How Does Your ASC Measure Up? Benchmarking Basics for Revenue Cycle Health

Until recently, when it came to “diagnosing” revenue cycle health, ambulatory surgery centers (ASCs) often turned to hospital or physician practice metrics, due to a lack of revenue cycle measurement tools developed specifically for them. But ASCs really needed a view into revenue cycle performance that factored in the business challenges unique to their business model and circumstances.

Regent Revenue Cycle Management (Regent RCM) has addressed that need head on with development of ASC-specific benchmarking tools that ASC leaders can customize and deploy. In a white paper titled, “Using ASC-Specific Benchmarks to Assess the Health of Your Revenue Cycle,” Regent RCM shares nine ASC-specific benchmarks to help track and measure revenue cycle performance. The paper outlines how surgery centers can use the benchmarks to assess their revenue cycle; including understanding how numbers can be improved, why they might fluctuate and how they can often be misleading.

The benchmarks dive deep into key components that shape and define revenue cycle health, offering both a benchmark and a Regent RCM “Gold Standard” to help ASCs understand what’s optimal and work to improve in each of the following areas:

1. FTEs/1000 Cases
2. Days Outstanding/Days in AR
3. Percent of AR Over 90 Days
4. Claim Lag
5. Charge Lag
6. Statement Lag
7. Claim Denial Percent
8. Clean Claim Percent
9. Net Collection Rate

The white paper also includes examples of success gained through application of the benchmarks. For example, one facility in the southeast significantly improved the efficiency of its Accounts Receivable efforts through consistent follow-up with accounts and a more thorough understanding of how each payer processes claims. In another ASC, a high volume orthopedic center, collections were nearly doubled from May to December, with no significant changes to volume or case mix. In this case, Regent RCM’s benchmarks helped the ASC work with its clearinghouse to develop custom edits to ensure clean claim submission.

Regent RCM is a leading provider of innovative and cost-effective revenue cycle management services exclusively for ASCs. To learn more about the company’s benchmarking tools for ASCs, download the white paper here.

asc revenue cycle billing analysis

Uncovering Improvements through Denied Claim Cause Audits and Management

No ambulatory surgery center wants to miss out on revenue because of inefficient revenue cycle management practices.

An organized and streamlined revenue cycle requires an ASC to get every detail of coding, billing, and collections right the first time – and on time. By following a few straightforward – but important – steps, ASCs can review their current revenue cycle management processes and identify any problem areas that need to be resolved.

Regent RCM has developed a new guide that outlines three regular audits ASCs can incorporate to uncover mistakes and inefficiencies in order to enhance revenue cycle performance. The guide recommends three strategies to analyze and improve:

  1. Denied claim cause and management
  2. Coding accuracy
  3. Payer contract adhesion

In this blog, we outline the denied claim assessment and how to better manage these audits.

Around 10 to 20% of healthcare provider revenue is tied up in denials, and the top two causes for denied claims are missing information and inaccurate information. ASCs can dramatically improve their financial performance just by reducing the number of claim denials.

Regent recommends taking these actions to manage denials more effectively:

  • Act immediately. – Address every denied claim within a week of receiving notice from an insurance company.
  • Investigate the cause. – Reach out to the payer to understand why the claim was denied and how it can be amended.
  • Track past claims. – Analyze the reasons for denied claims and approaches that have been successful to tweak current processes.
  • Watch for patterns. – Pay attention to which errors, like misspelled names or missing information, are most common in denials.
  • Focus on prevention. – Remember that avoiding denied claims is the most effective way to minimizing days in A/R.

Learn how to implement this audit and our other strategies to uncover revenue cycle inefficiencies and boost financial performance. Download the guide.

Billing Mistakes and How to Avoid Them: Part 2

An ambulatory surgery center depends on an efficient revenue cycle management process for financial and operational stability. Because the revenue cycle involves complex and overlapping processes, an ASC needs a revenue cycle solution that can manage everything from billing and collections and payer contract negotiating to measurement and reporting and automated workflow tasks.

Billing mistakes can cause serious problems for an ASC, interfering with its immediate cash flow and long-term financial health. In a recent post, Regent RCM outlined prevention tactics for four common ASC billing errors. The second part of this series will examine four additional billing mistakes and how to avoid them.

  1. Not Reconciling Billing

It is crucial for ASCs to monitor patient files carefully, making sure that all performed procedures are billed and followed up on. Unbilled procedures result in lost revenue, damaging a center’s revenue cycle. Similarly, cases that are denied or rejected by the payer must be properly appealed or processed.

