Ambulatory surgery center revenue cycle managers can benchmark key performance indicators to find strengths and weaknesses in the center's process, and then make improvements. "By implementing an internal audit of your key performance processes, you will identify gaps that will have a positive impact on your revenue cycle once corrected," says Vice President of Revenue Cycle Management at Meridian Surgical Partners April Sackos. These key performance indicators include:
1. Month-end data — RCM monthly indictors that should be reviewed for optimal revenue cycle performance.
• Aged accounts
• Days in A/R
• Cash Collections
• Payer Mix
• Case Mix
• Average Reimbursement Per Case
• Percentage of Denials
2. Claim submission — make sure claims are submitted in a timely fashion. 48-72 hours should be the goal. Accuracy is key, submitting clean claims on the front side of the revenue cycle is critical.
3. Contract compliance — review contract compliance/payment variances to make sure payers are submitting the full negotiated amount. Loading contracts into the patient accounting system helps staff members identify compliance issues and monitor expected reimbursement rates.
"Centers need to know their payer contracts and be aware of any variances," says Ms. Sackos. "Having contracts loaded in your patient accounting system ensures that you are not leaving money on the table."
If loading contracts into the patient accounting system isn't possible, create a "contract matrix" sheet for staff to reference.
4. Accounts receivable — following up on all claims can positively impact the surgery center's revenue and cash on hand. Take time to benchmark A/R and follow-up rates to optimize collections.
Centers that are understaffed often have one person trying to manage all aspects of accounts receivable. Depending on the case volume, payer mix and specialty mix, the ASC may need to hire additional staff.
5. Payment postings — spot check payment postings to make sure payments and adjustments are posted correctly. Ms. Sackos says key questions to consider here are:
• Are payments being posted daily?
• Are under/over payments handled correctly and timely?
• Was the balance transferred correctly and statement generated to the patient timely?
• Are credit balances being processed correctly and timely?
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