Meet the Team: Dacia Aviles

In our ongoing Meet the Team feature, we introduce the many members of our team who make Regent RCM so successful.  Today we shine the spotlight on:

Dacia Aviles

Where is your hometown? Born and raised on the North Side of Chicago near Wrigley Field. So you know what that means…. Go Cubbies!

What do you do at Regent RCM? I’m a Revenue Cycle Specialist. I’m responsible for billing, payment posting and account receivables for a surgery center.

How long have you been working at Regent RCM? I started January 2018, so I’m still new to Regent, but I carry 18 years of revenue cycle experience as well.

Where did you work before joining Regent RCM? Prior to joining the team, I worked for Anne & Robert H. Lurie Children’s Hospital.

What is your favorite part about working at Regent RCM? I love Regent RCM’s friendly and respectful ambience, everyone is willing to help with any question I have. I also like the concept of working for one client because I’m able to see that difficult accounts are resolved almost instantaneously. When several individuals are working the same client account it can get messy. RegentRCM’s method and approach is much more effective!

What has been your greatest professional achievement? When I worked at Loyola I was doing Physician reimbursement for out of state Medicaid. At that time there wasn’t much experience with out of State. so I had to take the initiative to learn the rules of each state and figure out how to generate reimbursement.  It turned out that Indiana was the largest population coming to Loyola’s ER. I was able to create a guide from beginning to end with instructions on how to enroll providers, bill correctly and learn to reach EOB’s. Once I finalized the guide, I was seeing payments come in so that Loyola can continue to succeed. When it was time for me to leave Loyola I felt the guide I created was greatly appreciated by the next person. I know what it feels like to not know and needing to learn a whole new ball game.

What is one fun fact about yourself your co-workers don’t know? I love crafting and the kid in me loves Roller-Skating…two of my happy places.

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. 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!

luz renteria revenue cycle management asc

Meet The Team | Luz Renteria

In our ongoing Meet the Team feature, we put a name and a face on the amazing members of our team who made Regent RCM clients so successful. In our last post, we learned about revenue cycle specialist Windy Cortez. Today we would like to introduce revenue cycle specialist Luz Renteria.

Where is your hometown and what is makes it a great place to grow up?

I grew up on the South Side of Chicago.  I love the city, there is so much life and culture, and we certainly have the best skyline of any city in the U.S. (Sorry NYC!)

How long have you been working at Regent RCM and how does the culture influence your work?

Since starting at Regent RCM, I have loved the culture of the company. It is an inspiring place to work and I feel valued and appreciated. I look forward to coming to work each day and I believe this spills over to our customers. When you feel good it lifts up everyone around you – whether it’s a coworker across the hall or a customer hundreds of miles away.

What is your favorite part about working at Regent RCM and how does this influence/affect the service you provide customers?

Transparency is essential at all levels for better relationships and a healthy work environment and Regent RCM really “walks the walk” by promoting open dialog and communication.  Everyone at Regent RCM is urged to ask questions, speak openly, share new thinking and ideas, and above all, we are encouraged to work collaboratively to solve problems for our customers.

What has been your greatest professional achievement?

Working at a hospital, you have many face-to-face interactions with patients.  I had the pleasure of meeting a single mother who was raising her two special needs children on her own, and quickly learned that she had recently lost her job, and subsequently, her health insurance. While she was trying to make ends meet, she faced a number of roadblocks and her children’s medical costs continued to grow.

I helped her by scheduling a meeting with one of our financial counselors in hopes of finding a solution. At the end of the meeting, the mom had qualified for health coverage at no cost to her, and also had qualified for additional programs for her children.

This situation doesn’t happen every day – or even every year – but being in a position to help this mother find the resources she needed during a very trying time felt great!

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

I plan to one day backpack through Peru and South America.  I am not sure when that day will be, but I know it will happen and look forward to the adventure!

