A Guide to Revenue Cycle Management for Surgery Centers

Chapter One

What is Revenue Cycle Management?

Revenue cycle management (RCM) is a term that is so widely used in the healthcare industry that its full meaning and importance can often become lost. There are many definitions of RCM, but let’s use the following: Surgical RCM in healthcare simply means all the activities taken to ensure that an ambulatory surgery center (ASC) receives the deserved and appropriate revenue for a patient’s encounter, from when their appointment is first booked through when their balance is paid.

As healthcare technology continues to evolve, administrators require tools that can leverage analytics and create revenue cycle solutions. A few areas that have a considerable impact on RCM include case costing, payor mix, contracts, and workflow automation. Being aware of each of these areas throughout the revenue cycle management process is crucial to ensure success. 

In this guide, we’ll navigate how patients are involved, internal processes, key performance indicators (KPIs), how revenue cycles work within an ASC, how software plays a key role, and what you should look for in revenue cycle services (RCS) support.

First, let’s consider revenue cycle management and the patient experience.

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Chapter Two

How Revenue Cycle Management and Patient Experience Intersect

The importance of patient engagement continues to increase, which requires the revenue cycle process to be as painless as possible. While talking about payments can be a sensitive topic for patients, it’s crucial that providers have a communication plan in place, which includes before patients enter your facility, while they are there, and even after they leave.

The more engagement you have with patients, the better. This not only ensures the payment process will be as smooth as possible, but patients will also have a better overall experience, which includes confidence in the value of care they received.  Just as the patient’s experience with the RCM process is important, evolving your processes is equally important.

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Chapter Three

Evolving Surgical Revenue Cycle Processes

Following a value-based model, there are several areas for ASCs to consider for their RCM processes. First, regulations can influence how you run your business as well as the revenue cycle process. Second, your facility should consider focusing on the services you excel in, rather than promoting many services, in which you might not have as much experience. Third, make sure that your facility is communicating its value and collaborating within your community. Lastly, understand your costs so that you can be proactive about your RCM process.

By making thoughtful RCM decisions, you will help ensure that your revenue cycle processes are evolving to meet the needs of your patients and facility.

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Chapter Four

Keep an Eye on KPIs

Another vital area to consider for success with RCM at your facility is, key performance indicators or, KPIs. By examining your KPIs, you will gain an understanding of how you’re doing on a monthly basis. If you’re unsure about where to begin, here are three major KPIs to start with.

Cash Collections as Percent of Net Revenue

This essentially means you need to understand your expected and deserved reimbursement for the services you provide. This number may also be referred to as net revenue or your cash goal. You must be able to evaluate if your facility is collecting as much cash as possible. If not, it might be time to review net revenue on a monthly basis and discover areas for improvement. 

Days to Bill

Depending on how long it takes your facility to send a bill, this may be another factor preventing you from maintaining a healthy revenue cycle. Ensure you’re consistently meeting your facility’s goals.

Age of Accounts Receivable

While you want to receive payment as quickly as possible, there may be times when you will have aging accounts receivable (AR). Much like determining how many days you have to send a bill, also determine how many days signifies an old account. Measures to consider: 60 or 90 days.

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Chapter Five

Surgical Revenue Cycle Processes for ASCs

Every ASC has payment and collections risks. It’s important to address and adjust your processes as needed to help ensure you’re meeting regulatory changes and addressing increased patient responsibility.

A few recommended practices to consider:

Streamline Patient Financial Clearance

Due to the increases in patient financial responsibility, ASCs must be sure to go beyond eligibility verification. This requires providers to be transparent with patients, which includes providing payment estimates, collecting payments preferably prior to service but at least before a patient leaves the office, and obtaining prior authorization when needed.

Proactively Address Denials and Rejections

A good percentage of revenue for healthcare providers is often tied up in denials. It’s crucial for providers to determine benefit eligibility, obtain medical necessity paperwork, validate prior authorizations, and more to decrease chances that a claim could be denied.

Intelligently Collect Payments

To reduce the risk of delayed payments or even non-payment, ASCs need to communicate with patients and payers concerning how they would like to receive and send information. It may also help to provide patients with multiple ways to pay, whether it’s online, by phone, or in person. Many patients prefer managing payments online, so this is one area you can’t afford to ignore.

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Chapter Six

Surgical Revenue Cycle Software

Data Integrity, Security, and Transparency

When seeking a software solution for RCM, you will probably have many requirements to ensure the option you select will work for your facility. Three areas we know are essential are data integrity, security, and transparency.

With the ability to capture and analyze a large amount of information, providers can understand and communicate with patients on a greater level than ever before.

Ensuring the integrity of your data is a key step in being able to rely on the information you possess. In this area, receiving data in a timely manner is essential. For example, if you’re acting on data that is 30 days old, it might be too late to make adjustments, or it may have already cost you money.

Watch the Full Webinar Now: Common Obstacles to Getting Paid in an ASC

Since information is incredibly sensitive, your software must be protected. This means having a multilayered identity verification process in place.

It is worthwhile to focus on transparency for patients, payers, and providers. Concerning patients, a growing number are requesting access to their information, allowing them to be more involved with their care. For payers and providers, access to this information is helpful for collaboration.

Finding a Software Solution That Meets Your RCM Needs 

Challenges with managing your revenue cycle occur on a weekly, if not daily, basis. The good news is that there are solutions to help you improve your overall performance.

Many facilities can solve their greatest problems, such as verifying patient insurance coverage, collecting patient payments, incomplete or inaccurate charges, and disruptions from billing staff turnover, by using a RCM solution. 

A few software solution capabilities that can help your revenue cycle process include:

• Patient management
• Claim preparation and submission
• Claim management
• Accounts receivable (A/R) management
• Follow-up

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Chapter Seven

What to Look for in a Surgical Revenue Cycle Services (RCS) Partner

While everything we’ve shared so far is applicable for ASCs managing their own RCM, many lack all the necessary resources to fulfill these recommendations. Fortunately, you have the option to outsource to a revenue cycle services (RCS) provider. 

Outsourcing provides many benefits. Not only can it often save you money, it can also help to collect more revenue, improve transparency and deliver enhanced consistency.

Once you identify that your facility might require help from a RCS provider, what are some qualities you should look for?

The right RCS partner will: 

1. Provide a revenue cycle assessment and optimization strategy
2. Provide constant monitoring and adjustments to RCM processes
3. Communicate routinely, effectively, and professionally
4. Hold and maintain relevant certifications
5. Provide positive references and experience working with similar organizations

Surgical RCM is a crucial part of your facility’s operations. Ensure you’re setting yourself up for success by frequently evaluating your processes and implementing changes over time when opportunities for improvement present themselves.

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