As the evolution from volume-based care toward value-based care continues, it is more important than ever for center leadership to apply advances in technology and management processes that enable them to collect revenue efficiently and consistently.
Regent Revenue Cycle Management (Regent RCM), a provider of innovative billing and collection services exclusively for ASCs, has partnered with ZirMed, a platform provider of comprehensive, end-to-end cloud-based RCM solutions, since 2011. Together, we leverage our expertise to provide turnkey solutions that combat the complex issues faced by ASCs such as coding, claim denials and patient collections.
To ensure a healthy revenue cycle, Regent RCM and ZirMed recommend five key strategies to maximize cash flow and collections, while minimizing the time required to do so.
• Verify insurance coverage up front. Nothing wastes time and money like filing claims for procedures that are not covered. According to Emily Reder, ZirMed partner relationship manager, center leaders should not bog billing staff down with calling, faxing and logging into multiple payer websites as they search for eligibility information. Instead, workflow efficiencies can be generated using a single application that can quickly verify coverage from all payers. Remember, insurance denials can inflate A/R greater than 90 days to high levels. The Regent RCM gold standard for contracted payers for A/R over 90 days is 12 percent or less, while centers that have a high Medicare population should be reporting less than 10 percent.
• Code claims correctly the first time. The advent of ICD-10 has made this a difficult task. ICD-9 had approximately 13,000 codes, while ICD-10 has approximately 68,000—over five times as many. This makes it more difficult and time-consuming to wade through codebooks or toggle between different programs and websites. Proper coding is a critical component of the revenue cycle and one of the primary factors when it comes to meeting Regent RCM's clean claims rate benchmark of 98 percent.
• Minimize claim denials. Centers should select a claims management application that guides business office personnel through the process of creating and submitting claims based on national standards, as well as payer parameters. Edits should be setup so claims that are not clean will be caught with clear explanations of what needs to be fixed prior to submission. ZirMed's average first-pass clean claims rate is above 98 percent because of its advanced claims-scrubbing technology. Regent RCM, too, boasts a gold standard clean claims rate of 98 percent. We accomplish this by using proper coding, a knowledgeable billing staff and the claims scrubbing technology in ZirMed.
• Act quickly against denials. Denied claims slow revenue realization and affect staff productivity. But blindly accepting them, disputing them or appealing them aggressively without the right tools is ineffective. Employing ZirMed's Denial and Appeal Management application will automatically provide staff with the required payer-specific paperwork, and will also populate, print and mail the appeals. The ZirMed application can help centers reach our gold standard of less than 10% denials. Keeping the denial percentage low will help keep days in A/R and percent of A/R over 90 to a minimum, as well.
• Arrange for/ Collect patient out-of-pocket expense up front. High-deductible health plans have put more financial responsibility on the patient. But, the chances of collecting a patient's outstanding balance drops by 50 percent once the patient has been seen. Employing ZirMed's Patient Estimation application, which goes beyond eligibility verification to predict a patient's total financial responsibility, is recommended. The goal should be to arrange for/ collect the total out-of-pocket patient expense prior to the patient being seen. Not doing so decreases the likelihood of collecting that amount post-visit substantially. Net Collections Rate , which Regent RCM nicknamed "The Great Lie Detector," reveals the percentage of eligible money that the center actually collected. Improving up-front collections will increase NCR, and Regent RCM's gold standard is greater than 97 percent.
The partnership between Regent RCM and ZirMed leverages the deep expertise of two companies to improve the efficiency and effectiveness of the collections process. By following the five strategies outlined above, verifying insurance coverage up front, coding claims correctly the first time, minimizing claim denials, acting quickly against denials and arranging for/collecting patient out-of-pocket expense up front, centers will align themselves to maximize revenue and productivity.