ASC ICD-10 Preparation

Top 4 tips to quicken your ASC’s ICD-10 preparation

The implementation of ICD-10 is set for October 1, 2015, and though it’s been delayed previously, this new deadline is set to hold. This means that your ambulatory surgery center should be taking the necessary steps to prepare to use 10th addition of the International Classification of Diseases by the World Health Organization (WHO).

We recently debunked some common myths surrounding the updated coding system, and if you haven’t already, it’s now the time to turn your focus on ensuring that your ASC is completely ready for the transition. With less than 100 days until October 1, use these tips to optimize your time as you prepare for ICD-10 to ensure your center is ready. And remember, improper preparation can have negative impact on key performance indicator (KPI) metrics such as AR days and revenue.

Focus on small-scale successes

With the deadline fast approaching, gradual improvements are no longer an option. Instead your center should shift its focus to repeated small-scale successes in order to produce outcomes in a tangible process.

Change the perception

Many of your staff members may view ICD-10 as an unnecessary complication. Changing their perception of the coding system by hosting meetings regularly to review the new codes will make business office employees feel more comfortable and confident, making the system easier to adopt when the time comes. You can also have your staff use online tools to look up, verify and validate codes, which will reduce incorrect codes from being input.

Cut down meeting times

Instead of a more traditional approach to planning and preparation, you should now think outside the box with a different structure for project management. Instead of lengthy status meetings once a month, plan on shorter daily or weekly meetings to keep your revenue cycle specialists on track with their progress.

Assess your internal capabilities

Some centers may have a solid business office in house who can sufficiently handle the transition to ICD-10 without a negative impact on KPIs. It’s important to assess whether or not your internal revenue cycle specialists can manage the implementation. If the answer is no or you are not sure, you might want to consider transitioning to outsourced revenue cycle management services with an external provider that is fully prepared.

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.

ASC benchmarking

What does it take to get your center healthy?

For an ambulatory surgery center to be financially healthy, it requires that data, analytics and reporting tools be set in place to monitor the success of certain key performance indicators (KPIs) that allow the center to be in total control of the revenue cycle.

If an ASC does not have visibility of these KPIs via a real-time management console or analytics tools, no one might realize that there is a problem within the revenue cycle, which could ultimately cause significant revenue and timing challenges.

Signs an ASC is not financially healthy

There are a few tell-tale beacons to watch for to determine your center’s financial health:

  • A monthly decline in revenue
  • A monthly increase in A/R days

If these changes occur, a center must immediately begin to examine the root cause of the issues and formulate a plan of attack to regain consistent performance and overall financial health.

Improving an ASC’s financial health

Ultimately, successful financial health comes down to this: Revenues exceeding expenses. On the cost side, you should examine business office staffing costs to determine if they’re optimized with the right people in the right roles. On the revenue side, you should look at revenue per case as well as the revenue per contract. Each contract should be uploaded into the management information system (MIS), and every revenue cycle specialist should have an intimate understanding of each contract. This ensures that the correct reimbursement is being received.

To begin to understand your center’s financial health status, you can take a proactive first step and complete a business office audit to determine what issues exist, where the issues are and where changes need to occur.

Once you recognize the need to improve your ASC’s financial health, the center has two options: Keep RCM internal or outsource RCM.

To make this decision, it’s best to objectively analyze your center’s capabilities and strategies. If your center has the resources, expertise, technology and performance to not only sustain a healthy revenue cycle but improve upon it, you can implement internal changes. However, if this is not the case, then outsourcing RCM to an organization that’s dedicated to each piece of the revenue cycle may be the best top line and bottom line approach.

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.