Solution: Utilize a system that tracks all performed cases and ensures that they are billed out within a certain timeframe. Use automated tools as much as possible, setting up notifications and reminders to follow up on claims or make edits as necessary.

  1. Neglecting to Appeal Claims

Inaccurate payments are unfortunately commonplace within the revenue cycle. The real problem arises when ASCs fail to appeal incorrect or incomplete payments in a timely manner. If a center doesn’t maintain a quick and streamlined appeals process, it can fall into harmful patterns and struggle to meet its financial goals.

Solution: Address flawed payments right away, setting a specific turnaround for sending out appeals. Regent RCM’s standard is to appeal all under- and no-pay claims within 24 hours.

  1. Not Measuring Performance

Unidentified problems can’t be fixed. Kept busy with day-to-day responsibilities, ASCs often neglect to monitor key performance metrics of their revenue cycle – and any problems with net collection rates, A/R days, or statement, charge, or claim lags remain unresolved.

Solution: Implement measurement and reporting software to track specific benchmarks in the revenue cycle. Gauge the current health of the ASC’s performance, and set goals going forward. For example, the Regent RCM gold standard net collection rate is a minimum of 97%.

  1. Errors in Payment Posting

Erroneous payment posting can lead to confusion and financial losses for an ASC. A simple mistake, such as a typo in a payment amount, has a domino effect: an incorrect patient responsibility and billing statement, back-and-forth communication with the patient, a statement adjustment, and so on.

Solution: Check that all billing, payment, and collection information reconcile properly. If it is a challenge to manage the process with in-house staff, outsource it to a company with expertise in revenue cycle management. Regent RCM uses sophisticated software to post payments, ensure that they are paid according to contract, and turn over bad debts to collections.

Need expert assistance in improving your revenue cycle management? Contact Regent RCM

Internal Auditing for ASCs: Are You Receiving Maximum Revenue?

How would you rate the overall financial health of your ambulatory surgery center?

Are you producing maximum revenue – or are you running into obstacles that interfere with your profitability?

As an ASC administrator, you have an extensive to-do list on any given day. However, it’s important to make time to step back and look at your big-picture financial goals and processes.

Conducting an internal revenue cycle audit is an effective way to evaluate your ASC’s operations, identifying financial stress points, strengths, and opportunities. An internal audit examines, quantitatively and qualitatively, all components of the revenue cycle process. It helps you ask the right questions to reveal what is working and what can be improved, helping your center get on track and stay on track.

If you’ve noticed negative changes in important benchmarks, such as accounts receivable days, net collection rates, or statement and charge lags, a revenue cycle audit may be the best course of action.

According to Regent RCM’s Director of Revenue Cycle Management Erin Petrie, a successful self-audit focuses on four main financial areas of an ASC:

Reimbursement

Do a thorough examination of your center’s billing and reimbursement procedures, paying close attention to payer contracts and total revenue collected.

Coding and Billing

Evaluate coding procedures, whether your ASC has a certified coder on staff or outsources services. Determine if cases are coded and billed correctly, identifying inaccuracies that could delay, reduce, or invalidate claims.

Staffing

Assess how administrative employees spend their time and what causes their pain points. What

facilitates smooth operations? What requires excessive time or effort to accomplish?

Observation

Scrutinize business office functions over time, noting recurring inconsistencies or inefficiencies. Look for solutions, through technology or processes, that could address these problems.

To help you get started, the experts at Regent Revenue Cycle Management have developed a free guide, “How to Self-Audit and Improve Your ASC’s Financial Health.” It takes an in-depth look at key revenue cycle functions, giving you the information you need to keep your ASC within compliance while producing maximum revenue. Download the full guide here.

3 Tips to Maximize Surgery Center Billing and Coding

Regent RCM’s gold standard for days outstanding is 30 days or less, although the right number for a center could range from the mid- to high teens all the way up to 50, depending on payer mix and case mix. In this blog post, we’ve summarized 3 ways to keep days outstanding in check.

Manage Lags and Turnaround Time

Claims should always be sent the same day charges are entered, so the claim lag should be the same as the charge lag. If centers are experiencing a significant difference between the two, this is an indication that your billing department may be holding claims or that they’re entering charges prior to receiving the operative report. Managing lags and turnaround time is one of the easiest ways to decrease your days outstanding. “The charge entry lag is measured from the date of service to the date charges are entered. The charge entry lag should be less than five days, with the gold standard being less than two and a half days.” Said Erin Petrie, Regent RCM’s Director of Revenue Cycle Management.

