ASC Revenue Cycle Management

Regent Revenue Cycle Management Spearheads Benchmarks to Assess Surgery Center Revenue Cycle Health

New white paper defines nine metrics centers can customize, deploy, and measure to improve performance.

Regent Revenue Cycle Management (Regent RCM), an independent division of Regent Surgical Health and a leading provider of innovative, cost-effective revenue cycle management services exclusively for ambulatory surgery centers (ASCs) in the United States, today released a white paper outlining nine ASC-specific benchmarks to accurately and consistently assess the health of a surgery center’s revenue cycle.

“One of the toughest challenges for surgery center leadership is determining if their revenue cycle is healthy,” said Regent RCM Vice President Michael Orseno. “Our new white paper gives ASC leadership more visibility into that performance, and to help them understand how numbers can be improved, why they might fluctuate, and how they can often be misleading. Using our benchmarks, ASCs can accurately measure revenue cycle health, and ultimately, locate every dollar they are entitled to.”

Lacking standardized revenue cycle measurement tools, specific to ASCs, leadership leaned on hospital or physician practice metrics. Given the differences in payer mix, case mix, and contracts, those metrics not only caused confusion, they failed to provide the assessment tools centers needed to be successful and to compete in an increasingly competitive healthcare market. Regent RCM’s white paper outlines nine critical metrics that centers can customize, deploy, and measure to gauge their financial health.

“Many of these metrics, such as Days Outstanding and Clean Claims Percent, are certainly familiar, but centers can’t currently use them as benchmarks because they don’t know what the gold standard should be for their case-mix and contracts,” said Orseno.

An important theme of this paper is how the nine benchmarks relate to each other. “Until now, center leadership might question how their center’s revenue cycle could be performing poorly when its Days in A/R are under 30. The numbers often lie, and these benchmarks can pinpoint the problem areas,” added Orseno.

Among the nine metrics is a benchmark for the optimal number of full-time business office employees per 1,000 cases. The exclusive metric was developed by Regent RCM after it mined data from ASCs for several years. “Surprisingly, we found that busier centers are often more efficient,” stated Orseno.

The white paper also features examples of ASCs where the application of the benchmarks is already improving revenue cycle management. An out-of-network center in the southeast, for example, learned first-hand the impact Regent RCM’s benchmarks have on improving financial health. Since working with Regent RCM, the center has become more efficient in A/R. The center in March 2016 shattered a trio of records, achieving 42 days in A/R, $895,590 in collections, and at 26.3%, its lowest percent of outstanding accounts in A/R over 90 days.

To download the free white paper, click here.

About Regent Revenue Cycle Management

Regent Revenue Cycle Management (Regent RCM), an independent division of Regent Surgical Health, is a leading provider of innovative, cost-effective revenue cycle management services exclusively for ambulatory surgery centers throughout the United States. Regent RCM harnesses Regent Surgical Health’s 15 years of ASC industry expertise, allowing Regent RCM to consistently outperform industry benchmarks. To learn more visit www.regentrcm.com or join the conversation via Twitter.

Becker's ASC and Spine Review

Join Regent RCM in Chicago at Becker’s Annual Spine, Orthopedic and Pain Management Conference

Regent Revenue Cycle Management (RCM) is counting down to the 14th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine conference hosted by Becker’s ASC Review.

Taking place June 9-11 in Chicago, the conference offers attendees a variety of sessions featuring 131 physicians, primarily spine surgeons, covering a spectrum of topics ranging from Current Issues in Spine and Pain Management to Developing a Spine Program at an Ambulatory Surgery Center (ASC). In total, more than 215 speakers will cover 117 sessions during the three-day event.

Several sessions that will be of particular interest to ASC billing and collections staff include:

  • Key Concepts to Improve the Profitability and Outcomes of Spine Programs – Thursday, June 9, 2:40 – 3:15 p.m.
  • Bundled Payment for Spine and Orthopedics – Thursday, June 9, 2:00-2:35 p.m.
  • The Changing Healthcare Environment, Implications of Medicare and Impact on Commercial Payor Contract Negotiation for Spine, Orthopedics and Pain Management – Thursday, June 9, 2:40-3:15
  • Tough Coding and Billing Issues for Spine and Pain Management – Friday, June 10, 1:05-1:50
  • Bundled Payments in Self-Insured and Self-Pay Patients – Friday, June 10, 1:55-2:35.

For more information on the conference and registration, download the brochure here.

Visit Regent RCM at booth #7 to find out more about turnkey ASC billing and collections services and how Regent RCM’s services consistently outperform industry benchmarks allowing surgery center leadership to focus on high-value activities. Click here to contact a member of the Regent RCM team to learn more.

