Upfront Collections: Lessons Learned at Glasgow Medical Center

COVID-19 has made running an ASC even more challenging with slower reimbursement from payers, which has created cash flow issues for some centers. Regent Revenue Cycle Management is working closely with its ASC partners to help them collect as much of their revenue as possible during this challenging time.

At Glasgow Medical Center, efforts paid off in notable achievements for the month of May with total dollars outstanding over 90 days decreased by $31K compared to the previous month and was the center’s lowest amount in that category since 2016, said Regent RCM Revenue Cycle Manager Vianca Bautista. This accomplishment was one to celebrate, given that the majority of outstanding dollars in the aging bucket were patient self-pay, one of the toughest categories to collect at the backend.

Year-over-year, Glasgow’s results on upfront collections looked great, too, with percentage of due collected improving from 11% in 2019 to 40% in 2020. And, financial counseling accounted for 43% of upfront collections in 2019, compared to 100% in 2020.

“It makes a significant difference when patients are aware of what they will owe when they check in,” said Regent RCM Manager, Leslie Favela. “Before we defined our process around upfront financial counseling and upfront collections, patients would check in, have their surgery, and afterwards in the billing notes, it would say, ‘Couldn’t collect because patient was not aware of balance.’ Now the patients are coming in either with a plan or with payment. They are already educated, and that eases patients’ minds as well.”

So far in 2020, Glasgow achieved 155% of its cash goal, and saw a significant 17% decrease in AR days over 90, and had average AR Follow Up over the last three months of 99%.

“While payers have incurred new costs due to the pandemic, they have also realized savings that balance those,” said Alex Reyes, Vice Presidents of Operations for Glasgow. “The decrease in elective surgery cases has resulted in savings for health plans. And with cases lower, there is now a more dedicated effort to get claims processed correctly and efficiently.”

In addition, at Glasgow, according to Favela, the upfront collections process was adjusted this year to utilize patient phone calls instead of letters to communicate with patients about upfront collections. “I think that helps increase the number patients actually paying upfront. We make contact directly with them, versus relying on a letter in the mail.”

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Strategic Approach to Upfront Financial Counseling Proves Success at East Hills Surgery Center

COVID-19 has created cash flow issues for most ASCs due to decreased volume and slower reimbursement. In response, we are working closely with our centers to ensure they are collecting as much of their revenue as possible during this time. And our approach is paying off.

At East Hills Surgery Center, a focused approach to upfront collections has been key to improving revenue cycle management and has resulted in significant improvements, even when New York state had more coronavirus cases than any single country outside the US, in April. Percentage of due collected improved from 16% in 2019 to 36% in 2020, and financial counseling accounted for 36% of upfront collections in 2019, compared to 99% in 2020.

“Basically, it all comes down to having the correct processes in place,” explains Leslie Favela, Regent RCM’s manager of revenue cycle business development. “It’s about making sure that we’re reviewing every single case and ensuring that we’re making the best decisions for the center and the patient.”

Attention to correct processes and disciplined focus have delivered very strong revenue cycle management statistics for East Hills over the past months: The center achieved 149% of its cash goal, and saw a significant decrease in AR days over 90 on the strength of an average for AR follow up over the last three months of 99%.

Favela attributes the success at East Hills to having dedicated staff focused on collections, and a strategic approach to upfront financial counseling.

“Often we find that centers are kind of open-ended on what they’re asking patients to pay upfront,” she says. “We always start with the highest estimate, and then work from there. I think that the centers tend to reduce it right away without explaining the potentially highest amount to the patient. So we start high and then give wiggle room, rather than starting in between and later having to lower it from there. We find then that another result of increasing upfront collections is a drop in AR, so we have less bad debt to write off, and fewer receivables moving into the aging buckets.”

“East Hills reached their cash collection goal,” Favela continued. “The team has been diligent on working on the AR, and then we took advantage of a slower business period to make sure that we touched all accounts to bring in the most money. This has been an effective formula.”

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