Maximize the Value of End-of-Month Reports
- 1. THE ASCA JOURNAL | JUNE/JULY 2020 | ascfocus.org STAYING CURRENT with ANSI/AAMI ST79 What ASCs need to know FDA UPDATES EXTENDED USE DRUGS LIST TO MEET COVID-19 DEMANDS JOINING FORCES AGAINST COVID-19 PANDEMIC GREEN YOUR OR EMBRACE CHANGE COVID-19SEE PAGES 6, 14 AND 16
- 2. 22 ASC FOCUS JUNE/JULY 2020 |ascfocus.org DOING BUSINESS The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion. monthly comparison of case totals; CPT codes per case; write-offs and refunds; and the average number of days it takes to receive reimburse- ment (i.e., days in A/R). The amount of data examined and the multiple manipulations of this data available make this report one of the most use- ful for gauging revenue cycle per- formance. Since the A/R summary report can effectively display data in multiple ways, it is a great tool to pinpoint where revenue leaks occur. The “aging by payer” report provides important payer-related information. It measures this data by total balance owed by each payer and allocates payer bal- ances into 30-, 60-, 90- and over 150- day groups. This information also is compared to previous months to identify outstanding payer balances according to age. Such comparisons support faster recognition of slower payer reimburse- ment trends and identification of staff performance shortcomings. Two reports that identify A/R fluctuations caused by case mix are “volume by payer” and “volume by specialty.” These reports can iden- tify reasons why collections are declining while the center’s caseload remains unchanged. The volume by payer report illustrates each payer’s percentage of your caseload. Volume by specialty provides an overview of each specialty’s percentage of the caseload. Learning from and Acting on the Data Understanding the data provided by these reports and converting it to practical use is an important part of the EOM process. The A/R summary report identi- fies possibilities for total A/R varia- tions, which can point to additional Maximize the Value of End-of-Month Reports Identify and improve your center’s revenue cycle management efforts and cash flow BY CARYL SERBIN YourASC’s end-of-month (EOM) reports serve mul- tiple purposes. They help your accountant with tax purposes and your ASC’s governing body in understanding the center’s performance. These reports also could be used to improve the effi- ciency of your revenue cycle manage- ment (RCM) team and cash flow. These reports can play an impor- tant role in identifying billing and payer trends and problems, providing your RCM team with vital information to stem negative effects on the reve- nue stream. Many ASCs, however, fail to use their EOM reports to evaluate more than accounts receivable (A/R). While the aging of A/R is essential in assessing financial health, it is not the only important information to glean from appropriate EOM reports. These reports can pinpoint weak areas in staff performance and be used to measure revenue cycle functions through reg- ular auditing, which is an often-over- looked management task. Areas of Focus When exploring the many EOM reports available to your ASC via its software, the following are notewor- thy for helping identify areas needing further examination. Please note that report names might vary by software. The “A/R summary” report, roll- ing on a 12-month basis, provides vital A/R-related information, such as growth or decrease in total A/R over a specified period. It also breaks this information down into other crit- ical measures. These include charges and collections per case; gross and net collections; net revenue per day; Reprinted with permission from the Ambulatory Surgery Center Association.