 

Why Hospitals Shouldn't Handle Revenue Cycle Management

Top 4 reasons hospitals shouldn’t handle revenue cycle for their ASCs

While an ambulatory surgery center (ASC) can be independently owned, managed through a management company or managed by a hospital, it is usually best for revenue cycle management (RCM) to be handled internally by the ASC or an outsourced partner. Hospitals are oftentimes looking for ways to reduce costs of operating an ASC, which could include incorporating the ASC’s RCM with the hospital’s RCM operations. However, there are many reasons why a hospital is not equipped to successfully handle revenue cycle for their ASCs.

Here are the top 4 reasons hospitals should not handle RCM for their ASCs:

1. Management information system

The management information system (MIS) is the system used to bill and collect. However, a hospital’s MIS is  not ASC-specific and therefore not configured to work well in an ASC environment. Since most MIS systems are incompatible, the hospital may need to spend additional time and resources on interfaces between the hospital system, the ASC system and peripheral applications in order to exchange vital information.

The hospital’s MIS may also not be set up to bill for a surgery center. Standard hospital systems are typically setup to bill on the UB-04 claim forms, while ASCs need to be able to bill on both the UB-04 and CMS-1500 claim forms. Additionally, hospitals may not be able to load ASC payer contracts into the system or report on ASC-specific key performance indicator (KPI) metrics that ASC leadership must monitor, such as revenue per case.

2. Billing Staff

A hospital’s billing and collections staff may not have the expertise and experience needed to understand the specifics of billing for an ASC. For example, centers often have to bill CPT codes with modifiers which help further describe a code without changing its definition.  One prime example is multi-level pain injections, which CMS only pays on a primary code and bundles subsequent codes. It’s not only a mistake to bill out bundled codes separately, but against Medicare guidelines, so the center could be fined.

 3. Attrition

Hospitals typically have very large, complex billing departments. Along those lines, a hospital’s business office staff may only have general hospital experience and not ASC-specific knowledge and expertise needed to understand the various best practices of ASC revenue cycle. Due to their size, hospitals often see a higher turnover rate with the business office employees, which may not provide the continuity needed in the smaller, ASC environment.

4. Problematic AR days

Hospitals often have higher days outstanding than ASCs. While hospitals typically hover in the 40 to 50 day range, better performing ASCs achieve less than 30 days outstanding. When a hospital is billing for both itself and an ASC, it many not devote the necessary time and resources to both. Since the hospital charges and subsequent reimbursement is substantially higher than the ASC, the hospital may be more attentive on collecting the larger amounts  as opposed to the smaller payments coming out of the ASC.  The hospital may therefore go after the ASC “low-hanging fruit” , allowing AR days to increase and collection rate trends to decline, putting a major strain on the financial health of the ASC.

An optimized revenue cycle management strategy is imperative to the financial health of an ASC. Oftentimes, the ASC and its stakeholders can benefit greatly by handling billing and collections internally or transitioning to an outsourced RCM provider.

Meet the Team | Lorena Gonzalez

In our ongoing Meet the Team feature, we introduce the many members of our team who make Regent RCM so successful. Today we’ll find out more about:

Name: Lorena Gonzalez

Hometown: Chicago, Illinois

What do you do at Regent RCM? I am a revenue cycle specialist. I handle all of the billing, payment posting and collections for a center in Colorado.

How long have you been working at Regent RCM? I have been working at Regent RCM since February 2015.

What is your favorite part about working here? It is both a professional and friendly environment.

What has been your greatest professional achievement? My greatest professional achievement is having more than 15 years of experience in the healthcare industry.

What is one fun fact about yourself your co-workers don’t know? I love to travel, and the beach is definitely my favorite place to be.

Revenue Cycle Analysis

Case study: Undergoing the transition to outsourced RCM services

In 2012, a West Coast multispecialty ambulatory surgery center began working with Regent Surgical Health to manage and take minority equity in the center, but they chose to keep billing and collections in-house. However, the center was experiencing financial unhealthiness with key performance indicator (KPIs) metrics moving in the wrong direction, specifically high AR days and low net revenue.

In February 2013, the center realized its struggle with cash, revenue per case and proper business office staffing could not be righted internally so they made the decision to transition to outsourced revenue cycle management. They selected Regent RCM, an independent division of Regent Surgical Health, for a one-year contract to help turnaround their revenue cycle operations. During the contract period, Regent RCM was able to significantly reduce the center’s AR while increasing cash and net revenue.

