zirmed logo revenue cycle management

Part One: Regent Partner ZirMed Weighs in on High Deductible Plans

ZirMed®, which empowers healthcare organizations to optimize revenue and population health with the nation’s only comprehensive end-to-end platform of cloud-based financial and clinical performance management solutions, partners with Regent RCM to make sure ASCs have the shortest revenue cycle possible and get paid on time for services rendered. ZirMed Partner Relationship Manager Emily Reder has worked directly with Regent RCM for a year-and-a-half, but ZirMed’s association with Regent RCM goes back to June 2011.

In the first of a two-part blog series, Reder shares her perspective on the rise in patient responsibility and how this trend impacts the revenue cycle.

“We see that high deductible plans are becoming more and more popular because, from a premium perspective, that’s sometimes what’s affordable,” stated Reder.

She explained that ASCs and other providers once depended on getting all or most of their payment from the payer. But now ZirMed is finding that it’s double the amount of work for providers to get paid by the patient rather than the payer, due to higher deductibles and the time and expense required to collect from patients after they receive services.

“It’s expensive to send unpaid bills into collection,” said Reder. “So that game has really changed and we’re focusing more effort on collecting as much as possible from the payer, but also having a follow-up plan to make sure that once you get through the adjudication process with the payer, you’re on really solid footing to collect the rest from the patient.”

To accomplish that, Reder stressed the importance of establishing a foundation when the patient is first seen. “We call it the patient access phase of the revenue cycle, where you’re first seeing the patient, getting information from them, and collecting as much information as you can upfront,” said Reder. “Eligibility verification is very important, being able to create the start of a consumer-like process for the patient. Patients are really starting to behave more as consumers rather than traditional patients, because they’re having to pay for care out of their own pockets.” And Reder does not see that trend changing anytime soon.

In the second segment of this blog series, Reder will discuss how Regent and ZirMed are helping ASCs best address this trend while effectively managing the revenue cycle.

For more information about Regent RCM click here.

To contact ZirMed or request a demo, click here.

concerns about transition to outsourced RCM

Top concerns about the transition to outsourced RCM

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

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

Revenue

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

Staffing

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

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

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

ASC staff meeting revenue management

Regent RCM provides 3 ways ASCS can reduce costs for a stronger RCM strategy

Regent RCM recently spoke to Becker’s ASC Review to provide insight on how to reduce the costs related to an ambulatory surgery center’s business office. This includes everything from smart staffing practice management, which can become expensive quickly.

1. ASCs should invest in IT as information technology can lead to major cost savings over time. For example, electronic insurance verification and payment posting reduce the number of business office employees needed as well as lower one of the highest ASC expenses.

2. Another suggestion is to invest in a solid business office staff and hiring the best of the best for the job. Instead of hiring multiple people, an ASC can capitalize on one employee who can successfully wear more than one hat and manage numerous business office functions.

3. The third way to cut business office costs is to consider outsourcing RCM.

ASCs run on lean resources. Staff members wear multiple hats and revenue cycle management can easily slip through the cracks. The right RCM outsourcing provider can handle coding, billing and all of essential tasks related to revenue cycle to bring more money to the table.

To read the full story in Becker’s ASC Review, click here.

8 steps to prepare for ICD-10

WHITEPAPER: 8 Steps your ASC Must Take to Prepare for ICD-10

ICD-10 is coming, and it won’t wait for your ambulatory surgery center (ASC) to get prepared. In fact, we’ve all had ample time to prepare. But due to frequent delays in implementation, and the massive amount of time and money it would take to implement on an individual level, most of the healthcare community has put it off.

In order to get your center prepared, we have compiled insights on the 8 critical steps your ASC should take to prepare for ICD-10.

Complete the form to download the white paper:


ASC billing and coding

Global Provider Programs Can Lower Costs, Improve Care

Bending the healthcare cost curve presents a continual challenge for U.S. policymakers and industry thought leaders.

For decades, novel treatments, expanded access to care and an aging population generally resulted in the growth rate of U.S. healthcare outpacing that of all other goods and services in the economy.  While healthcare-related inflation has slowed overall in the past decade, cost containment is expected to remain a top priority in the years to come. Key factors include an increasingly older U.S. population and an influx of patients from the Affordable Care Act.

Employer-based global provider programs are one solution to this long-term challenge. By bundling payments for procedures at ambulatory surgery centers, these programs can lower treatment costs and facilitate access to leading high-quality providers across the country. Even more, global programs negotiate fixed pricing for employers and often allow employees to visit out-of-network specialists with no out-of-pocket expenses.

