Becker's ASC Review

Executive Briefing: 44 Executive Briefing: Sponsored by: H ow well is your ASC's revenue cycle performing? If you can't answer this quickly and confidently, you may be overdue for a revenue cycle assessment. A revenue cycle assessment is a type of audit that examines an ASC's revenue cycle metrics and processes to identify issues that negatively affect cash flow and can contribute to surgery center failing to collect money it is rightfully owed. It's best practice for ASCs to undergo revenue cycle assessments at least annually, have them performed proactively (i.e., before cash flow problems become more difficult and time consuming to address) and have them completed by a third party. However, not all revenue cycle assessments are the same. That's important to understand because any assessment shortcomings are likely to miss problems and inefficiencies, thus indirectly contributing to unsatisfactory ASC revenue cycle performance. What should you expect from an effective revenue cycle assessment? Nothing less than the following 10 deliverables. 1. Deep dive into performance. A revenue cycle assessment shouldn't just look at an ASC's surface-level performance and metrics. Staying on the surface can significantly reduce the benefits of the assessment as revenue cycle problems are often not evident. That's why an effective assessment digs into an ASC's revenue cycle performance. This includes examining critical key performance indicators, including days to bill, days to pay, cash collections, payments greater than 90 days, days in accounts receivable, AR greater than 90 days, denial rate and clean claim rate. The examination should help identify a slew of potential issues, including poor denial and follow-up processes, high self-pay balances, charge entry errors, incomplete operative notes and failure to negotiate or load payer contracts. 2. Comparison of KPIs to standards. An examination of KPIs is only valuable if you know what those KPIs should be. An effective revenue cycle assessment will include a comparison of your KPIs to industry standards, taking into consideration your surgery center's specific qualities (e.g., specialties, payer mix) when applicable. 3. Opportunities for improvement. Identifying problems is one critical part of an effective assessment. Another: sharing steps you can take and recommended practices to address those problems, boost your metrics and better streamline cash flow. The guidance provided should come from experts in ASC revenue cycle performance (more on this later) who base their suggestions and tips on the experiences of performing numerous assessments and working with other like ASCs. 4. Appropriate number of cases reviewed. A revenue cycle assessment is completed through the assessment of a group of patient accounts. To paint an accurate picture of an ASC's revenue cycle performance, this figure should usually be around 20 cases, with those cases selected at random. The latter is important because taking a randomized approach helps ensure a variety of accounts are scrutinized, which increases the likelihood of identifying a range of major and minor issues impacting cash flow. The assessment provider should be open to adjusting the number of cases for various reasons, including looking at fewer accounts if major recurring problems are found or upon your request, such as if the assessment is focused on specific accounts associated with a biller. 5. Personalized impact. How revenue cycle issues and KPI performance impact ASCs will vary by surgery center. For example, an ASC with a high volume of Medicare patients should have a lower days-to-pay KPI than an ASC with more patients covered by commercial insurance since Medicare typically reimburses faster. As another example, ASCs with a high volume of Medicare patients are likely to have lower revenue per case than centers with more patients covered by commercial insurance since third-party payers tend to reimburse at higher rates. A revenue cycle assessment should be personalized to your ASC and its specific qualities. Such personalization is critical to understanding how those issues identified are affecting and likely to affect your center's short- and long- term performance. 6. Detailed report. Following completion of a revenue cycle assessment, your ASC should receive a detailed report. This report should include: • a summary of the findings; • an analysis of your ASC's revenue cycle KPIs and how they measure up with industry standards and best practices; and • a breakdown of each assessed account's findings and other critical details. Turning over every stone: What to expect from an effective revenue cycle assessment By Angela Mattioda, Vice President of Revenue Cycle Management Services, Surgical Notes

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