Challenges of bringing RCM back in house

Once the center was financially healthy and back on track, administration opted to bring billing and collections back in-house by hiring a local revenue cycle specialist. Ultimately, the center was unable to handle the full extent of revenue cycle management on its own, and the KPI metrics almost immediately began to move in the wrong direction – revenue dropped while AR days were back on the rise.

Recognizing the need to permanently transition to outsourced RCM services

In February 2015, Regent RCM was brought back into the fold to investigate what went wrong and what steps could be taken to correct the issues. Regent RCM performed a business office audit and discovered that there was virtually no claim follow up. The center has never performed its own internal audits so they were somewhat surprised to learn that this was the case. Without the necessary training, experience and expertise, payer short pays and/or denials were not being appealed and follow-up either wasn’t happening or not following best practices, which ultimately left money on the table.

Benefits of working with an external RCM provider

When the center transitioned back to working with Regent RCM, the same revenue cycle specialist they had worked with previously was assigned. As a bilingual, seasoned specialist with experience working with this center, the Regent RCM specialist was a logical and natural fit to jump back into the position she formerly held.  Additionally, the Regent RCM revenue cycle specialist had a strong understanding of payers, contracts and California law likely to impact the center’s revenue cycle. Specially, she had significant experience working with Blue Cross and Blue Shield in California as well as California MediCal.

The transition back to outsourced RCM was smooth given Regent RCM familiarity of the nuances of the center. The center’s management information system (MIS) was cloud-based so Regent RCM was able to gain access seamlessly. Additionally, there was an accessible coding system in place, which allowed Regent RCM to receive timely notifications so the specialist can send out bills in a timely manner.

Since taking back over, Regent RCM has regularly scheduled internal audits to ensure timely and complete claim follow up, claims are billed appropriately and their revenue cycle specialist uses reporting and analytics tools that allow for customized reports to track progress.

Regent RCM has once again been able to drop AR days  – from 43 to 33 over the course of just two months! During this period, cash collections have also increased by 47 percent from $366,000 to $538,000 monthly.

Questions About Revenue Cycle Management

Questions to ask if you’re considering outsourcing RCM

We’ve recently explored the transition process from internal billing and collections to outsourced revenue cycle management services. If your center is having issues impacting its financial health, you’re experiencing negative KPIs such as increased AR days and decreased revenue and you don’t have the time and resources to address these pain points, then it might be time to consider working with an external RCM provider. Understanding you most likely have concerns about this transition, it’s important to ask questions in order to get a better understanding of how the transition process works.

What are your areas of expertise?

First and foremost, seek to understand in what areas the external provider excels. Often, it’s a good idea to let an external provider handle all of the back end business office needs from managing payer care contracts to improving AR days, so you want to make sure they are an expert in all parts of billing and collections. You’ll also want to ask detailed follow up questions to ensure the organization’s knowledge and experience align with your needs to optimize the revenue cycle.

Can you describe and demonstrate the technology that you use?

These days it seems like technology advances at the speed of light, so it’s important that your external service provider have a solid understanding of the software and platforms they use. Being tech savvy is now a requirement for successful revenue cycle specialists, and it’s highly recommended that the billing and collections staff undergo regular training to ensure they are up to date on the latest technologies.

What is your hiring process?

To add to the previous question, it’s useful to learn about the outsourced RCM providers hiring process for their billing and collections staff. Regent RCM, for example, takes a well-rounded approach to hiring new employees. Candidates are required to complete a skills assessment in addition to undergoing an interview with the hiring team. Knowing that candidates are fully vetted to ensure they have the necessary experience, knowledge and personality will make any transition process significantly smoother.

Do you leverage reporting and analytics?

In order to measure progress, reporting and analytics tools are essential. Even more effective is a provider with real time management console capabilities that allows them to monitor KPIs against both industry standards and their own benchmarks. Because such a dashboard operates in real time, the revenue cycle specialist can instantly see when a problem arises and begin taking the necessary steps to find a solution.