Many benefits for patients, ASCs

Even within the same market, there can often be big cost differences for identical surgical procedures. By working directly with the provider, employers can negotiate one rate for expensive hip, heart, spine and knee procedures that includes bundled payments for surgeons, facility costs and anesthesiologists. The ASC offers the employer predictable costs through a select panel of national providers, while the ASC receives more cases.

For employees, these programs add an additional layer of benefit to existing healthcare plans. Typically, traditional PPO health insurance plans provide access to a wide selection of general practice physicians and specialists, but do not cover all providers in a given geographic area. As a result, when scheduling a surgical procedure, providers and patients must navigate a complex system of surgeons, facilities and anesthesiologists, who may not all be “in network” for the patient.

In- and out-of-network deductibles also can quickly add up and patients frequently can incur thousands of dollars in out-of-pocket expenses. Global provider programs typically waive all patient expenses, including deductibles, coinsurance and copays. In addition, accommodation and round-trip travel for the patient plus a family member are usually included.

Understanding the challenges

Although global provider programs offer numerous benefits for payers, providers and patients, external stakeholders must be careful to understand the finer details. Additionally, these terms must be carefully negotiated with internal stakeholders. For example, patient volume may increase, but sometimes results in a lower reimbursement rate than other contracts.

Brokering global provider programs also requires extensive medical knowledge and established relationships with physicians and anesthesiologists. Payment allocation, too, can be problematic early on in the process. These issues are typically settled, however, once patients are engaged.

ASC Billing Staff Meets With Physician

Overcome the 4 Most Common Pitfalls in ASC Revenue Cycle

A different version of this article first appeared in Becker’s ASC Review

By Carrie Pallardy

Michael Orseno, revenue cycle director at Regent RCM, identifies four common areas that translate into lost income and the policies ambulatory surgery center leaders can put in place to overcome these revenue cycle issues.

Insurance verification. Insurance verification is a simple process, but when overlooked it translates into lost revenue. If insurance is not verified, ASCs may lose money on uninsured patients or those who recently lost their benefits. “At Regent centers, 100 percent of cases need to go through the insurance verification process. This has alleviated past issues of performing cases for free,” says Mr. Orseno.

A policy for regular insurance verification is easily implemented. With software, such as HST Pathways and ZirMed, verification can be instantly obtained and viewed in a patient’s chart. ASC leaders are able to see whether a patient’s insurance is active, their co-pay, co-insurance, deductible and remaining deductible. Pre-operative authorizations still require manual staff time, but the entire process serves as a way to prevent lost revenue.

Scheduling. Proper scheduling is key to ASC efficiency and operational success. But, scheduling is not only about maximizing operating room time. The types of cases scheduled are equally important. Effective schedulers will have a grasp how profitable cases are based on case cost and payer reimbursement. “Perform case costing and know your margins,” says Mr. Orseno.

Scheduling is of particular importance in centers that rely on a high volume of out-of-network cases. “In out-of-network facilities you want to avoid scheduling cases with patients that have a high out-of-network deductible or no out-of-network benefits ,” says Mr. Orseno. Insurance verification is the first step in understanding which cases make sense to schedule and which do not.

As a number of ASCs begin to take on higher acuity cases, such as joint replacement, the implant price becomes an important consideration during scheduling. A single implant can cost $20,000. Perform a return on investment analysis and determine whether or not reimbursement for the procedure will cover its costs. Consider implementing a protocol requiring administrator approval before scheduling a high-price implant case.

Insurance follow-up. Thorough follow-up ensures ASCs capture as many dollars as possible for the cases performed. “Know your contracts and don’t accept anything less than what you are contractually owed,” says Mr. Orseno. In the case of out-of-network centers, payers will often attempt to settle for 20 percent or less of a procedure’s gross charges.

Policies need to be put in place to verify that the center is receiving maximum reimbursement. If a payer is not meeting contractual levels, appeal the underpayment immediately. In out-of-network centers, create a threshold for reimbursement and if that threshold is not met, escalate the issue with payers.

Patient collections. Rising patient deductibles and out-of-pocket costs are a well-known issue in healthcare. ASCs will lose money unless they make an effort to discuss this fact with patients prior to the procedure. “The chance of collection drops 50 percent after the procedure is done and it continues to drop every 30 days without payment,” says Mr. Orseno.

