Becker's ASC Review

50 Executive Brief: Revenue Cycle Technology collections? Would these patients sign up for virtual visits over the internet and be willing to pay in cash? These examples show that there has to be a new way of execut- ing the revenue cycle. When an MIS Becomes a Predictive Tool An MIS can extend further into a predictive tool providing vital clues to the future of the center. This could vary from calculat- ing how much the center will earn in 2014 to considering the im- pact of the new healthcare laws on the center's profitability in two years. Predictive systems are often learning systems that base decisions on not just historical data but also incorporating current data and external data. There are many commercially available predictive algorithms but the right systems provide precise insight at the time of need. For example, IBM Watson, an artificially intelligent computer system capable of understanding natural language, has recently an- nounced an application program interface that can be integrated and used by other systems. Developments such as these would allow future center administrators to leverage computational pow- er of complex predictive system to make operational decisions more analytically. Future center administrators will see them- selves as custodians of data who can direct systems and extract useful insights. Artificial intelligence systems are used every time we swipe our credit card, shop online or buy a book. It's time to apply them to the revenue cycle. Automating Revenue Cycle Management There are several aspects of the revenue cycle that are repeat- able and predictable. The functions and tasks are similar. From optical character recognition software to software that can inte- grate in the backend with clearinghouse databases, there are several avenues to minimize manual work of the revenue cycle. Here are a few examples where intelligent software scripts can save time, resources and also increase quality. Scheduling. By using online scheduling tools to integrate patient portals where patients can schedule themselves in, surgery cen- ters can minimize phone calls associated with scheduling func- tion. Extending access to physicians' phones/tablet devices can allow physicians to independently monitor schedules without as- sistance from staff. Eligibility, benefits verification and authorizations. Software programs can automatically verify eligibility of patients and bene- fits for most major insurances. Some of these programs are com- mercially available or can be developed in-house. Similarly, there are automated programs that can be used to obtain insurance authorizations well before the procedure date. Claims submission. With the implementation of EHR systems, claims can be automatically entered, scrubbed and reviewed against Local Coverage Determination guidelines and clean claims can be submitted directly to clearinghouses. Automated quality. Prior submitting claims, automated quality scripts can verify claim data against all possible insurance rules to submit errorless claims. Examples of such rules can be from checking compatibility of the reported ICD code with the CPT code to verifying for appropriate modifier usage. AR activity can be controlled by ensuring clean and timely claim submissions. Claim status. Custom or commercially available software can be deployed to verify payment status of claims. Using software al- lows this process to be conducted daily and therefore optimize calling insurance companies for AR follow-up. AR tracker. Instead of the traditional 0-30, 30-60, 60-90 and 90- 120 day bucket system to track claims cycle, AR tracker software can allocate follow-up calls based on average payment days of different insurance companies. A predictive system could even provide suggestions on a future follow-up date based on a call made to an insurance company. Patient collectables. Centers can use software that can track a particular patients account since the date of service. It can be pre-programmed with a fixed time period, after which the software automatically generates patient statements and reminders. State/federal compliance. Many states require ASCs to adhere to the process of submitting service quality data to state regis- tries. For example, in New York State, it is obligatory for outpa- tient surgery centers to submit quality data to SPARCS and HCRA reporting systems. Software can be developed to automate data submission. Future of Revenue Cycle Management When technology is actively applied to fundamental processes such as revenue cycle management, the natural evolution would be for complexity in billing to disappear. There would be no more billing errors, delayed payments, denials from insurance compa- nies, mounting patient payments or AR days. Physicians would submit claims correctly and get paid instantly. Patients would have clarity on the type of service that will be provided and the as- sociated costs with it. Insurances wouldn't build business models around staggered reimbursements. However, until such a Utopian future happens, using advanced technology will help center ad- ministrators and owners utilize their time toward meaningful chal- lenges. n GUIDE TO A PREDICTIVE REVENUE CYCLE FOR ASCs 1. 2. 3. 1(866) DOC-NEXT | www.nextservices.com/ASC build a basic dashboard to track operations use dashboard to make operational decisions 3 most imp needs of patients, physicians and staff at the ASC 3 key numbers to track daily, weekly and monthly Prioritize list based on High, Medium, Low Build a basic, dynamic dashboard that allows drilldowns Integrate PMS, EHR, external systems (e.g. health exchanges) Create rule-based workflow (e.g. # of AR calls for Mary) Build automations (e.g. generate statements if X occurs) Integrate MIS with internal processes such as HR teach MIS to predict outcomes Build correlations using historical clinical and admin data Identify broad trends (e.g. payments from BCBS in Q3) Use commercial/ custom machine learning algorithms Teach MIS to learn from the past and predict the future MIS (info system) PREDICTIVE REVENUE CYCLE ASC DASHBOARD SERVICES AND SOFTWARE PLATFORM FOR AMBULATORY SURGERY CENTERS BILLING | CONSULTING | EHR NextServices is a healthcare and technology company. Ambulatory surgery centers utilize our integrated services and software platform that offers revenue cycle management and a mobile EHR. sales@nextservices.com • 1(866) 362-6398

• Cover