Managing Days in AR

Revenue Cycle Challenge #1: Managing Days in AR

For your ambulatory surgery center (ASC) to operate efficiently, you need to prioritize revenue cycle management and identity and address any problems that are affecting your billing, collections, or cash flow.

Regent RCM helps ASCs nationwide find solutions to revenue cycle challenges. We provide billing and collection services that outperform industry benchmarks and allow you to focus on your most important responsibilities. In a new content series, we will outline some of the most common revenue cycle challenges and how to navigate them.

Revenue Cycle Challenge #1: Managing Days in AR

Days in AR is a metric that offers a lot of information about your ASC’s financial health at a glance. The industry standard is that days in AR should not exceed 30% but Recent RCM’s gold standard is keeping days in AR over 90 below 25% and making sure AR follow-up includes 95% of claims per month.

Steps to Improve Days in AR

If you want to improve your center’s days in AR, you can start by taking these actions:

  • Do a quality audit

Review your billing and collections processes, looking for any gaps in your revenue cycle. How quickly are you billing claims after the date of service? Is your center receiving a high volume of claims denials? Are claims appeals sent quickly (within 24 hours)? Who is responsible for following up on outstanding claims? Can you identify a need for additional staffing or training?

  • Focus on financial counseling and up-front collections

Patients can be responsible for as much as 30% of payments, and up-front collections are a major factor in days in AR. If patients are unaware of their financial responsibility or unprepared to provide copayment, deductible, or co-insurance amounts, you will likely see negative effects in your AR over 90 days.

Incorporate patient education and financial counseling into your revenue cycle management, and establish a clear up-front collections process. Do patients know what they will owe before they come in for a procedure? Do they have a payment plan? Talk to patients in advance, offering financial counseling and outlining up-front collections expectations to decrease days in AR. We have seen this step make a big difference in improving collections and financial health for ASCs we work with.

Read about two of Regent RCM’s ASC success stories from 2020.

2020 Highlights: A Year of Growth & Continuous Improvement

In a year of unforeseen challenges, our team at Regent RCM is proud of our collective achievements — both within our company and in partnership with our ASC clients.

As we get ready to wrap up 2020 and look ahead to a new year, Erin Petrie, Regent RCM Vice President , shares her thoughts on this year’s highlights and what she is excited about in 2021.

“We accomplished a lot that I think is pretty amazing for the year,” said Petrie. “Obviously, we faced a number of challenges with COVID, but we actually improved our metrics or held them at the same level from the previous year. Our A/R percentage over 90 days decreased by four points, our A/R follow-up improved 3%, and our cash remained about the same. I’m very excited about the staff’s ability to do that.”

Moving to Remote Work

Regent RCM’s staff had never worked from home before, and with very little notice, we closed our office and became a fully remote company during the pandemic. We had to find solutions for a few logistical hiccups, such as moving PCs to home offices and setting up VOIP phone lines, but our team quickly adjusted.

“We didn’t have a lot of time to plan what a fully remote staff would look like,” said Petrie. “I was confident that we could do it, but I was surprised by just how well we did under the circumstances. Everyone was juggling a lot of priorities — like parents working and doing e-learning with their kids. We spent a lot of one-on-one time with our staff, helping them prioritize things and work out a time management plan that made sense for them.”

Making Time for the Wish List 

One silver lining of the pandemic was that while new case volume slowed down for ASC centers, our staff put the unexpected downtime to good use. We pursued projects that will improve the service we offer our clients, including gathering extensive information about our centers and different payer policies, so we have a robust database of information to draw from in the future.

“We spent a lot of time working on our wish list projects,” said Petrie. “We worked on a good deal of standardization — for example, creating “best appeal” templates so that a higher percentage of first-level appeals are successful, and second-level appeals aren’t necessary. We also put together a thorough training plan for the staff that has reduced training time from three or four months to three weeks. We’ve seen that plan be very successful.”

Carrying Lessons Forward into 2021

Regent RCM’s priority moving into 2021 is determining how we can continue to serve our centers better. We have identified that there’s a need for ongoing training and support, and we are exploring new ways to develop best practices, learn from one another, and share experiences across all of our centers.

