R process & workflow issues. Regent RCM’s primary goal was tailoring effective solutions to AIASC’s specific needs.

For more information on how Regent RCM nearly doubled the monthly collections for AIASC, read the case study here or call 312-882-7228 to find out how Regent RCM can help your ASC.

Billing and collections analysis

Addressing concerns about transitioning to outsourced RCM services

Last week, we discussed concerns you might experience as you consider transitioning from internal revenue cycle management to outsourced RCM services. Now we’ll address some of the most pressing concerns that you may be facing.

Decreased revenue

One of the most prominent concerns is that the transition process may lead to decreased revenue. Importantly, choosing to outsource RCM not only adds consistency and predictability, it offers the ability to increase monthly revenue. An external provider, such as Regent RCM, reviews and takes the time to understand all of your center’s payer contracts as the foundation for success. Once the initial review is complete, a targeted assessment is done, and any outstanding payments are collected.

The external provider also looks at past reimbursements per each contact, and if money has been left on the table, they will help you recoup the lost revenue for your center. For example, if your ASC was owed a $1,000 reimbursement but you were only paid $800, the external provider will help you get that lost money. Whenever possible, they will renegotiate a better rate and increase revenue per case.

The outsourced RCM provider will also examine your out-of-network revenue. In cases where negotiations have not been pursued, pursuit of available monies becomes paramount to bring in money left on the table in these situations as well.

It requires the diligence of a dedicated team who has the time and resources to focus on optimizing and increasing revenue coming into your center. Additionally, a provider like Regent RCM has the proper process and workflow in place to make the transition to outsourcing an effective one and ultimately bring more revenue into your ASC.

Supporting staff

The other major concern with the transition process relates to staffing, whether it’s supporting current internal business office staff members or wondering what to do when there is a billing and collections gap.

Centers that have long-term employees don’t have to let them go just because you choose to outsource. If you have good people working in your ASC, they can simply be redeployed within the center to fulfill the front end of the business office or to take on roles that also match their skillsets. Transitioning to outsourced RCM services take the complex billing and collections piece off the table, allowing the internal staff to focus on core priorities and optimize the center as a whole.

In situations where an internal role is left unfulfilled because of high turnover or a senior billing a collections staff member retires, an external RCM provider can help maintain continuity to keep the business office running. External RCM providers offer contingency plans that allow you to engage in succession planning. You won’t have to ask yourself what will happen down the road, and how you’ll stay ahead of it to avoid a revenue drop. At the end of the day, you need planning and strategies in place because predictability keeps the process running smoothly.

Next up, we’ll provide a real-world example using a case study that details the transition process and the success an ASC can find by outsourcing RCM services.

concerns about transition to outsourced RCM

Top concerns about the transition to outsourced RCM

Changes in certain key performance indicators (KPIs), such as increased AR days and decreased revenue, may be negatively impacting your revenue cycle and your ambulatory surgery center’s bottom line. Recognizing the signs that your center may not be financially healthy can help you to take the necessary steps to correct the problems. After examining the situation, you may find that you cannot solve the RCM issues internally and that it’s time to consider outsourcing revenue cycle management.

As you consider working with an external provider, concerns may arise about the transition process. There are two main concerns we frequently come across:

Revenue

One of the biggest concerns that the transition creates the risk of a short term loss of revenue due to the inherent moving parts of the transition itself. Because of this, you might be concerned that revenue will fall short in a specific month.

Staffing

Another major concern is about staffing, which is twofold. You want to support current employees, but you recognize that your center may be experiencing revenue cycle issues because you don’t have the right staff members in the right roles. Additionally, if an integral employee retires, or your center is experiencing a high turnover rate, you may not have the resources to fill these necessary roles in a long-term capacity. Considering transitioning to an external RCM provider may leave you wondering what the future of your center may look like.

We understand that change can be challenging, and even though you recognize that your center could benefit from the transition to outsourced RCM, these concerns may serious hesitation in taking that first step.

Stay tuned for upcoming posts when we address these concerns and look at a case study detailing a successful transition to outsourced RCM services.