- 3. ASC FOCUS JUNE/JULY 2020 |ascfocus.org 23 DOING BUSINESS in number of codes per case indi- cate the need for a coding audit and coder education. ■ A decrease in gross or net col- lections causes an increased A/R total. This might indicate payer trends in claim processing or poor collector productivity. If investiga- tion of payer trends—payer aging report—fails to identify backlogs in claim processing, perform a col- lection audit, concentrating on out- standing claims over 90 days to determine timeliness of collection efforts. Audit results might signify a need for an improved tickler sys- tem, provision of appropriate aged A/R reports to collectors and/or additional collector education. ■ An obvious increase in monthly patient refund amount might reveal an upfront collections issue. Audit the timeliness and adequacy of insurance verification, patient financial counseling and/or up- front collections processes. Share the results with staff. An increase in payer refunds might indicate an issue with posting third- party payer reimbursements. Deter- mining whether to audit the charge posting or payment posting process depends on whether write-offs are completed at the time of billing or reimbursement. The payment post- ing audit should include examina- tion of the number, dollar amount and reason(s) for write-offs. The aging by payer report measures total A/R by sorting the total balance due into separate buckets by payer and age of the account(s). To determine patient balance amount, separate patient and third-party payer A/R. If the majority of over 90 days is patient balances, audit upfront collection policies and procedures, including those for pay- ment plans, patient statements and bad debt. Share the findings with staff to determine any need for changes in policies and procedures and/or additional education. ENDOSCOPY SUPPORT PRODUCTS ENVIRON-MATE ® DM6000 SERIES CALL US BEFORE YOU BUILD 800-201-3060OR REMODEL! DM6000 Utility/SPD DM6000-2 Endoscopy No more canisters! reports that might reveal the exact cause(s). Run the physician utiliza- tion report to identify a decrease in caseload by specific provider(s) and determine if it is an ongoing trend. Intermittent or single-month case- load decrease might mean the pro- vider is on vacation. If the caseload decline trends over several succeed- ing months, the provider might be performing cases elsewhere. Contact the provider to ascertain the reason for this decrease. The following examples demon- strate how RCM functions can impact the results of A/R as a measurement of your ASC’s performance: ■ AchangeinthenumberofCPTcodes assigned to each case might indicate a need to investigate whether the center’s specialty mix has changed (volume by specialty report). If no significant change is detected, inves- tigate your coding process. ■ A decrease in CPTs per case might be the result of erroneous bundling of procedures by an inexperienced coder. Conversely, inappropriate unbundling of procedure codes can increase CPTs per case. Signifi- cant and continuing fluctuations Reprinted with permission from the Ambulatory Surgery Center Association.
- 4. 26 ASC FOCUS JUNE/JULY 2020 |ascfocus.org The volume by payer report, or payer mix, might identify an increased number of cases from a lower-pay- ing payer and decreased caseload from higher-reimbursing payers. If a substantial decrease is found in the amount of cases from a specific payer, contact the payer representative to determine the reason(s). Payer mix variables might cause the following: 1. decreased total A/R due to cases with lower reimbursement/higher write-offs—e.g., Medicaid—re- placing higher reimbursing pri- vate payer cases; 2. increased aged A/R due to an in- crease in slow-paying cases, e.g., workers’ compensation, liability, out-of-network; and 3. decreased A/R due to a de- crease in caseload from a high- reimbursement payer. Follow up with the appropriate provider or payer to ascertain reason(s) for a change in case mix. The volume by specialty report reveals how changes in caseload by specialty might causeA/R fluctuations. If there is no appreciable decrease in total cases, review the case mix by specialty report. If a significant drop is detected in the number of cases per- formed by a high-volume orthopedic surgeon, and your scheduler is filling open schedule blocks with gastroenter- ology cases, this will cause a dramatic decrease in your total A/R and cash flow. Contact the orthopedic surgeon to identify the reason for the decreased caseload. If you determine that you will permanently lose the cases, mar- ket to other high-volume, high-reim- bursement providers. Prioritizing EOM Reports EOM reports provide valuable informa- tion that can help identify and improve your center’s RCM efforts. Research all applicable reports available in your soft- ware to identify those reports that pro- vide insight into your specific revenue stream challenges. Once identified, review these reports on an ongoing basis to determine if auditing and staff edu- cation efforts result in positive changes in your ASC’s financial health. Caryl Serbin, RN, is president and founder of Serbin Medical Billing in Fort Myers, Florida. Write her at caryl@ serbinmedicalbilling.com. DOING BUSINESS Reprinted with permission from the Ambulatory Surgery Center Association.