With the shift to pay-for-performance rapidly approaching, ambulatory surgery centers and physician-owned facilities need to be at the top of their game to ensure they are not losing revenue.
Terry Coleman, MBA, president of in2itive Business Solutions, shares insight into how he is propelling the company forward to help ASCs prepare for a value-based payment system and vital ways ASCs can bolster their revenue cycle management function.
Question: You joined in2itive's team in February after serving as Nueterra's director of business services. How did your role at Nueterra prepare you for this next phase of your career?
Terry Coleman: As the director of business services, I would go into facilities all over the country and help them better understand where they could improve their processes. It really gave me a broad understanding of how we could deliver targeted services to ASCs and physician practices that would bolster their day-to-day operations, and truly elevate their efforts to ensure they are profitable. Many ASCs have limited staffing, resources and time for training — that's precisely the kind of support in2itive can offer.
I also worked in hospital administration at Liberty Hospital, which was a 19-provider physician group; I helped them move into a patient-centered medical home as well as transition into meaningful use and a new electronic health record system. Even before entering the hospital arena, I was at a billing company, CBIZ, for 14 years. But thinking about the hospital environment, things move very slowly there, and I wanted to get back into the ASC side. The outpatient setting allows me to work in such an environment where I can drive positive change, alongside dedicated physicians who have the freedom to decide how their surgery center will function without all the layers of bureaucracy.
Q: What are some of the biggest challenges you see in RCM?
TC: You can talk to anyone in the healthcare industry and the first challenge they will list is an increase in patient responsibility. Patients have more skin in the game, due largely to high deductibles, and it has turned into a larger challenge than anyone anticipated. It all comes down to patient education and helping patients better understand their insurance policies and financial obligations.
ASCs cannot forgo the importance of informing patients of the ins and outs of their insurance policy. Surgery centers should tell patient what they owe and when, as well as whether pre-approvals or other criteria have been meet.
A patient may feel misled or blindsided if ASCs don't offer such information based on the assumption that a patient knows the intricacies of their policy. In turn, this confusion could lead to negative patient satisfaction scores.
When working with ASCs, the first step entails devising a well-thought-out strategy to help patients fully understand their financial reconcilability. Based on that strategy, we create an implementation plan that guides an ASC's staff through collecting and providing that patient information appropriately.
Another challenge was the transition from a paper world to an electronic world, even though the growth in technology has been amazing for the healthcare industry. And in conjunction with technology, there has been more government regulation, which has led to more compliance-related issues we must contend with and stay on top of.
ASCs and physician practices are facing an increase in medical necessity. Facilities are sending out more appeals than ever, and payers want to ensure the cases and/or services we are providing are absolutely necessary to keep costs down. This is an understandable issue, but has made daily operations more difficult for ASCs.
ASCs also struggle with finding skilled staff, as there are not strong training programs for medical billers. Billers are a loyal group of people — once they get in somewhere, they want to stay there. However, they are hard to find, and ASCs often may not have anyone to train them and spend resources to train them appropriately.
Q: How much can a practice lose, on average, in lost revenue each year? What are some ways they can reduce this figure?
TC: I have seen some ASCs leave up to 20 percent of lost revenue on the table. This is a huge number, and it is a number that can be easily prevented. To avoid losing revenue, ASCs should ensure they have proper coding, capture all of their implant costs, manage their insurance contracts and file appeals correctly.
On the back end, ASCs should follow up on their claims in a timely manner. Centers should know what is going in and out in terms charges and payments, so it is critical for centers to review accounts daily and routinely reach out to patients to collect payments.
Q: What is in2itive focusing on this year? What are you trying to address to help practices with their RCM?
TC: I want make sure our clients understand all their key indicators such as where they currently stand and where I believe they should be. It's important for ASCs to understand their numbers and I want to help them do so.
Currently, we are working to overhaul in2itive's monthly reporting to our clients so we can help them better understand everything going on in their revenue cycle. To help ensure we give clients clean, easy-to-follow reports, we implement strong policies and procedures that extract information from multiple systems and let us deliver the same essential information to all of our clients.
Q: How is the health insurance industry changing? How is in2itive working to stay ahead of the curve?
TC: I would say the two biggest changes coming for ASCs are bundled payments and pay-for-performance. These will be the future and we have to stay ahead of that curve. We are working with clients to ensure we are getting up-to-date information on bundled payments and the pay-for-performance payment system. We also have monthly meetings to make sure they are making informed decisions to prepare for the future.
Q: What are some advantages to outsourcing your billing and claims?
TC: Cost savings are directly related to the ability to collect more on every dollar. We have the resources, we have the trained staff and we have the oversight to ensure every collectable dollar is collected.
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