Becker's ASC Review

68 Executive Briefing: Executive Briefing: Boosting Your ASC's Revenue Cycle "At that time, we had average days in A/R greater than 45 and working a large book of collections cases," she says. "We were literally living payday-to-payday and had no profit to distribute to our investors. Recently, we distributed a sizeable amount to our investors! Enough said." She attributes this to improvements in technology and electronic funds transfer. "The result is that the total reimbursement in the current 60-day buckets is up with claims going to secondary and patient responsibility much more quickly," she says. Encouraging cash payment for patients without insurance also makes a difference. Cash payment is efficient for the revenue cy- cle because the surgery center receives the full payment without needing to bill the insurance company separately from the patient. "We are geographically situated between Washington, Montana and Canada and as a result see a fair number of patients from those ar- eas with either high deductible plans or uninsured," says Ms. Sabo. "For these patients and any others for whom we will not be billing insurance we have begun offering a cash-pay package and plan. We are very excited about the potential for this program and the possibili- ties for this to be utilized for local businesses that self-insure." Key benchmarks It's important to assess revenue cycle benchmarks fairly and work with revenue cycle staff to correct any errors. "We use the information purely for learning purposes and in no way is it used punitively," says Ms. Sabo. "Mistakes may occur in any step in the process, from data entry at scheduling/reception to items missed by the clearinghouse, to billing errors r/t electronic submission. All are opportunities to learn and perform better." A few of the key revenue cycle benchmarks to watch include: 1. Days in accounts receivable — close to 30 days 2. Denials upon first submission 3. Comparison between contracted amount and actual payment 4. Days from the date of service to receive an operative report from the physician 5. Days from the date of service to file a claim 6. Number or percentage of appeals required 7. Bad-debt percentage 8. Number and size of RAC audits "If the days in AR step out of line, I want to know what has changed," says Ms. Sabo. "Regarding denials, if we know where the ball was dropped, we are able to learn from the experience and prevent a similar occurrence in the future." Tips for revenue cycle optimization A smoother revenue cycle is ideal for the center's health as well as ownership distributions. ASCs with positive cash flow can make a determination to investor distributions on a regular schedule. "We have a system where our money comes in and after we meet payroll and vendor obligations, we reserve the rest for quarterly distributions," says Mr. Ollayos. "We put that money aside starting the first week of the quarter so we can budget and then make the distribution payments at the end of the quarter." Here are 11 tips to keep your accounts receivable on track: 1. Verify insurance benefits on every patient and all cases scheduled. 2. Double-check the demographic information for the patient. 3. Contact patients to inform them about financial responsibility. 4. Inform patients you collect their payment before or on the day of service. 5. Discuss payment forms and third-party financing options before surgery. 6. Postpone a procedure when able to improve the patient's financial situation. 7. Have physicians dictate as soon as the surgery is done and then transcribe the report. 8. Obtain pre-certification and referrals when required. 9. Make insurance claims submission, remittance and remit- tance advice electronic 10. Establish and maintain a patient balance statement cycle. 11. Write-off bad debt in a timely manner. n in2itive Business Solutions is a proud industry leader in healthcare revenue management and consultation for ASCs and surgical hospitals, with a leadership team that's spent a collective 75 years reconciling accounts and uncovering lost revenue. Our services are highly personal and easy to customize and include consulting, transcription, coding, A/R management and month- end reporting, all available as short or long-term contracts. We're a fun, flexible, hard-working team that not only strives for the industry's best customer service—we achieve it! "We have a system where our money comes in and after we meet payroll and vendor oblicagions, we reserve the rest for quarterly distributions. We put that money aside starting the first week of the quarter so we can budget and then make the distribution payments at the end of the quarter." —Joseph Ollayos, administrator of Tri-Cities Surgery Center

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