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Is Outsourcing Revenue Cycle Management the Right Decision for Your ASC?
Is Outsourcing Revenue Cycle Management the Right Decision for Your ASC?
In this challenging healthcare environment, several economics and regulatory driving forces are causing ASCs to more closely scrutinize their cash flow. Fortunately, if such analysis raises any red flags, there are measures ASCs can take to better protect their financial lifeline.
One option growing in popularity is the outsourcing of revenue cycle management (RCM) to experts. While this choice may not suit every facility, it is worth understanding why the current economic and regulatory environment makes it a worthwhile consideration.
Affordable Care Act (ACA) — As the new administration is developing a new healthcare plan, the ACA is still in force. In most cases, patients are responsible for a larger portion of their medical care, and ASCs must be diligent in collecting the patient's co-pay and deductibles.
Migration of device-intensive procedures to ASCs — As more complex procedures are performed in ASCs, there is an increased use of expensive implants. Surgery centers need to be aware that these procedures often include the implant in their reimbursement allowance. It is incumbent upon the ASC to thoroughly review their managed care contracts to determine adequate coverage for these increased costs.
Increase in regulations and compliance — Preventing fraud continues to be a high a priority for the government, which is why ASCs must ensure compliance with proper coding and billing requirements. If you choose to outsource your RCM, you will need to select a billing company with ASC-experienced and certified ASC billers and coders who use ASC-specific software and have a written and active compliance plan in place.
Managed care trends — Increased mergers between healthcare plans over the past several years is limiting the number of available managed care contracts available to ASCs. This reduced competition between payers has resulted in lower reimbursement schedules. Negotiating an agreement is now more difficult and takes longer to accomplish (consider allowing 3-6 months for completion). Because of the increasing strength and clever tactics of managed care organizations, delays in payment, denials and incorrect allowances are more prevalent. It is imperative that payment posters remain well-educated and alert for any changes and possible payment trends as they occur.
These economic factors will necessitate that ASCs reassess not only minimally profitable procedures but also specialties that continue to decrease in reimbursement. Optimal, compliant coding will become paramount in maintaining a positive cash flow.
The one quality each of these challenges share is their increased need for cohesive and up-to-date billing efforts. For coding, billing, payment posting and collections, each team member involved in these processes must remain aware of newly released information from the Centers for Medicare & Medicaid Services and managed care. Changes in coding and billing requirements are modified frequently, so ongoing education is critical.
When Outsourcing is a Good Fit
If you are struggling in any area related to your billing and collections process, outsourcing might be an option worth exploring. Here are some questions to ask yourself to help determine whether outsourcing would be beneficial for your center:
- How much are you investing in your billing staff's salaries and benefits?
- How do you handle staff turnover and absenteeism? Do you have staff members who cover the billing staff when they are absent? If so, you may want to factor in these staff members' salaries and benefits.
- Is your coding optimized but compliant (e.g., not unbundled)?
- How many days do you average between date of surgery and the claim dropping? Every day of delay is money not in the bank.
- What are your days in accounts receivable (A/R)? Each day's delay in receiving your reimbursement makes that payment worth even less as every additional dollar earned by an increase in collections can produce additional interest revenue.
- Do you understand the method being used to determine your days in A/R? Does it make sense and accurately reflect how long it takes your staff to collect monies owed to your center?
- Are you able to prioritize your revenue cycle inside your center or do other business office tasks/special projects to reduce the amount of time your staff actually spends on billing and collecting?
- Are your write-offs performed accurately? This may falsely affect your days in A/R.
Measuring your ASC's Billing Health
Questions to ask and answers you should be looking for (answers are based on industry benchmarks):
Q: What are your calendar days in A/R?
A: 45 days or fewer
Q: What percentage of the A/R is over 120 days old?
A: 15% or less
Q: What percentage of the A/R is patient payment plans (important in this era of high deductibles)?
A: Less than 5%
Q: Do you work every A/R account at least every 30 days (and are there are collector notes to verify this)?
A: Yes
Q: What is your process for incorrect or non-payment of claims?
A: Immediate resubmission
Q: What is your average length of time between claim submission to payment (if submitted electronically)?
A: 1-3 weeks
Q: What is your average success rate (claims paid on first submission)?
A: 95% or better
Q: What is your average net revenue to collection ratio?
A: 100%
All of your answers should match industry benchmarks. However, with managed care's increasing trends in denials and payment errors as well as the continuous changes in Medicare reimbursement and allowable procedures, it takes many man-hours to properly track these changes and respond to them. This is in addition to the time necessary for coding, billing, payment posting and collections.