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.

ASC billing department

A well-rounded interview process leads to successfully hiring the right revenue cycle specialists

In our last post, we looked at what qualities a successful revenue cycle specialist possesses. Today, we examine why determining if a candidate is the right fit for an internal revenue cycle specialist position can be a challenge. A potential hire who looks perfect on paper may not have the people or communications skills needed when it comes to the in-person interview, so developing a well-rounded interview process ensures that the candidate who is the best fit in all aspects gets the job.

Provide a skills assessment

Creating a skills assessment test provides you with a solid indication of their previous experience, knowledge and problem-solving skills. It’s not a matter of getting every question right, but rather assessing their critical thinking and thought process on the questions he or she got wrong. This also provides insight into whether or not the candidate will be teachable.

Complete a multi-person interview

In addition to the skills test and examining the candidate’s resume, the in-person interview helps you establish if this person possesses the necessary qualities and is a good fit for both the position and the team. It’s beneficial to have the potential new hire interview with a few different employees. At the conclusion of the process, the interviewers can discuss their thoughts and opinions to come to an informed decision on whether to hire the individual.

Tailor interview questions around the culture of the ASC

The in-person interview also gives the interviewers a chance to see if the candidate is well suited to the center’s culture. For instance, Regent Revenue Cycle Management (RCM) works with a one-to-one model, providing each ASC with a dedicated revenue cycle specialist. This allows the specialist to develop a strong, vested relationship with each center, and it’s important that any new hires can fulfill this model.

Another way to determine if the candidate fits in with the culture is to ask questions regarding the center’s values. Regent RCM, for example, tailors questions around its RISE (respectfulness, integrity, stewardship, efficiency) values. The individual’s answers to the interview questions will provide insight as the whether he or she possesses these non-negotiable qualities.

This well-rounded interview process provides a multi-dimensional look at each candidate to help you best determine who will be the optimal fit for your center.

Revenue Cycle Manager

What qualities does a successful Revenue Cycle Specialist possess?

If an ambulatory surgery center (ASC) is going to handle billing and collections internally, staffing the role of revenue cycle specialist is critical to the overall operations and financial health of that center.

Potential new hires should possess certain qualities in order to be strongly considered during the interview process. Some characteristics are inherent and may be deal breakers, while others are teachable traits for the right candidate.

Qualities of a successful revenue cycle specialist

  • Hard worker: Having a strong work ethic is inherent and not something that can be taught. Being a hard worker is one of the most important qualities to look for in potential new hires, because they will be committed to consistently getting the job done and doing it well.
  • Team player: It’s important that a billing and collections staff member be a people person. This role requires frequent interactions with other members of the center as well as patients so it’s imperative that he or she have good people skills.
  • Communication skills: Because being a revenue cycle specialist requires interaction with a variety of people, communication skills are a must. The ability to communicate effectively and facilitate dialogue between the various departments of the ASC as well as with patients is a necessity.
  • Passion for healthcare: To ensure that your new hire will produce the best quality of work, he or she should have a real passion for the healthcare industry and specifically the revenue cycle aspect. Employing a person with such passion can give you the confidence that they will consider this a long-term opportunity and will likely look to grow within your organization.
  • Professional/scholastic achievements: While it’s certainly useful for a candidate to have previous billing and collections experience in an ASC setting, it isn’t necessarily a deal breaker if they don’t. If this is the case, see if they have impressive scholastic and/or professional achievements, such as awards, goals reached or promotions, which shows they are hard workers, committed and open to learning.
  • Tech savvy:  Having universal computer skills and the ability to learn quickly are additional qualities that each successful revenue cycle specialist should possess. No longer are billing and collections staff members working on a single software platform. Now it’s important that potential new hires know how to use various software tools and applications including Microsoft Office Suite. An ever-growing body of work is now done in these programs these programs, in addition to enhanced billing and collections and analytics platforms.

Stay tuned next week when we examine why determining if a candidate is the right fit for an internal revenue cycle specialist position can be a challenge.

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