“Our focus is on continuous improvement,” said Petrie. “We’ve increased our staff’s quarterly metrics, raising our targets for things like percentage over 90, A/R follow-up, and quality audits. We want to keep raising the bar, and we look forward to 2021 as another opportunity to build stronger partnerships with our centers.”

Read about two of our ASC success stories from 2020.

2020 Greatest Hits: Rising Above Challenging Times

As 2020 proved to be challenging, the team at Regent Revenue Cycle Management (Regent RCM) helped its clients stay focused on revenue cycle even during the shutdown. It is clear that managing growth and profitability is a key challenge continuing to face Ambulatory Surgery Centers (ASCs) and their leaders. Following are links to the articles that proved to be this year’s greatest hits.

Making the Most of Downtime in order to Reopen Stronger Than Ever

During the height of the COVID-19 crisis, ASCs paused non-essential procedures in order to preserve resources for hospitals that were treating an influx of sick patients. In turn, this left ASCs with a reduced or nonexistent case volume. Regent RCM provided suggestions on how to use the downtime to be ready to ramp back up as quickly and efficiently as possible: Payers & Payer Contracts, Continuing to Work A/R, and Conduct a Self-Audit. Click here to learn more.

White Paper: Proactive Cash Flow Management

This year was made more challenging with slower reimbursement from payers, which created cash flow issues for some centers. As centers ramped back up to 80-90% of total cases, proactive revenue cycle management and cash flow became more important than ever before.

Regent RCM Vice President Erin Petrie said, “ASCs want to collect everything they have available, and that means paying close attention to two buckets in particular. We look at all aging accounts receivable and on any new cases, we work with centers to maximize what they are collecting upfront from patients.”

Download the white paper and read two center case studies that highlight the effectiveness of a renewed focus on optimizing cash flow and managing revenue cycle.

5 Ways to Optimize Your ASC’s Revenue Cycle

As ASCs continue to navigate ongoing challenges such as rising healthcare costs and complex insurance environments, it is critical that you take a more proactive approach to managing your center’s profitability and cash flow. We shared five strategies to optimize your ASC’s revenue cycle management:

  • Triple-check insurance eligibility
  • Communicate with your billing and coding team
  • Monitor your AR
  • Capture all charges
  • Measure key numbers

When you improve your billing and collections processes, you get paid quickly and accurately, strengthening the overall financial health of your center. Read more here.

Learn more about optimizing your center’s revenue cycle management by visiting the Regent RCM News & Insights page.

quarterly award

Congratulations to our Q1 Award Winners

Regent Revenue Cycle is pleased to present our Distinguished Performance Award recipients for Q1. Each recipient met or exceeded all Regent Gold standard performance benchmarks including:

  • AR follow up
  • Decrease in % of AR over 90 days
  • Highest quality audit results for Q1

Our revenue cycle specialists provide consistent high-value and excellent customer service to our clients and are dedicated to delivering exceptional quality.

“The whole team is proud of this group of employees,” said Vice President of Revenue Cycle Management, Erin Petrie. “These individuals go above and beyond to deliver excellence and exemplify our R.I.S.E Values: Respect, Integrity, Stewardship, and Efficiency.”

Congratulations Rebecca Johnson, Dacia Aviles, Mayra Casco, Lorena Gonzalez, Celia Kulis, Lilia Casas, Maria Murguia, Gabriela Alcaraz, and Angie Valentin.

Updated Gold Standard: A/R over 90 Days

In 2017 we introduced ASC-specific benchmarks. And since then, we have routinely leveraged data and industry trends to review and revise the benchmarks, making updates in order to improve our own processes and approach and ensure our centers capture all the revenue they are entitled to.

In 2020, we’re updating A/R over 90 Days: today, our gold standard is below 25%.

“If a center is getting lower than 25%, it would likely mean that someone is taking write-offs versus exhausting appeals to those claims,” explained Regent RCM Vice President Erin Petrie. “Originally, we were aiming for a gold standard of 20% but when we standardized our data over two years, we saw that the percentage was closer to 30-35%. Since then, we have been digging in to better understand why the percentage is higher and when it might be a sign that the center’s revenue cycle is healthier as a result.”

