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.

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 RCM Launches New Guide Empowering Surgery Center to Self-Audit Operations

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. Regent Revenue Cycle Management (Regent RCM), a leading provider of innovative, cost-effective revenue cycle management services exclusively for ambulatory surgery centers nationwide, recently published a new self-audit guide to help center administrators audit operations to ensure their ASC stays within compliance while producing maximum revenue.

“Conducting a self-audit is the fastest way for centers to get on track and stay on track,” says Erin Petrie, Director of Revenue Cycle Management at Regent RCM. “A routine audit gives your center the mechanism it needs to ask and answer the questions that lead to stronger financial health.”

Revenue cycle management for a surgery center is complex. In the guide, How to Self-Audit and Improve your ASC’s Financial Health, Regent RCM experts suggest ASC administrators examine four areas affecting the financial function of an ASC: reimbursement, coding and billing, staffing, and observation (workflow and process).

In addition, to bring clarity to surgery center billing, Regent RCM’s Petrie suggests centers monitor ASC-specific benchmarks such as accounts receivable days, net collection rate, statement lag and charge lag, for information to trigger a new audit.

“When you notice negative changes in important benchmarks, a business office audit can be the best course of action,” Petrie contends. “A full business office audit examines both quantitatively and qualitatively all components of the revenue cycle process to determine strengths and weaknesses.”

Click here to download the free guide.

Revenue Cycle Analysis

4 Key Areas Analyzed During a Business Office Audit

Ambulatory surgery center (ASC) administrators are charged with improving their ASC’s financial health and periodic business office audits are key to identifying, both quantitatively and qualitatively, a center’s strengths and opportunities.

On the surface, an audit sounds intimidating. But according to Michael Orseno, VP of Revenue Cycle at Regent RCM, it doesn’t have to be that way.

“We want our centers to maximize revenue and a routine audit is the fastest way to get on track and stay on track,” said Orseno. “The audit identifies issues – then working with our partner centers, we implement strategies and processes to correct them; it’s that simple.”

A Regent RCM audit goes beyond a traditional reimbursement assessment by examining four areas vital to the function of an ASC: reimbursement, coding, staffing and observation (workflow and process).

  1. Reimbursement. Regent RCM conducts a thorough review of a center’s billing and reimbursement procedures, including reviewing payor contracts. “Ensuring that an ASC is being reimbursed the full and correct amount per each procedure code for every case is one of the most important billing practices to maximize revenue for the center,” said Orseno. “Due diligence is crucial and for our partner centers, our team of revenue cycle specialists are intimately familiar with every payor contract.”
  2. Coding and Billing. Whether a center outsources its coding services or employs a certified coder, Regent RCM’s audit evaluates coding, determining if cases are coded correctly and billed properly. “We watch for inaccurate modifiers, which can negate or reduce payment on an otherwise clean claim,” noted Orseno, “and when applicable, we pay particularly close attention to implant coding errors.”
  3. Staffing. More business office staff does not always equal more efficiency, and striking a balance is difficult. Regent RCM’s audit diligently tracks business office FTEs in all of its facilities and compares facilities against the gold standard.
  4. Observation. Regent RCM’s expertise comes from exclusively developing, executing and refining revenue cycle management strategies. “Leveraging our collective experience, our team observes business office functions and processes and looks for inconsistencies and efficiencies,” said Orseno. “For example, a front office employee may be spending vast amounts of time verifying insurance benefits when this can be accomplished more efficiently with the use of technology.”

To learn more, read a case study revealing how an audit uncovered coding errors which led to recouping more than $590,000 in additional funds.

A recent blog highlighted what to expect from a business office audit, including Regent RCM’s methodology. Ready to schedule an audit for your center? Call (312) 882-7228 today.

Revenue Cycle Management Solution

4 ASC Revenue Cycle Things to Know This Month

Each month Regent Revenue Cycle Management (Regent RCM) explores the top news and headlines affecting the ambulatory surgery center (ASC) industry. This month in the news: St. George Surgical Center in Utah is committing to price transparency; The number of anterior cervical discectomy and fusion (ACDF) surgeries is rising as a result of the growing elderly population in the country; Four important legislative changes that impact ASCs; and a trio of ways to maximize reimbursement through anesthesia.

St. George Surgical Center is Appealing to Consumers through Price Transparency

As consumers seek low-cost, high-quality care, St. George (Utah) Surgical Center tells patients how much a procedure will cost before it is performed, which may be a trend that takes hold during healthcare’s continuing shift toward value. Click here to learn more.

Outcomes of Spine Surgery in an ASC

According to Dr. Anthony Asher, ASCA board member, director of the Neuroscience Institute at Carolinas HealthCare System and a senior partner at Carolina Neurosurgery and Spine Associates in Charlotte, North Carolina, the number of anterior cervical discectomy and fusion (ACDF) surgeries continues to rise as a result of the growing elderly population in the country and can be performed as safely as in an inpatient hospital setting . Click here to read more.  

