Here are five ways orthopedic surgery centers can stay practice successful revenue cycle management.
1. 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.
2. Elect staff members to monitor finances, particularly pre-collection and billing functions. Elect staff members to monitor finances. These specialists' primary role is to meet with patients before surgery to pre-collect copays, deductibles and co-insurance amounts and work out payment plans as needed, Ann Margaret McCraw, CEO of Midlands Orthopaedics Surgery Center in Columbia, S.C., says. Delegating specific responsibilities, such as pre-procedural collections, to staff members helps ASCs collect in a more efficient manner. "Our financial account specialists collect both for our professional practice and ASC, so our patients don't have to make separates trips for different bills," she says. "These staff members are trained to have those sensitive conversations with our patients and know how to interpret statements, EOBs and explain deductibles. So it helps our ASC and practice because the payments from one patient are all funneled to a specialist, and it's nice for our patients because it alleviates confusion on their part as they navigates bills from both entities."
3. Tighten up front-end revenue cycle management. Exercising diligence on the front-end of revenue cycle management will make a significant difference on your revenue cycle efficiency, says Melody Winter-Jabeck, administrator at Ravine Way Surgery Center in Glenview, Ill. This is particularly true when checking coverage and verifying patient information as soon as possible. Ravine Way Surgery Center collects all patient information and follows up with a phone call to the patient's insurance company to find out the patient's financial obligation. "It's all about having really solid front-end management," Ms. Winter-Jabeck says. "This means your ASC has to be diligent with checking coverage and communicating well with patients so that there are no surprises for them. The more information you can verify with patients on the front end, the faster revenue comes around. Patients may not be aware that there is a $1,000 out-of-pocket fee for surgery."
4. Focus on training coders. Dave Wold, CEO of Healthcare Information Services, believes that the in-house employees handing coding should be certified coders. If not, the practice should spend the time and money to have them trained. He recalls overhearing a physician ask his coder, "Susan, you know all this stuff already don't you? You don't need any training." Mr. Wold says that is a question that leads to only one answer: "You're right, doctor, I don't need any training!" The practice should view training of staff to be as important as CME for physicians, he says. It takes time and resources to correct inaccurately coded claims and the surgery center won't receive reimbursements until the information is correct. Coders can get the training through Webinars or in local seminars.
5. Incentivize employees to keep a close eye on revenue cycle management. Not keeping track of the accounts receivable and billing process is one of the biggest mistakes orthopedic practices can make, says Nancy Moore, president of NBP, a management support company. "Often, the physician trusts employees to do the best job possible to manage the A/R and billing process, and sometimes it's not being handled well," she says. "Employees should be educated every year about reimbursement changes and carrier level changes. You also have to have good oversight from the management."
The trained employees who handle the revenue cycle responsibilities should be compensated appropriately because these employees are controlling the surgery center's cash flow. "In oversight, employees really need to be held accountable, incentivized and rewarded for good work," says Ms. Moore. "This doesn't always happen, especially now when it's tough to get reimbursement, but at the same time you can't cut corners." Orthopedic surgery centers should set solid goals for the revenue cycle managers, such as maintaining the A/R greater than 120 days at 15 percent or lower of total A/R, a net collection ratio greater than 95 percent, and incentivize employees with compensation when goals are met.
1. 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.
2. Elect staff members to monitor finances, particularly pre-collection and billing functions. Elect staff members to monitor finances. These specialists' primary role is to meet with patients before surgery to pre-collect copays, deductibles and co-insurance amounts and work out payment plans as needed, Ann Margaret McCraw, CEO of Midlands Orthopaedics Surgery Center in Columbia, S.C., says. Delegating specific responsibilities, such as pre-procedural collections, to staff members helps ASCs collect in a more efficient manner. "Our financial account specialists collect both for our professional practice and ASC, so our patients don't have to make separates trips for different bills," she says. "These staff members are trained to have those sensitive conversations with our patients and know how to interpret statements, EOBs and explain deductibles. So it helps our ASC and practice because the payments from one patient are all funneled to a specialist, and it's nice for our patients because it alleviates confusion on their part as they navigates bills from both entities."
3. Tighten up front-end revenue cycle management. Exercising diligence on the front-end of revenue cycle management will make a significant difference on your revenue cycle efficiency, says Melody Winter-Jabeck, administrator at Ravine Way Surgery Center in Glenview, Ill. This is particularly true when checking coverage and verifying patient information as soon as possible. Ravine Way Surgery Center collects all patient information and follows up with a phone call to the patient's insurance company to find out the patient's financial obligation. "It's all about having really solid front-end management," Ms. Winter-Jabeck says. "This means your ASC has to be diligent with checking coverage and communicating well with patients so that there are no surprises for them. The more information you can verify with patients on the front end, the faster revenue comes around. Patients may not be aware that there is a $1,000 out-of-pocket fee for surgery."
4. Focus on training coders. Dave Wold, CEO of Healthcare Information Services, believes that the in-house employees handing coding should be certified coders. If not, the practice should spend the time and money to have them trained. He recalls overhearing a physician ask his coder, "Susan, you know all this stuff already don't you? You don't need any training." Mr. Wold says that is a question that leads to only one answer: "You're right, doctor, I don't need any training!" The practice should view training of staff to be as important as CME for physicians, he says. It takes time and resources to correct inaccurately coded claims and the surgery center won't receive reimbursements until the information is correct. Coders can get the training through Webinars or in local seminars.
5. Incentivize employees to keep a close eye on revenue cycle management. Not keeping track of the accounts receivable and billing process is one of the biggest mistakes orthopedic practices can make, says Nancy Moore, president of NBP, a management support company. "Often, the physician trusts employees to do the best job possible to manage the A/R and billing process, and sometimes it's not being handled well," she says. "Employees should be educated every year about reimbursement changes and carrier level changes. You also have to have good oversight from the management."
The trained employees who handle the revenue cycle responsibilities should be compensated appropriately because these employees are controlling the surgery center's cash flow. "In oversight, employees really need to be held accountable, incentivized and rewarded for good work," says Ms. Moore. "This doesn't always happen, especially now when it's tough to get reimbursement, but at the same time you can't cut corners." Orthopedic surgery centers should set solid goals for the revenue cycle managers, such as maintaining the A/R greater than 120 days at 15 percent or lower of total A/R, a net collection ratio greater than 95 percent, and incentivize employees with compensation when goals are met.