After insurance has been verified, ASC leaders can sketch an estimate of what a patient’s financial responsibility will be based on the deductible and co-insurance. Review a patient’s benefits with them and explain the cost. Determine a set amount that is due before the procedure and explain payment options for any amount remaining after the payer has adjudicated the claim. Open communication prepares patients for their financial responsibility and mitigates the risk of ASCs losing on collections.

Interested in ensuring your center is receiving maximum reimbursements? Contact Mike Orseno, Revenue Cycle Director of Regent RCM for a revenue cycle audit.

ASCs take control of billing and coding

Automate Your Revenue Cycle

In today’s world of shrinking reimbursements, centers are looking for ways to decrease costs without sacrificing efficiency. By automating functions and tasks in the business office, facilities can reduce staff costs while also increasing efficiency. The list below represents a list of functions that Regent centers employ to achieve gold-standard revenue cycle metrics:

Insurance Verification. Automating insurance verification is nothing new – more than a decade ago facilities were accessing payer websites to verify patients’ benefits. Today with the integration of clearinghouses and management information systems, it’s possible to obtain up-to-date insurance information in seconds. At our centers, employees are able to obtain instantaneous, up-to-date insurance benefits populated right into patients’ charts in HST Pathways via ZirMed. This can be done either in batch mode or individually.

Scheduling. Several Regent centers use an automated scheduling system, decreasing the number of registration errors and increasing efficiency. SCOR Technologies offers a product that allows physician offices to view the ASC’s OR schedule and request appointments. Once accepted by the ASC, the patient information automatically populates in HST. Other home-grown electronic scheduling systems are in place at other Regent centers as well.

Claims Processing. Today nearly all facilities send their claims electronically, however, gold standard facilities setup customized edits with their clearinghouse to catch erroneous claims at the time of submission instead of waiting 30 days for an insurance denial. This process will help reduce Days Outstanding.

Payments. Most payers are able to send electronic payments directly to a facility’s bank account through electronic funds transfer (EFT). Your funds will be available more quickly and the chances for fraud are reduced.

Remittance/Payment Posting. Along with EFT, the majority of payers are able to send patient remittance electronically (ERA). Once centers have setup ERA, they can begin posting their payments electronically via Auto-Post. Auto-Post eliminates the timely keying of each individual payment thereby reducing key-stroke errors and increasing efficiency. HST allows the payment poster to approve each individual payment prior to auto-posting payments. This allows for greater flexibility with incorrect payments.

Contract Upload. Regent centers upload all payer contracts into HST. So at the time of posting, the payment poster can instantaneously verify whether the payment is correct and if not, flag it for follow-up. The uploading of the contracts also allows management to run an end-of-month Contract Variance Report to track insurance underpayments and determine if trends exists. These trends can lead to developing clearinghouse edits to prevent insurance denials.

Statement Generation. Gone are the days where centers take an entire day or half-day to print statements, stuff envelopes, affix postage and mail statements. Regent centers upload the patient statement files weekly from HST to ZirMed, which processes the patient statements for a price less than the centers could do it themselves. ZirMed statements look professional and can contain the facility’s information and/or logo.

Reports. For centers without a customized reporting package, some of the canned reports from the management information system may need to be modified from time to time. If you’re constantly performing the same modifications to reports in Microsoft Excel such as formatting and calculations, you can automate this process in Excel by developing macros. Macros have saved staff time at our facilities. For example, one facility was spending an inordinate amount of time each morning formatting scheduling reports for specific doctors. We developed a macro that reduced the time to format a report from 20 minutes to just one key-stroke.

Along with automating functions, the working of revenue cycle tasks can be automated, provided you have a robust management information system such as HST. Worklogs can be used as a type of “checks-and-balances” system for revenue cycle staff. For example, by setting up a task for CHARGES NOT ENTERED, a biller will be able to check his/her worklog daily to ensure all charges were entered. Utilizing a worklog will also make staff more efficient and cut down on the amount of paper an office uses. Most Regent centers utilize the Accounts Receivable tasks such as NO PAYMENT RECEIVED FROM PAYER, and PATIENT HAS NOT PAID FOR 30, 60, 90…DAYS SINCE LAST STATEMENT. Standard operating procedure is to print out an A/R report and work it line by line. The problem is that the report is out-of-date by the time the staff member gets to the bottom of the first page due to payers and/or patients paying subsequent to the report being run. The worklog is updated nightly so it is never out-of-date – staff will always be working receivables due. Management is also able to run worklog reports to track staff efficiency.

