Best Practices in ASC Revenue Cycle Management

Revenue Cycle 101

Focus on the important role that revenue cycle management (RCM) plays in the financial viability of an ASC. Topics covered include basic concepts of RCM, key drivers that impact ASC cash flow and the patient experience. If you work on the business side of the ASC but have limited experience with RCM, this session is for you.

AEU Content Area: Financial

Lori Martini, CASC Chief Executive Officer Stratify Management Solutions

Revenue Cycle 201: A Streamlined Approach to Monitoring the ASC Revenue Cycle

Get an overview of best practices for managing the ASC revenue cycle operations team. It all begins in the physician’s office, where staff must use the correct CPT code to properly document the scheduled procedure—something that’s particularly important in cases with multiple procedure codes. Discuss examples of how to educate office schedulers on the ASC’s insurance contracts and tips for submitting accurate patient demographics.

The most significant role on the RCM team is the ASC’s insurance verification specialist. Because billing is complicated and varies from payer to payer, it can be beneficial to hire (or train) someone who understands the entire billing process. Identify the insurance verification specialist’s responsibilities and discuss tips on how to streamline their daily tasks. Learn how to ensure the physician is dictating the entire procedure accurately and how daily coding reviews/audits ensure accurate billing before the claim is sent. Consider the pros and cons of managing the revenue cycle in house versus outsourcing it as it pertains to billing, collections and denials as well as appeals, and learn how to communicate effectively with your billing company.

AEU Content Area: Financial

Colleen Ramirez, RN, CASC Chief Administration Officer Bone & Joint Surgery Center of Novi

Contracting 101: Introduction to the Basics of Managed Care Contracting

Get an overview of the key contractual terms within a managed care contract and review the various ASC reimbursement methodologies. Discuss the stages of a negotiation cycle, including the development of a contracting strategy. The session will conclude with a brief negotiation case study.

AEU Content Area: Financial

Naomi Kruger, MPH Senior Director, Strategy and Payor Engagement SCA Health

Revenue Cycle KPIs and Benchmarking

Financially successful ASCs rely on an effective and efficient revenue cycle. Key performance indicators, referred to as KPIs, are quantifiable measurements that enable centers to benchmark their revenue cycle processes and identify opportunities for improvement. This session examines a variety of revenue cycle KPIs and their corresponding benchmarks. Gain insights into how to use KPIs to assess and analyze your revenue cycle and explore various opportunities for improvement.

AEU Content Area: Financial

Becky Ziegler-Otis, MHA, RHIA, CPHQ, CHC, CASC Assistant Executive Director/Regulatory/Accreditation Specialist/Healthcare Consultant ASC Quality Collaboration Wausau Surgery Center

Business Office Policies and Procedures

Take a look at best practices for business office policies and procedures. Discuss required versus recommended policies for accrediting organizations as well as for CMS and other federal and state regulatory bodies. Review policies that help delineate business office staff responsibilities and authorities, examine the need for separation of duties within the business office, and discuss how often to update policies.

AEU Content Area: Financial

Jessica Rodriguez, MBA, CASC Executive Director OAM Surgery Center at Midtowne

The Coding Audit: A Measure of Your ASC’s Financial Health

A compliance plan that incorporates routine coding audits not only detects incorrect coding practices—it is also valued by some federal agencies when determining whether reasonable efforts were taken to avoid and detect fraud and abuse. A coding audit serves as a baseline indicator of coding accuracy, which ultimately impacts your facility’s financial health. This session will discuss key aspects of the coding compliance audit program, including the type of audit, selection process, frequency, financial classes, sample size and accuracy rates.

AEU Content Area: Financial

Cristina Bentin, CMA, CPPM, COC, CCS-P President Coding Compliance Management

Collection Strategies for Payers and Patients

Explore strategies your ASC can employ to ensure payer and patient collection success. On the payer side, we will discuss the importance of providing access to payer contracts for scheduling, insurance verification and financial counseling, billing, payment posting, and the role of the collections department. Gain an understanding of payer-specific contractual language outlining requirements for clean claims, including claim forms, multiple procedures and modifiers. Review timely filing guidelines and consider special circumstances or exclusions such as implants.

Successful patient collection strategies start with obtaining accurate and complete insurance verification and relaying this information to the patient. Get clarification on how to generate proper patient estimates and implement upfront collection of the patient’s financial responsibility. Identify best practices for post-procedure collections, examine statement language and frequency, and discuss various modes communication that allow for consistent contact between staff and patients.

AEU Content Area: Financial

Tara Gillon, ASP, CRCP-P Chief Operations Officer Serbin Medical Billing

Best Practices for Case Costing

If you don't know what it costs your facility to perform cases, how can you know if your reimbursement is covering your costs? You can't! This session will discuss how to determine your costs and why case costing is critical to the financial health and success of your center.

AEU Content Area: Financial

Ann Geier, MS, RN, CNOR(E), CASC Chief Nursing Officer Ambulatory Healthcare Strategies