Successfully managing ambulatory surgery center (ASC) profitability and cash flow means keeping a tight rein on your center’s revenue cycle. One way many ASCs do this is by carefully tracking against Regent’s revenue cycle management (RCM) benchmarks. But when a potential revenue cycle leak is suspected, a deeper look at three key reports offers problem-solving insights.
“When it comes to revenue cycle leaks, there are three reports in particular that will give you enough insight to be able to tackle most any issue you see. Obviously, you’re looking into this for a reason: maybe it’s because your cash flow is slowing down, or maybe your percent (of Accounts Receivable) over 90 days is picking up,” says Regent RCM Vice President Erin Petrie. “Starting with these reports will give you an opportunity to narrow the scope of what you’re looking for, so you don’t have to go through and look at every single account. It highlights target areas.”
The three leak-sealing reports Petrie recommends are Aging AR by Payer, your ASC’s Unbilled Case Log, and your Denials Report. She explains the power of each:
Aging AR by Payer
While Aging AR is a routine benchmark report, digging into Aging AR data by Payer can be an efficient way to identify trends and potential problems when you suspect a revenue cycle leak.
“If all of a sudden you notice that your Blue Cross 120 bucket just got huge because everything’s rolling over from 90, you can tell that there’s probably an issue with that payer versus if you look at the summary AR report and see that all of the 120 buckets – regardless of payer – are starting to pick up,” says Petrie.
She explains that an uptick in the 120 Days AR bucket across the board may indicate a problem with the biller not following up or sending claims out incorrectly in the first place, whereas if you see that it’s just one payer or a couple payers specifically, that is likely a payer related issue. “If it’s a payer issue, you would then dig into that particular payer’s accounts to see what the notes are on those accounts so you can solve for whatever is going on.”
Unbilled Case Log
If your look at the Aging AR reports has determined that the problem is more of an across the board performance issue, Petrie recommends a second key report:
“By taking a look at your unbilled case log, you can see if you have a spike in cases that weren’t dictated by physicians or weren’t billed because they’re waiting for an implant invoice or something,” she says. “Obviously you’re not billing those cases without that information, but the date of service remains the same. That means when you do bill them, all of a sudden, those cases are going to drop directly into your 90 bucket instead of your 0 bucket. So that unbilled cases log is a good one to monitor. You don’t want to see wild swings where all of a sudden one month you have like a quarter of your case volume that’s just not dictated.”
The third report Petrie recommends to ASCs seeking to plug revenue cycle leaks tracks reimbursement denials, offering a view into why payment may be held up.
“The payers tend to change things in midstream,” Petrie explains. “For example, maybe all of a sudden Blue Cross will start requiring a prior authorization when they hadn’t before, so now you’ll see all of these ‘prior auth’ denials and you’ll have to go back in to solve for that, and also figure out how to avoid those going forward.”
Petrie says the denials report is a good place to figure out two key leak-busting tactics: how you can correct everything that’s sitting out there to be collected, and where training and preparation might help you avoid those mistakes again.
Managing to avoid revenue cycle leaks is especially challenging for ASCs because the process can be time and resource intense.
Says Petrie: “It can be overwhelming when you think about how many accounts you have to look at to try to figure out what’s going on. ASC administrators don’t have the time to go through thousands of accounts. And the ASC software doesn’t always have the most robust reporting, just because that comes at a pretty high price tag, so you’re stuck doing lot of manual reporting. But if you take this approach and try to narrow it down so that you’re not looking at every account out there, that might help get you going. If you start with those three reports, they’re broad enough that you should be able to get the data from any system you’re using, and use it to narrow your scope so you’re not searching for a needle in a haystack.”
For more information about investigating revenue cycle leaks, contact us.