There are couple of variables that centers should note:

Patient Responsibility & Financial Counseling – Up-front collections are a contributor to A/R over 90 and if a center doesn’t have an up-front collections process in place, it is very unlikely to get to 20% for A/R over 90 Days. Why? Because patients can be responsible for as much as 30% and that takes time to collect.

“When patients lack financial counseling, it often results in the patient being unprepared to pay copayment, deductible and/or co-insurance amounts,” explained Petrie. “This contributes to unsecured debt and drives up days in A/R. We work with our clients to operationalize upfront patient financial counseling and collections and we are seeing dramatic results.”

Quality Auditing – Audits help identify where education is needed among staff and assist in finding gaps and leaks in the revenue cycle. Petrie noted: “By conducting an aggressive appeal the first time, the percent of A/R over 90 Days automatically goes down. High-performing ASCs will inevitably experience claims denials, but during an audit we take an in-depth look at the center’s appeal process, that helps us get to the root of the issue and correct it.”

 

Make the Most of Downtime in order to Reopen Stronger Than Ever

During the COVID-19 crisis, ambulatory surgery centers (ASCs) are pausing non-essential procedures in order to preserve resources for hospitals that are treating an influx of sick patients. In turn, this is leaving ASCs with a reduced or nonexistent case volume. We provide suggestions on how to use this downtime wisely so your center will be prepared to ramp back up as quickly and efficiently as possible.

Payers & Payer Contracts

You should be taking this time to become familiar with what your most common payers are doing now. Some payers may be waiving authorization processes, and some may be waiving certain costs for patients. It’s also important to create a payer fee schedule to reconcile payments as well as review contracts to make sure you have the right fee schedule in place. ASCs also need to establish timely follow up processes and remember – don’t accept what the payer pays the first time.

Continue to Work A/R

Regular monthly A/R reports should be run to streamline follow ups, and billing staff should follow up with every account listed. The gold standard for follow up is at least 95%. This results in improved collections and a decrease in A/R over 90 days.  Running an audit can help identify gaps and leaks in the current revenue cycle. During an audit, you take a deeper look at your center’s appeal process which will help get to the root of the issue and correct it. Download our guide, 3 Revenue Cycle Audits that will Improve Collections & Lower Days in A/R, to get started.

Conduct a Self-Audit

Now may also be an opportune time to conduct a self-audit to ensure you’re collecting every dollar you are entitled to. As ongoing consolidation among healthcare payers squeezes surgery center reimbursements, periodic business office audits can be key to identifying a center’s financial stress points, strengths, and opportunities. We’ve published a guide to help you get started. Click here to download your copy or contact us if we can help.

2020 Business Office Manager

2020 Business Office Manager of the Year Announced at Annual Conference

Regent Revenue Cycle Management (RCM) kicked off 2020 by hosting our annual Business Office Manager Conference in South Padre Island, Texas. Ambulatory surgery center (ASC) business office managers from all over the United States were in attendance.

Laina Roberts from Plaza Surgery Center earned the Business Office Manager of the Year award. Stefanie Herrick was also recognized for her achievements at Surgery Center of Wasilla.

Roberts started in 2019 and has made a positive impact from day one. Prior to her start, Plaza Surgery Center had about 3% of the month’s cases unbilled by month end. Through process adjustments, organization, and consistency, Roberts reduced that number to less than 0.5%, essentially eliminating the issue. Roberts has also overhauled some important HR filing and functions, and she is beginning to tackle the credentialing program.

“Laina is doing exceptional work and she exemplifies the best qualities in an ASC business office manager,” said Regent RCM Vice President Erin Petrie. “Her tenacity, attention to detail, and willingness to dig in and make a difference contributes to the success of her facility. We’re thrilled to recognize her as this year’s winner.”

In her role at Surgery Center of Wasilla, Herrick has positively impacted the morale of the center, improved employee engagement, and has revamped all of the business office functions.

“We congratulate Stefanie and Laina; we are so pleased to have them leading our centers, training others, and exemplifying excellence,” added Petrie.

If you’re interested in joining our team, click here.

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 about an efficient revenue cycle 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.

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.

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