Recouping revenue without reengineering workflow: Part one

Amidst an ever-changing reimbursement landscape, today’s ambulatory surgery centers (ASCs) are unsure how to improve their revenue cycle performance and increase profitability without affecting vital aspects like daily workflow. With an emphasis on insightful reporting to gain an edge, part one of this two-part series highlights five tips to optimize revenue cycle management (RCM) and increase profitability without sacrificing quality or time of other departments.

For any ASC to improve revenue cycle performance, its leaders must be aware of common points where money can hemorrhage. The following areas are easy to assess and can yield significant financial returns without adding much work to already over burdened providers or business office staff.

1. Pre-registration: A facility’s pre-registration rate for scheduled patients should be 98 percent or higher. Spending just 10 more minutes during scheduling to complete pre-registration, scan insurance cards and determine eligibility during patient onboarding will save, on average, three to four hours of business office staff time correcting outdated insurance or bad policy data after the claim denial. Today’s EHRs even have embedded eligibility workflows, so there is no excuse for receiving a denial due to incorrect patient insurance.

2. Medical necessity checks and documentation: When scheduling a procedure, or any associated test such as an MRI or CT scan, be sure to complete a medical necessity check and relevant documentation. Medical necessity checks for exams and procedures should be performed at a rate of 100 percent. If skipped, your ASC runs the risk of delivering free services. For Medicare patients, consider the requirements stated within the National Coverage Determination (NCD).Send payer documentation requests to the ordering physician, who should include progress notes or other medical entries documenting why the procedure was medically necessary as well as the final test report. Payer denials due to medical necessity failures are completely avoidable.

3. Appointment call abandonment rate: Maintain a goal appointment call abandon rate of less than 2 percent. If your value is greater, dollars are slipping away at the first step in your revenue cycle. Ensure front-office or call-center staff undergo additional training for prompt, efficient response time to incoming calls. This is your first chance to make a good impression and foster patient engagement.

4. Aged A/R: Only15 to 20 percent of your accounts receivable (A/R) should be older than 90 days. If your value is higher, analyze accounts to ensure Medicare is paying at the primary responsibility level within22 days of the claim date. Primary commercial payments should be received within 60 days. If you have HMO/PPO contracts, be sure payment obligations are being met within your contract’s stated timeframes.

5. Charge master review: When was the last time you reviewed your charge description master (CDM)? It should be updated annually. New entries are required whenever new equipment is purchased or when the ancillary staff’s process has been updated. Ensure each charge amount is at least 20 percent more than Medicare’s allowed amount. If not, you are leaving money on the table. Payers will only reimburse up to the submitted charge amount, not a penny more. When the charge amount is less than their allowed amount, you’ve immediately lost potential reimbursement. A poorly maintained CDM is one of the most commonly overlooked leakage points for revenue cycle.

Aligning these five steps from pre-registration and onboarding through CDM review can help ASCs easily recoup dollars without adding strain on limited RCM and business office staff. Within each phase, thorough documentation will hold staff accountable while easing reporting submissions for reimbursement programs.

Be sure to read part two of this series, which covers five additional revenue cycle savings opportunities from contract review to patient payment plans.

Joncé Smith is the Vice President of Revenue Cycle Management for Stoltenberg Consulting, Inc.


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