Becker's ASC Review

18 ASC Turnarounds G astroenterologists are busy running the clinical aspects of their practices, but many savvy GI physicians are taking an active role in the financial side of medicine. Three GI field experts weigh in on revenue cycle management best practices, challenges and opportunities for GI practices and endoscopy centers. Question: What are some of the most important revenue cycle metrics for GI practices and endoscopy centers to track? Larry Good, MD, FACG, Founder, CEO Good Pharmaceutical Development, CEO, Compas- sionate Care Center of New York: Seasonal pat- terns are the most important metric to track in cash flow, so that one can prepare for the histori- cally slow pay periods: the first and third quarters of the year. Michael S. Morelli, MD, CPE, FACG, President, Indianapolis Gastroenterology and Hepatol- ogy: • Expected gross collection rate, i.e. what per- cent of your total charges you expect to col- lect. While it is difficult to determine an exact expectation, you should have some idea what this percentage is. You should also calculate how changes in payer mix, service mix, payer fee schedules and other variables will impact the expected rate. • Actual gross collection rate. While this can vary from practice to prac- tice based on your charge structure, it is useful within your own prac- tice to compare your expected collection rate and to prior years. It is important to look at gross collection rate in addition to net collection rate, as it will help you understand whether your contractual allow- ances are in line with expectations based on your contracts. Monitor those services that have significantly high collection rates as compared to the other services being analyzed to be sure your charges are set high enough to capture all of the reimbursement from the third party payers. • Net collection rate, i.e. the percent of your charges collected after con- tractual allowances are taken into account. • Total days in accounts receivable • Percent of accounts receivable over 90 days • Percent of accounts receivable over 60 days • Percent of clean claims submission – Percent of claims that are ac- cepted by the clearinghouse for immediate transmission for payment Barbara G. Tauscher, MHA, FACMPE, AGA Practice Management and Economics Commit- tee; Director of Operations, Gastroenterology, East and South Divisions of The Oregon Clinic (Gresham): • Cost and revenue per case. Although this isn't a revenue cycle metric, you'll want to assure that your cost per case hasn't exceeded your revenue per case. • Staffing costs. Again, not associated with recycle management, staffing costs usually account for the highest portion of your expenses. Explore ways that some functions could be completed by non-RN staff, for example. • Days in A/R. Are you efficiently and effectively billing and collecting? Do you have clean claims being sent out? • Copayment/deposit collection rate. Do you collect every copayment at the time of service? Do you collect deposits for every endoscopy case in which the patient will have an out-of-pocket cost? • Denial rates. Track the types and frequency of denials. Can you im- prove any processes to decrease the denials? • Payer mix. This metric should be tracked at least every quarter. Is your payer mix becoming more Medicare/Medicaid and less commercial? If so, why? Q: How can GI physicians keep abreast of these important met- rics while running a busy practice? LG: Good office management and tight account receivable tracking are key. If payments are off at other periods, it will make it impossible to deal with the slow payment months. Aggressive follow-up on delinquent accounts is necessary. MM: Keeping abreast of these most important metrics is best accomplished by having your internal accountant or revenue cycle manager (or representa- tives from your billing company if you outsource) publish these metrics ev- ery month. This requires an information technology structure to be in place and a good relationship with your billing company, if you outsource your billing. Procuring data and creating analytical benchmarks and dashboards is the only way to keep a handle on this important part of your clinical practice. BT: Each practice should develop a monthly dashboard that includes the measures that they want to review each month and quarter. The dashboard should include the number of new patients seen per month. This is a good indication of whether your practice is growing or is maintaining their reve- nue stream from established patients. The dashboards should be reviewed by the executive committee, finance committee and/or all physician groups. If problem areas are identified, an action plan should be developed to correct it. Q: Does it make more sense for GI practices to keep revenue cycle functions in-house or outsource? LG: In my opinion, it is always preferable to keep management in house to maintain control and accountability. MM: This is a tough question and is often practice specific. Things to con- sider when making this decision include the following: 1. Do you have the ability to hire the right personnel to keep your rev- enue cycle functions in-house? Certified coders with experience in GI and an experienced and knowledgeable manager are essential. Appro- priate IT and system support will also be required. 2. If you are considering outsourcing, compare billing companies with whom you might contract. a. What is their model of operation? Are they a full service company or a hybrid model? Under a hybrid model, your practice will be ex- pected to perform some portions of the revenue cycle. Know exactly what services they will provide and what services your practice will be expected to provide. GI Financial Playbook: 3 Experts on Revenue Cycle Management for GI Centers By Carrie Pallardy

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