These questions are meant to direct your attention to important aspects of your billing process and assist you in evaluating your billing needs. Depending on your responses to the questions above, you may want to consider outsourcing.
Benefits of Outsourcing
Outsourcing provides you with access to a full team of reimbursement specialists, including certified coders, experts in managed care and Medicare reimbursement, as well as experienced insurance and patient collectors. It is sometimes difficult for ASCs to find experienced personnel to provide the necessary services to keep coding and billing compliant, coding optimized and collections current.
- Outsourcing can alleviate disturbances in your business office caused by vacations, illness and staff turnover and training of new personnel. Knowing that you're never without members of your billing team is an often-overlooked benefit.
- Optimized coding by a knowledgeable certified coder can often increase revenue, possibly off-setting the full fee for outsourcing services.
- Outsourcing can free up your staff members as they do not have to answer billing questions if patient calls are directed to the outsourced billing office.
- As denials and incorrect payments increase, outsourcing allows for the uninterrupted time necessary for collectors to immediately respond to and reconcile appeal issues. This will allow more stability in your cash flow.
- As ASC billing increases in complexity and regulatory changes are ever-changing, in order to remain compliant, it is necessary for your billing staff to monitor rules and regulations in addition to performing their other billing tasks. Outsourcing alleviates the need for these time-consuming processes and gives you piece of mind knowing that your billing company has a written compliance plan in place and your reimbursement team is closely watching for these changes and being audited regularly for compliance.
- Outsourcing companies can often lower the days your money remains in A/R, catch incorrect payments and correct them promptly, optimize coding and perform immediate and thorough appeals. This, along with timely and effective collections follow-up, can convert your billing department to a profit center as opposed to a cost center.
- An excellent RCM company can actually increase your revenue and provide your center with a dependable cash flow.
Want to learn more about the many ways outsourcing can benefit your ASC? Download the free white paper "The 'ABCs' of Outsourcing Your Revenue Cycle Management" found here and contact Serbin Medical Billing, an industry leading ASC revenue cycle management firm, by clicking here, emailing caryl@serbinmedicalbilling.com or calling (239) 208-4908.
Article: https://www.linkedin.com/pulse/outsourcing-revenue-cycle-management-right-decision-your-caryl-serbin
Why ASCs outsource their revenue cycle management
Why ASCs outsource their revenue cycle management
Written by Caryl Serbin, President and Founder, Serbin Medical Billing | April 05, 2017 |
There are many reasons why ambulatory surgery centers choose to outsource their revenue cycle management to an independent contracted company. The three most common motives are as follows:
1. Constantly changing compliance and security issues. As government regulations increase and become more complex, it is incumbent on the ASC's business office to stay current on changes in Medicare, Medicaid, OIG, HIPAA and differing state requirements to avoid non-compliance.
Experienced revenue cycle management companies can relieve this burden and ensure coding, billing and collections are completed while maintaining compliance to applicable regulations.
2. Accounts receivable average above industry standards. Maintaining an acceptable level of days in your accounts receivable requires constant attention to, and enforcement of, third-party payer responsibilities. Most ASC business offices have a single person assigned to collecting payer and patient balances. This is likely to result in shortcomings when you take into consideration that thorough collection processes require:
• constant monitoring of third-party payer changes;
• comparison of payments to contract allowances;
• immediate follow-up on erroneous payments;
• follow-up on non-payment;
• follow-up on incorrectly submitted claims;
• requests for additional information;
• determining patient responsibility;
• sending patient statements;
• follow-up on patient balances;
• refunds;
• write-offs;
• adjustments; and
• collection agency determinations.
With all of these responsibilities, as well as answering telephones and covering other business office positions, it's not uncommon to see days in accounts receivable continue to mount.
Qualified revenue cycle management companies provide a team of ASC-experienced personnel whose only responsibility is to seamlessly provide these collection services and keep your accounts receivable at or below industry standards.
3. Decreased revenue. Any or all of the reasons listed in #2 above can result in inconsistent cash flow that limits the ASC's ability to meet regular financial responsibilities such as the following:
• Rent/lease payments
• Salaries/benefits
• Utilities
• Supplies
• Other overhead expenses
There is also, of course, the matter of owner distributions.
