Here are five ways to use data, training and physician participation improve your revenue cycle process in 2011.
1. Invest in software that benchmarks your revenue cycle processes. According to Brice Voithofer, vice president of anesthesia and ASC services for AdvantEdge Healthcare Solutions, the first step in improving your revenue cycle process is investment in a capable system. "A lot of ASCs have grown out of a specific specialty — for example, a GI group or an ophthalmology group — and they say, 'Let's use our current practice management system. It will be fine for the ASC," he says. "That system is fine to get the bills out, but it's not going to do what you need [in terms of comparing billing data]."
He says 2011 should see several systems that are geared specifically toward the ASC market. While there are plenty of systems that can perform basic ASC billing functions, ASCs who want to improve the revenue cycle should really invest in a system that can compare case costs, urologists and specialties to determine where profits and losses arise.
2. Understand your current situation. If your ASC has implemented a system that tracks and benchmarks revenue cycle data, Bill Gilbert, vice president of marketing at AHS, says you should start by figuring out the center's baseline. "I'm talking about things like days in A/R, how good the collections performance is, how many denials you receive," he says. "The place to start is to know how a center did in 2010, which points to areas of improvement in 2011."
Obviously, a busy center with a limited billing staff can only concentrate on so many issues at once. Mr. Gilbert says the numbers from your data analysis should point to the most pressing areas of need. "If your days in A/R are trending up, that's an indication that something needs to be looked into," he says. "If denial rates are going up, you probably need to look at denial rates by payor." Again, implementing software that can look at data based on different characteristics or categories is essential.
3. Increase front-end training. If your data indicates a high or increasing number of denials, Mr. Gilbert says the problem probably lies with your front-end staff. "That means a need for training, maybe some job aides and adjustments to how front end staff are using the system." He says problems with denials can be caused by a variety of errors, and not understand the billing system can cause problems easily. When your center implements new software, take a few days to coach your staff on the ins and outs of submitting claims. This will save you a lot of time re-submitting denials that arise from a lack of comfort with the system.
4. Explain patient responsibilities prior to service. Mr. Gilbert and Mr. Voithofer predict that high-deductible plans and large patient-responsible amounts will decrease in 2011. "Last year, there was a substantial increase of patients on high-deductible plans, and logic would say that's going to continue," Mr. Gilbert says. "Therefore the key is helping patients understand those plans before they ever show up for surgery."
This means calling the patient or sending a letter prior to surgery that explains the patient's estimated responsibility. Mr. Voithofer also recommends asking for a significant deposit at the time of service if the patient will owe most of the balance. "The patient will be okay with that because they know they're going to be on the hook for a substantial sum, but you're not taking the risk of charging $1,500 and having to refund $500 when the claim gets adjudicated," he says.
Because patient financial obligations can change after service, Mr. Voithofer also recommends letting the patient know the minimum amount he or she will owe. "You can say, 'We know it's going to be more than this. This is the starter,'" he says. That way, you can increase the likelihood that the patient will set aside at least that amount to pay for the procedure.
5. Improve communication between the surgeon's office and the ASC. More than ever, ASCs need to be in regular communication with the surgeon's office to ensure accurate information on every claim. New models of care place greater emphasis on the "continuum of care," meaning providers communicate on a patient's status and condition to ensure nothing is forgotten in the transition between facilities. This applies to the transition between a physician's office and the ASC, when details on patient history, procedure information and other details may get lost in the shuffle. Establish a relationship between your front desk staff and the receptionist or nurse at your surgeon's office, and follow up regularly.
This also means that the surgeon should be more involved in explaining patient responsibilities, Mr. Voithofer says. "[That information] coming from an MD or a DO carries more weight than from the clerk sitting in the back office," he says.
Learn more about AdvantEdge Healthcare Solutions.
