Becker's ASC Review

67 Executive Briefing: Boosting Your ASC's Revenue Cycle Sponsored by: P uzzled about why your surgery center doesn't seem to have enough cash at the end of the month? If you're having trouble covering costs and making distributions, it's time to take another look at revenue cycle management. You might not be maximizing your collections. "Simply put, without charges, there is no collections; without col- lections there is no money," says Sandy Berreth, RN, BS, MS CASC, administrator at Brainerd Lakes Surgery Center in Baxter, Minn. "Without money you cannot pay for fixed or variable costs. If you don't pay the bills, you don't have a surgery center." And there are several challenges to the medical billing cycle to- day, including: • Higher-deductible health plans • Patients not understanding their coverage • Inability to pay because of economic constraints • Medicare replacement plans with narrow networks and sepa- rate credentialing The transition between insurance companies can also cause is- sues. "We have seen a number of claims denied due to lapse in coverage which can be attributed to patients insured on the mar- ketplace and not making their premiums," says Kris Sabo, RN, ex- ecutive director of Pend Oreille Surgery Center in Ponderay, Idaho. "This is something I expect to get worse before it gets better." And not all the payment defaulters are those you'd expect. "Medical costs are usually unexpected, and often can force other- wise financially savvy consumers into collections and credit prob- lems; in the worst-case scenario, bankruptcy," says Ms. Berreth. If patients are unable to pay their bills, the loss goes directly to the ASC's bottom line. "We must learn to work with our patients. If we do that, they will be more likely to pay their bills." Go electronic all the way Electronic systems and software designed for the revenue cycle process will make the process easier and more accurate. "Having electronic systems is the number one thing you can do to shorten the steps of the revenue cycle," says Joseph G. Ollayos, ad- ministrator at Tri-Cities Surgery Center in the greater Chicago area. "ASCs need a system that allows them to track the important metrics, such as when claims are paid and whether refunds are sent appropri- ately. They really help the centers keep track of the revenue cycle." There is software available to help streamline the billing process and create efficiencies for staff members. "Integrated software systems for scheduling, billing and inventory assistance in managing demand and cost [help ASCs run more smoothly]," says Janie Kinsey, RN, CASC, administrator at Saint Luke's Surgicenter-Lee's Summit (Mo.), who uses the in2itive Business Solutions, which works with the center to use integrated software to provide targeted and timely service solutions. "Provid- ing adequate time for planning and implementation of these sys- tems will increase the long-term success and benefits." For example, an electronic health record system or an automated patient estimator can shave hours from the financial counselors' workload. "Normally the co-pay is around $150 to $250 and we call patients before their day of surgery to make sure they are able to pay the day of surgery," says Mr. Ollayos. "We also try to determine the patient's coverage and set expectations by looking up what part of their deductible has or has not been met and figure out what we can collect from them at the front desk. We ask them to bring their copay and insurance card with a photo ID to make sure there isn't any identity theft." Outsourcing claims Outsourcing these services could also have a positive impact on the independent ASC's bottom line. Ms. Sabo's surgery center began working with in2itive to manage the revenue cycle in Oc- tober 2014 and has already seen great benefit. How to Manage Your Revenue Cycle Better to Improve the ASC's Bottom Line "Simply put, without charges, there is not collections; without collections, there is no money. Without money you cannot pay for fixed or variable costs. If you don't pay the bills, you don't have a surgery center." — Sandy Berreth, Brainerd Lakes Surgery Center

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