ASC Billing & Coding

New spine codes offer numerous benefits for physicians, ASCs

In October 2014, the Centers for Medicare and Medicaid Services added 9 new spine and neck codes to its list of reimbursable procedures that can now be performed at ambulatory surgery centers.  As of January 1, 2015, the following nine codes are payable as separate procedures:

  • Neck spine fuse & remove bel c2(22551)
  • Neck spine fusion (22554)
  • Lumbar spine fusion (22612)
  • Neck spine disk surgery (63020)
  • Low back disk surgery (63030)
  • Laminotomy single lumbar (63042)
  • Removal of spinal lamina (63045)
  • Removal of spinal lamina (63047)Decompress spinal cord (63056)

CMS approval of these codes followed an industry-led initiative to educate regulators on why these common spine procedures can be successfully and safely migrated to ASCs — and performed at a much lower cost to taxpayers and patients than in a traditional inpatient setting. Even more, while some private payers have a long history of reimbursing ASCs for these cases, the new CMS guidance undoubtedly will pave the way for more insurance companies to take a second look at approving more ASC procedures. This expected shift would offer ASCs and physicians to take advantage of a variety of shifting dynamics in the national healthcare marketplace, including:

Higher volume

Today, millions of individuals in the United States suffer from chronic daily back pain. In its report “The US Spinal Surgery Market Outlook to 2017- Ageing population and Technological Advances to Intensify the Competition,” Ken Research estimates the total annual price tag for back pain in the United States — including diagnosis, treatment and rehabilitation — to be $50 billion.

Back pain sufferers in the United States also seek more surgical treatment than anywhere else in the world, according to Koncept Analytics data. The firm expects this trend to continue well into the future, as active baby boomers continue to retire and more advance treatments reach the marketplace.

“The US is the largest market for spinal surgeries and is expected to achieve significant growth on the account of aging population, growing number of younger patients, changing lifestyles and product innovations,” Koncept concluded.

Ken Research’s findings largely underscore these forecasts. The firm’s data shows that compounded annual revenue growth for U.S. spine procedures increased by nearly 6 percent between 2007 and 2012 – and is showing no signs of it letting up: Between now and 2017, Ken Research expects outlays for U.S. spine procedures to increase 4.8 percent annually.

“The revenues are estimated to largely be driven from the treatment of elderly patients in the US suffering from spine ailments,” the firm concluded.

Novel procedures

An aging U.S. population and increased reimbursements likely will not be the only factors affecting spine centers in the coming years. Clinical advancements, too, are expected to continue to play a major role. According to Koncept, “motion preserving technologies like artificial disc replacement, interspinous spacers and dynamic stabilization technologies in the recent past have provided surgeons with alternatives to fusion which has altered the face of spine market altogether.”

“It is expected that further innovations in minimally invasive surgeries coupled with other advancements will foster the growth in spine market as new and improved tools with enhanced features will make complicated spine surgeries easier to perform,” according to Koncept.

Better implants, transplants and biologic therapeutics are expected to increase demand for spine surgery in the next decade.  According to Ken Research, the market for spine-related allografts grew 6.5 percent between 2007 and 2012 and “is increasing rapidly, driven by the increase in the number of fusion surgeries carried in the US.” Nontraditional therapies also are improving the outlook for the sector.

“The advent of orthobiologics in the spinal industry is estimated to further add changes in the market,” Ken Research concluded. “The orthobiologics segment is likely to grow in the future due to an increase in ageing population of the US that will demand for the procedures involving a fast recovery and a quality treatment.”

Block time

By increasing patient volume at ASCs, the new CMS spine codes also help surgeons by maximizing their allocated block time in the operating room. In the past, some spine cases were unnecessarily performed on an inpatient basis because one or more of the procedures were not eligible for reimbursement at an ASC. With the new codes, many new cases can be migrated over to an outpatient setting – saving patients and taxpayers alike – while allowing surgeons to manage their available block time efficiently.

Block times are also an important tool for ASCs. They allow managers to oversee the facility’s business operations and require regular re-evaluation to ensure fairness among surgeons and success of the business overall.

Caveats remain

Although the new CMS rules provide a variety of benefits for surgeons and ASCs, spine procedures remain inherently risky both clinically and financially. As with all cases, patients must be screened rigorously to determine whether they are a good match for outpatient surgery.

Likewise, financial analysis must be performed for many of these new spine cases to ensure ongoing profitability. For example, some spinal fusion reimbursements still remain ungrouped by CMS. Depending on the specific implantation costs, reimbursements for some of these cases might be little more than half of the overall cost of the procedure.