Four Legislative Changes Impacting ASCs

CMS is bringing forth some changes that ASC leaders should note including an increase in ASC payment and 10 codes added to the ASC payable procedure list. Click here to read more.

Three Ways to Maximize Reimbursement through Anesthesia

As healthcare continues down the path of value-based care, ASCs take on more financial risk and must find ways to maximize reimbursements by improving performance regarding CMS’ ASCQR measures. Here are a trio of aspects of anesthesia to assess for quality. Click here to read more.

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ASC Revenue Cycle October Industry News Wrap-Up

Each month Regent Revenue Cycle Management (Regent RCM) explores the top news and headlines affecting the healthcare industry. This month in the news: The new MACRA final rule released by the Centers for Medicare and Medicaid Services (CMS) contains aspects that will impact ASCs; A new editorial weighs the pros and cons of “condiminiumizing” ASCs; Key specialties coming for ASCs next year; And a Deloitte survey reveals that a large number of physicians are still paid under fee-for-service payment model.

MACRA Final Rule Released

On Friday, October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) released its final rule that established the new Medicare payment methodology for physician services furnished under Medicare Part B, known as the Quality Payment Program (QPP). The rule contains many components that will impact ASCs. The QPP was enacted in 2015 as part of the Medicare Access and CHIP Reauthorization Act (MACRA) and has two participation options for physicians: The Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). Reporting for the first year of the QPP begins in 2017. Click here to read more.

ASCs: To Be or Not To Be “Condominiumized”

In an editorial, Stephen Sheppard, CPA, COE, reveals the pluses and minuses around the concept of “condominiumizing” ambulatory surgery centers (ASCs). This model involves separating a single physical ASC plant temporally among two distinct legal entities. For example, ASC-A could operate on Monday, Wednesday, and Friday, while ASC-B could operate on Tuesday and Thursday. Sheppard outlines the opportunities and obstacles. Click here to read more.

Key Specialties Coming for ASCs in 2017 

Ambulatory surgery centers are performing higher acuity cases and presenting opportunities for the healthcare system to provide quality care for patients at a lower cost. Paul Eiseman, vice president of business development at Regent Surgical Health, shares insights into specialties that have fared well in the ASC space and what is in store for 2017. Click here to read more.

Deloitte Survey: 86% of Physicians Are Still Paid Under Fee-For-Service Payment Model

Deloitte’s “2016 Survey of U.S. Physicians” survey has revealed that many physicians are reimbursed under a fee-for-service model instead of the value-based system in which providers are paid according to outcomes. Click here to read more.

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ASC Revenue Cycle September 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 story that describes the benefits that California ASCs gain from bundled payments; In its final rule on emergency preparedness, CMS has set new guidelines for ambulatory surgery centers (ASCs); and ICD-10’s impact on revenue cycle management a year after implementation;

Will the bundled payment model work for ASCs?

Even though bundled care has not been widely adopted in the ambulatory environment with commercially insured or federally insured patients, bundled surgical cases in California yielded positive financial and patient satisfaction results over a five-year span. From 2010 to 2015, over 2,000 commercially insured bundled surgical cases such as total and partial joint replacement and repair, major spine surgery, hysterectomy, thyroidectomy, mastectomy and breast reconstruction, were performed in California ASCs with overnight stay capability administered by Global One Ventures. In these bundled payment cases, 98 percent said they would recommend a bundled payment methodology to friends. Complication rates were low, with a combined rate of subsequent emergency room (ER) visits, infections and readmissions of 0.67 percent in 2015. And financial savings were significant with an average of $7,648 per case. The total cost is 30–60 percent less per bundled case than if the procedure had been performed in the hospital setting. Click here to read more.

CMS Releases Final Rule on Emergency Preparedness

The Centers for Medicare and Medicaid Services published its final rule for emergency preparedness on Sept. 16, which is scheduled to go into effect 60 days after publication. The final rule exempts ASCs from providing information about occupancy. However, ASCs are required to create a process to cooperate with local, regional, state and federal efforts for emergency preparedness in their community. Additionally, the final rule requires ASCs to document efforts to connect with emergency preparedness officials and collaborate in planning efforts when available. Click here to read more.

A Year Later: ICD-10’s Impact on Revenue Cycle Management

Last year, U.S. providers feared falling productivity, increased denials and reduced revenue as they prepared for the inevitable shift from ICD-9 to ICD-10. The new coding system increased diagnostic codes from approximately 14,000 to more than 68,000 and procedure codes from 4,000 to 87,000 with promises to improve quality reporting and outcomes measurement, and streamline reimbursement processes. What has been ICD-10’s influence on billing operations a year after implementation? Click here to read more.

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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