Conduct Periodic Coding Audits

It is extremely important to conduct periodic coding audits by an outside coding company, whether your center outsources its coding services or employs a certified coder. “Regent coordinates bi-annual audits on all of our centers using an outside firm. By doing so, we eliminate the conflict of interest a regular coding company may have in finding coding errors in the hopes of gaining additional clients. All centers should be held to an acceptable standard above 90 percent accuracy but be given a chance to rebut coding inaccuracies found during an audit,” said Petrie.

Some disparities found during our coding audits center around what was performed during the procedure and what was dictated. Sound coding practice is to always code from the operative report and not from the procedure.

Choose the Right Clearinghouse

Choosing the right clearinghouse can make a significant difference in the efficiency of your business office. Most clearinghouses can send electronic claims and receive electronic remittance (ERA). ZirMed and others set themselves apart by performing electronic eligibility in either batch or individual mode, providing real-time statuses and having the ability to setup center-defined, custom claim edits. In addition, ZirMed rolled out a new enhancement recently which allows some of our centers to send worker’s comp claims, traditionally sent on paper, electronically by matching up a scanned operative report to the electronic claim. This has caused a decrease in our A/R greater than 90 days for worker’s comp, which is habitually one of the more challenging financial classes.

Keeping days outstanding to a minimum is a worthy task for all ASCs, one that requires constant diligence and strong organizational efforts from everyone involved in the process. The fruits of this labor can lead to steadier collections, a more organized business office, and more integrity in your reporting data

Learn more about Regent RCM’s expert billing and coding services for ASCs

Meet the Team: Ariana Cisneros

In our ongoing Meet the Team feature, we introduce the many members of our team who make Regent RCM so successful.  In our last post, we learned more about revenue cycle specialists Gina Rice-Hill.  Today we shine the spotlight on:

Ariana Cisneros

Where is your hometown? Born and raised in Chicago

What do you do at Regent RCM? As a revenue cycle specialist, I help with self-pay for a couple of centers, calling patients to resolve their balances, and help with any billing questions they might have. I’m also training for insurance verification. After that I will hopefully take over responsibility to do billing, posting, and a little bit of everything for a center. I’m looking forward to learning lots of new things!

How long have you been working at Regent RCM? I’ve been with Regent RCM for about a month and a half now.

Where did you work before joining Regent RCM? Before making my way to Regent, I was working at Loyola University Medical Center in the billing customer service area.

What is your favorite part about working at Regent RCM? So far, my favorite part is having great coworkers that who’ve welcomed me onto their team. They’ve been very accommodating and have offered their help more times than I can count. It is always great to feel welcomed and see that at the end everyone works as a big team.

What has been your greatest professional achievement? I’m not sure what has been my greatest professional achievement as of yet, my mindset is to work hard every day and continue to out do my greatest achievement on a consistent basis. My goals are to be a great employee, work hard and be a good team member in order to help Regent RCM achieve its goals.

What is one fun fact about yourself your co-workers don’t know? A fun fact about myself is I love doing crafts, I like baking and I also enjoy decorating around my house or even helping decorate special events. I like being creative!

4 Reasons ASCs Fail and How to Manage for Success

While many trends in healthcare today point to the value of outpatient care, ambulatory surgery centers can still falter if they fail to actively manage risk in critical areas. The experts at Regent Revenue Cycle Management have observed four common mistakes, and together with Regent Surgical Health, can help centers turn each challenge into an opportunity for growth.

  1. Poorly Managed Contracts
    ASC administrators face a variety of challenges when it comes to successfully managing their payor contract negotiations. One common problem is that often hard-working and well-intentioned administrators and office managers are too busy balancing numerous job responsibilities to dedicate the needed persistence and focus required to successfully negotiate expiring payor contracts. But with careful preparation, ASC administrators can keep more money to reward and fuel center growth by negotiating payor contracts that will adequately cover the full cost of services and ultimately streamline healthcare costs for all. Key strategies include: incorporating Centers for Medicare & Medicaid Services (CMS) changes into contracting, planning for future case mix changes and updated procedures, building in annual increases and multi-year contract increases, and overall caution/careful attention to terms when it comes to preferred provider organizations (PPO) and third-party administrators (TPA).
  2. Skyrocketing Costs
    Monitoring expenses and tracking trends are essential to managing costs. For example, if a center is losing money on unprofitable cases and inefficient supply management, tools that help keep administrators in the know can help immensely. To address this problem, Regent has spearheaded solutions like the use of electronic preference cards to replace old, less precise metrics. Electronic preference cards provide a wide swath of data, as information is collected and compared across member facilities to get a clear picture of supply expenditures. This allows surgery centers to discern which physician items are driving up costs, and find out where real savings can be captured. In addition, Regent has found that integrating the information with the help of electronic procurement systems like Inventory Optimization Solutions (IOS) helps ASCs better manage costs throughout a single center as well as throughout the entire organization.
  3. Failure to Bring in High-Reimbursement Cases
    To succeed in an era of tightening reimbursement practices, an ASC needs to stay ahead of the competition by adding profitable procedures that may not be available elsewhere, or risk losing such cases to the competition. Procedures with potential to deliver strong profits include (among others) major spine cases and total joint replacements (TJR). Moving TJR surgeries to an ASC makes sense for many reasons, both clinical and financial. It is important to first assess outcomes on an inpatient versus outpatient basis to see whether the results vary by setting type or provider.
  4. Revenue Cycle Management
    The way an ASC manages the revenue cycle can make or break its profitability. And with the Affordable Care Act, Medicare and Medicaid payment bundling, and updated ICD-10 guidelines looming, the revenue cycle landscape is changing at a rapid pace. Specialized expertise is required to ensure optimal results while anticipating new opportunities, and revenue cycle management can’t be an afterthought. The team Regent RCM understands the intricacies of the ASC revenue cycle, where problems commonly occur and how to fix them, as well as how to optimize reimbursement.