By automating both revenue cycle functions and tasks, facilities can improve their bottom lines without negatively impacting productivity.

ASC Surgery

6 Tactics for ASCs to Survive in a Single Dominant Payer Market

As Seen In Becker’s ASC Review

Regent RCM Director of Managed Care, Andrea Woodell, discusses six tactics for ambulatory surgery center leaders to survive in a marketplace with one dominant payer.

1. Develop a strong relationship with the payer. Surgery center leaders should develop an excellent relationship at multiple levels within the insurance company. If the ASC does not have a designated managed care director, the administrator should be the point of contact for provider relations, while the scheduler can develop a relationship with the payer’s preauthorization department. The ASC’s medical director should also connect with the payer’s medical director to establish and reinforce the surgery center’s clinical excellence.

“If they don’t like you, they won’t help you,” says Ms. Woodell. “However, within all those relationships the surgery center should not lose site of the bigger picture, which is getting paid more. In addition, ensure claims are adjudicated within payer guidelines to avoid costly recoupments creating ill will towards the center.

2. Bring quantifiable cost data to the negotiating table. When entering into payer negotiations, provide objective documented cost information from your center. Go beyond the basics of providing invoices for implants. Have discussions regarding costs incurred to upgrade and maintain the physical plant, including items such as new lights for operating rooms, HVAC, or a new laser to add additional specialties that are currently seen at the hospital.

“If the dominant payer is not being equitable and covering costs, you can work with your local ASC association while respecting the confidentiality of the agreements,” says Ms. Woodell. “You can still have general conversations if they are not allowing procedures to be done in the outpatient setting. Demonstrate how ASCs are trying to broaden the scope of cases and relocate them to an outpatient setting.

3. Strive to be the best. Become the best clinical provider in the market and show payers you are achieving the best outcomes, highest patient satisfaction, employer preference and compliant Medicare reporting. If you can work with a large employer to provide better care than others in the marketplace, make sure the insurance company knows this preference.

“A great way to garner the payer’s attention is by having strategic employer groups advocate on your behalf,” says Ms. Woodell. “The payer’s customer is the company paying their premiums.”

The employers want their employees traveling a shorter distance, receiving better outcomes, recovering more quickly and missing fewer days of work. The decreased risk of infection and strong patient satisfaction at the ASC will also bolster employer preference.

“Get employers to advocate on your behalf. Surgeons can develop those relationships,” says Ms. Woodell. “It’s not just the workers compensation recipient, but all employees needing healthcare.”

4. Become the exclusive provider in your market. If your group can lock up a specialty within a certain geographic area, including key physicians and providing good outcomes, you have more leverage to negotiate better rates with the dominant payer.

“If you have proven outcomes for a unique specialty in the area, you can work with payers for a better rate,” says Ms. Woodell. “But your facility must have the ability to objectively document better outcomes, quicker return to work and higher patient satisfaction. Just saying these things doesn’t translate into improved reimbursement.”

5. Find the right location. If you are developing a new surgery center, the ideal location would be somewhere without significant ASC penetration. If you are locating or acquiring an ASC in a saturated market, don’t expect to see significant rate increases.

“If you are able to achieve any type of geographic isolation, that should be used to your benefit in negotiations with the dominant payer,” says Ms. Woodell. “I’ve seen single specialty groups in competitive markets that show they reduced subsequent office visits and achieved better outcomes successfully negotiate higher rates with notoriously difficult payers. This comes from having excellent clinicians and documentation.”

However, also understand how you are contributing to the single-dominant payer issue in the market. If you are negotiating good rates with the dominant payer, you’ll need to negotiate higher rates with other payers in the market, which can negatively influence the non-dominate payers’ growth.

6. Choose your partners carefully. It’s especially important in markets with one dominant payer to choose physician and administrative leaders who can positively influence your organization. This is also true for hospital and management company partners.

“Their leadership will greatly influence your ability to work with dominant players,” says Ms. Woodell. “If you’re looking for a hospital partner, chose one that has market penetration or a smaller hospital system leveraging geographic exclusivity.”

Physician leaders should be well-respected within the community with a reputation of clinical excellence and high patient satisfaction.

“Payers don’t want to work with a group that is generating patient complaints,” says Ms. Woodell. “You also want to work with physician leaders who can advocate on the surgery center’s behalf. They need to calmly and persuasively articulate the ASC’s needs at payer meetings.”

In today’s environment of shrinking payer reimbursements it is important to use every advantage to negotiate the best rates. Employing these 6 tactics will help you achieve that goal.

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