Choosing a Partner
Expert revenue cycle management companies pride themselves in their ability to increase an ASC's revenue and provide a reliable cash flow. In addition to experienced and resolute collection processes, there are other factors of working with a revenue cycle management company that can positively affect your revenue stream. They include the following:
• Optimized coding by a certified coder
• Clean claims out the door, fewer denials and erroneous payments resulting in faster and more accurate reimbursement
• Dedicated and determined collectors
• Experienced payment posters who scrutinize payments to determine if third-party payers are meeting their contractual obligations
In choosing a revenue cycle management company to work with your ASC's business office staff, it is important to find a company that is:
1. dedicated to and experienced in ASC billing and specific to your center's needs/specialties;
2. uses a team concept so your ASC always has the same billing personnel handling its accounts and providing assistance;
3. handles all regulatory and compliance requirements;
4. provides prompt communication and response to requests; and
5. operates in full transparency.
Note: These are just a few of the important considerations when selecting a revenue cycle management company. For more information, a white paper titled "The 'ABCs' of Outsourcing Your Revenue Cycle Management" is available here.
Caryl Serbin, RN, BSN, LHRM, is president and founder of Serbin Medical Billing (SMB), an ASC revenue cycle management company. SMB's primary objectives are to provide the best coding, billing and accounts receivable management services available to ambulatory surgery centers (hospital joint-venture, corporate-owned or independent) and anesthesia providers. Serbin has been a leader in the ASC industry for 30 years. She was the founder of the first ASC-specific billing company.
Is it Time for Your ASC's Revenue Cycle Check-Up?
Is it time for your ASC's revenue cycle check-up?
Written by Caryl Serbin, President and Founder, Serbin Medical Billing
Whether you outsource your ambulatory surgery center's billing or perform it in-house, it is important to regularly audit all areas of your revenue cycle. There are many factors that can affect an ASC's financial health. Each of these revenue cycle components should be examined routinely for efficiency and compliance.
Note: This article discusses some of the most critical revenue cycle areas to audit. For a more complete list, you can download a free "Check-Up Checklist" by clicking here.
Behind the Scenes
Areas that can negatively affect your center's cash flow and accounts receivable are often not easily detectable. The following components are often overlooked and rarely audited:
- Fee schedule: Is it up to date with current reimbursement rates?
- Third-party payer contracts: Are they loaded in your software with easy accessibility by payment posters?
- Software: Are you using ASC-specific software?
- New procedure codes: Are you up to date in adding all new procedure codes?
- Medicare updates: If you are a Medicare-participating ASC, you receive regular updates from Medicare. Do you read them and update your fee schedule or procedure code list when necessary?
- Billing policies and procedures: Do you have written policies and procedures outlining how to perform each revenue cycle function? If outsourcing, does your billing company have these policies and procedures in place, and do you have a copy of them?
- Compliance plan: Do you have a written, up-to-date compliance plan detailing all federal and state regulations/requirements?
Revenue Cycle Areas
These areas are the ongoing billing and collection activities performed by your staff or your billing company. The results of these activities are usually checked on a monthly basis by reviewing end-of-month (EOM) reports; however, EOM reports do not reveal other vital aspects of these functions that often go unnoticed. They include the following:
- Coding: Is your coder experienced, and does he/she maximize the codes used while remaining compliant?
- Charge posting/billing: Are claims being posted accurately, and are clean claims out the door within 24 hours of receipt from coder?
- Insurance collections: How soon do your collectors start calling insurance companies on delayed or erroneous payments? How often do they follow up?
- Payment posting: Are payments posted on the same day they are received? How are deposits handled?
- Patient collections: How soon — and how often — are patient accounts billed?
- Refunds/write-offs: Do you have a written procedure for handling both refunds and write-offs? If you are outsourcing, who handles these?
Reporting/Auditing
EOM reports should be substantiated by actual patient balance activities. They should be meaningful to your surgery center and easy to understand. However, reports generated by less-sophisticated software are often of a cookie-cutter variety and do not pinpoint where problems lie in your revenue cycle. Make sure to address the following:
- EOM: How do you measure your accounts receivable?
- Transparency: If outsourcing, do you have full access to all account activity and reports?
- Audits: Are all areas of revenue cycle management audited regularly, both internally and by an independent auditor?
Each of these listed areas of revenue cycle management has many facets. It is imperative for ASCs to routinely inspect them and others in great detail to ensure maximized revenue and consistent cash flow.
Caryl Serbin, RN, BSN, LHRM, is president and founder of Serbin Medical Billing (SMB), an ASC revenue cycle management company. SMB's primary objectives are to provide the best coding, billing and accounts receivable management services available to ambulatory surgery centers (hospital joint-venture, corporate-owned or independent) and anesthesia providers. Serbin has been a leader in the ASC industry for 30 years. She was the founder of the first ASC-specific billing company.