Success in 2025 will depend on leveraging the right expertise with the right technology at the right time to optimize your ASC’s revenue cycle performance. Below are five essential ways to drive next-level revenue cycle performance for your organization.
Transform Patient Financial Engagement
As high-deductible health plans and out-of-pocket costs continue to increase patient responsibility, a more sophisticated approach to patient financial engagement is needed.
Providing accurate estimates and setting up electronically managed payment plans can significantly reduce an ambulatory surgery center’s bad debt, often by 30 – 50% or more. In addition, nimble clients who adopt our digital payment solutions have seen a 238% improvement in patient collections and accelerated Payments Received Within 30 Days by 82%.
Digital payment solutions empower patients with easy, flexible options and payment plans while upfront, timely, and accurate estimates eliminate billing surprises and enhance patient trust and experience.
Improve Clinical Documentation with AI-driven Efficiency, Human-driven Expertise
Payers frequently update coverage guidelines, prior authorization (PA) rules and coding requirements which result in increased administrative burden and claim denials. According to the 2024 Experian Health “State of Claims” report, 76% of denials are driven by missing, incomplete or inaccurate documentation. In our experience, high quality documentation improves Days to Bill by 20 – 50%, reducing billing time by as much as 2 to 5 days, back-end denials 30% – 50%, and overall denial rates less than 5%.
Artificial intelligence (AI) and natural language processing (NLP) tools swiftly analyze initial dictation for clarity and quality but cannot ensure complete documentation or reimbursement delays. The incorporation of a highly qualified transcriptionist, or human-in-the loop (HITL), to review documentation especially Missing Op reports, incomplete physician documentation, inaccurate coding due to vague or insufficient notes and lack of medical necessity detail also creates a physician feedback loop that enhances documentation quality going forward. Better clinical documentation results in better coding accuracy, more appropriate reimbursement, fewer denials, and reduced physician queries.
Ensure Chargemaster Integrity Through Intelligent Claims Scrubbing
A high Clean Claim Rate (CCR) reduces delays in reimbursement and minimizes rework, improving and accelerating cash flow. The industry benchmark CCR is greater than or equal to 95%, while a best-in-class ASC is achieving 98 – 99% CCR.
The chargemaster, aka the charge description master (CDM), is a listing of items billable to a patient or their health insurance provider. Automated RCM workflows and claim scrubbing technology detect ASC billing issues before they occur while sophisticated algorithms with customized edits based on payer contracts and the ASC’s procedure mix ensure the chargemaster integrity, increasing CCR and revenue per procedure – which is especially important when reimbursement rates for ASC procedures are declining. Regular chargemaster reviews safeguard against under and overbilling by aligning with code changes, adjusting for contract changes, and ensuring CPT and revenue codes are applied correctly. Using a blended coding solution – AI-enabled coupled with human expertise to accelerate the coding process – dramatically improves accuracy, reducing the risk of costly payer disputes and compliance issues.
Utilize Intelligent Claim Follow up and Appeals
Effective claims management fuels a surgery center’s financial health while denied or delayed claims and inefficient follow-up lead to lost revenue. A proactive, technology-driven approach accelerates this process, ensuring timely reimbursement and reducing administrative burden.
Real-time claims statusing flags at-risk claims that need attention or are not likely to be paid and empowers an AR specialist to take immediate action, preventing potential revenue leakage. As soon as a denial is received, real-time routing ensures immediate, accurate follow-up based on denial type and payer which enhances accuracy and accelerates resolution with the insurance company. Further, dynamic appeals templates and proactive medical record submission maximize appeal success which when coupled with proactive identification and immediate response, minimize write-offs and aged AR, freeing up capital for reinvestment in facility upgrades, equipment, and patient services.
Improve Analytics and Proactively Prevent Denials
Comprehensive financial intelligence provides actionable insights that directly impact an ambulatory surgery center’s bottom line. Proactive denial management can significantly boost cash flow with some organizations achieving a 5-10% revenue increase simply by reducing denials. Key metrics to track and their importance include:
- Monitoring Clean Claim Rates (CCR) helps minimize billing errors before submission, preventing denials and delays.
- Tracking Days in Accounts Receivable (AR) helps improve cash flow and accelerate reimbursement cycles.
- Analyzing denial rates and identifying recurring patterns allows organizations to pinpoint systemic issues and implement targeted actions.
- Understanding collection rates by payer and patient type enables organizations to tailor strategies and maximize collections.
- Tracking provider productivity and benchmarking against industry standards helps enhance efficiency while ensuring compliance.
Summary
In 2025, the most successful ASCs, surgical clinics and hospitals will treat revenue cycle management as a strategic asset. By embracing technology, workflow automation, human expertise and review and real-time analytics, organizations can accelerate cash flow, minimize denials, and strengthen financial stability. The time is now to align your revenue cycle with the future of healthcare and position your organization for sustained growth.
Interested in learning more? Sign up for the March 4, 2025, Becker’s webinar with the nimble team, or visit nimblercm.com to learn more.