Are you interested in auditing your operations to ensure your ASC is maximizing revenue? A self-audit guide is available download here and will help identify your center’s financial stress points, strengths, and opportunities.

Meet the Team: Gina Rice-Hill

In our ongoing Meet the Team feature, we introduce the many members of our team who make Regent RCM so successful.  In our last post, we learned more about revenue cycle specialists Lisa Thomas.  Today we shine the spotlight on:

Gina Rice-Hill

Where is your hometown?

Born and raised in Downers Grove, IL, just outside Chicago.

What do you do at Regent RCM?

As a revenue cycle specialist, I work with a surgery center to handle their billing, payment posting, and accounts receivable. This allows me to focus my efforts to a single client, giving them 100% of my expertise and attention.

How long have you been working at Regent RCM?

I’ve been with Regent RCM for about a year now.  Preceding my work here at Regent RCM I worked with ATI physical therapy as an accounts receivable specialist.  Before that I worked as a patient account representative and financial analyst for a national operator of surgical facilities.

What is your favorite part about working at Regent RCM?

We’re a team here a Regent RCM and our team has a willingness to help each other; that’s hard to find in most workplaces, not here. It’s part of our culture, defined by our R.I.S.E. program. This has helped me to grow as a professional and as a person.

What has been your greatest professional achievement?

I don’t know if I can point to a single event that has been my greatest professional achievement, but I can point to my main motivator as an accounts receivable specialist – my drive to exceed clients’ expectations. I like knowing that I am preforming my job at the highest level possible and I am always trying to grow and improve, I take great pride in this.

What is one fun fact about yourself your co-workers don’t know?

Like a lot of people in Chicago, I’m a huge sports fan!

4 Coding & Billing Best Practices

Erin Petrie, Director of Revenue Cycle Management at Regent RCM, has worked in the medical field for nearly a decade, specializing in hospital administration and revenue cycle management. She draws from her experience to share best practices to help billers and coders manage a successful revenue flow.

  1. Verify patient information.

Prepare or update patient files in advance of their appointments. Check benefits and eligibility, making sure you have accurate information on factors such as copayments, deductibles, and balances due. Patients aren’t always aware of details related to their medical insurance – for example, if their employer has switched insurance companies, or if they need a referral from their general practitioner before seeing a specialist. Verify that the procedure code is billable under the patient’s insurance plan.

  1. Clarify patient financial responsibility.

Train your staff to communicate with patients about what payments they are responsible for. Make your ASC’s payment policies clear; ask front desk staff to confirm them when scheduling appointments, and post them in a visible area near check-in. Collect copay or co-insurance from patients at the time of service, and require payments toward past balances before scheduling new procedures.

  1. Submit correct claims the first time.

Be meticulous in producing error-free claims. Submitting an insurance claim, only to have it rejected, fixed, and resubmitted, can delay a payment by weeks or months. Avoid this frustrating cycle by double-checking claims for any errors in patient, provider, insurance, or billing information.

  1. Use proper codes and modifiers.

Go through each claim with a fine-tooth comb to confirm that you are using the appropriate codes for the services provided. Follow a standardized process to check information and minimize errors. Have you included all the necessary procedure and diagnosis documentation? Are you using the correct modifier for a procedure’s specific circumstances? Attention to detail in coding is critical for fast and accurate claims processing.

Learn more about Regent RCM’s expert billing services for ASCs.

reimbursement

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.

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