Read more about billing, coding and collections:
-Understanding Financials: Your Cash Flow Statement
-CMS Projects $4B in ASC Payments for 2011
-10 Statistics on Cash in ASCs
1. Invest in software that benchmarks your revenue cycle processes. According to Brice Voithofer, vice president of anesthesia and ASC services for AdvantEdge Healthcare Solutions, the first step in improving your revenue cycle process is investment in a capable system. "A lot of ASCs have grown out of a specific specialty — for example, a GI group or an ophthalmology group — and they say, 'Let's use our current practice management system. It will be fine for the ASC," he says. "That system is fine to get the bills out, but it's not going to do what you need [in terms of comparing billing data]."
He says 2011 should see several systems that are geared specifically toward the ASC market. While there are plenty of systems that can perform basic ASC billing functions, ASCs who want to improve the revenue cycle should really invest in a system that can compare case costs, urologists and specialties to determine where profits and losses arise.
2. Understand your current situation. If your ASC has implemented a system that tracks and benchmarks revenue cycle data, Bill Gilbert, vice president of marketing at AHS, says you should start by figuring out the center's baseline. "I'm talking about things like days in A/R, how good the collections performance is, how many denials you receive," he says. "The place to start is to know how a center did in 2010, which points to areas of improvement in 2011."
Obviously, a busy center with a limited billing staff can only concentrate on so many issues at once. Mr. Gilbert says the numbers from your data analysis should point to the most pressing areas of need. "If your days in A/R are trending up, that's an indication that something needs to be looked into," he says. "If denial rates are going up, you probably need to look at denial rates by payor." Again, implementing software that can look at data based on different characteristics or categories is essential.
3. Increase front-end training. If your data indicates a high or increasing number of denials, Mr. Gilbert says the problem probably lies with your front-end staff. "That means a need for training, maybe some job aides and adjustments to how front end staff are using the system." He says problems with denials can be caused by a variety of errors, and not understand the billing system can cause problems easily. When your center implements new software, take a few days to coach your staff on the ins and outs of submitting claims. This will save you a lot of time re-submitting denials that arise from a lack of comfort with the system.
4. Explain patient responsibilities prior to service. Mr. Gilbert and Mr. Voithofer predict that high-deductible plans and large patient-responsible amounts will decrease in 2011. "Last year, there was a substantial increase of patients on high-deductible plans, and logic would say that's going to continue," Mr. Gilbert says. "Therefore the key is helping patients understand those plans before they ever show up for surgery."
This means calling the patient or sending a letter prior to surgery that explains the patient's estimated responsibility. Mr. Voithofer also recommends asking for a significant deposit at the time of service if the patient will owe most of the balance. "The patient will be okay with that because they know they're going to be on the hook for a substantial sum, but you're not taking the risk of charging $1,500 and having to refund $500 when the claim gets adjudicated," he says.
Because patient financial obligations can change after service, Mr. Voithofer also recommends letting the patient know the minimum amount he or she will owe. "You can say, 'We know it's going to be more than this. This is the starter,'" he says. That way, you can increase the likelihood that the patient will set aside at least that amount to pay for the procedure.
5. Improve communication between the surgeon's office and the ASC. More than ever, ASCs need to be in regular communication with the surgeon's office to ensure accurate information on every claim. New models of care place greater emphasis on the "continuum of care," meaning providers communicate on a patient's status and condition to ensure nothing is forgotten in the transition between facilities. This applies to the transition between a physician's office and the ASC, when details on patient history, procedure information and other details may get lost in the shuffle. Establish a relationship between your front desk staff and the receptionist or nurse at your surgeon's office, and follow up regularly.
This also means that the surgeon should be more involved in explaining patient responsibilities, Mr. Voithofer says. "[That information] coming from an MD or a DO carries more weight than from the clerk sitting in the back office," he says.
Learn more about AdvantEdge Healthcare Solutions.
Read more about billing, coding and collections:
-Understanding Financials: Your Cash Flow Statement
-CMS Projects $4B in ASC Payments for 2011
-10 Statistics on Cash in ASCs