Business Advisor: The Benefits of a Deep Bench

Financial Management Coding Billing Collections Business Advisor

By: Wendy Stark-Riemer, MHA

Published: 8/12/2021

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Outside experts can help your facility secure more money from payers.


If you’re still doing most of your coding, billing and collections in-house and rely on traditional spreadsheets to track metrics that assess your facility’s performance, I feel your pain. That was the situation when I became director of our surgery center in 2014 and, not surprisingly, our accounts receivable was large and getting bigger by the month.

To help turn things around, we hired an outside revenue cycle management (RCM) company, which provides access to teams that assist with billing, coding and collections. Additionally, they help reduce the number of rejected claims and shorten how long it takes to get reimbursed after submitting a claim. We also began working with an analytics software platform, which converts information from business management systems into usable grids and graphs, allowing us to drill down into our data in order to make more informed decisions.

The results have been impressive. We cut the time it takes to send bills to insurers from 10 days to five days. That, in turn, helps us reduce how long it takes to get paid from 52 days to 28 days. In each of the first six months with the new firm, we brought in an average of more than $800,000 on accounts that were more than 90 days old and had been left uncollected by our previous RCM company.

If your revenue cycle management needs to be revamped, working with a team of experts can help you achieve similar improvements.

Next-level analysis

The RCM company we partnered with produced immediate results. The bills got sent out in fewer days from the dates of surgeries than ever before, which of course resulted in us getting reimbursed in less time. Still, though, our archaic way of keeping and tracking records led to time-consuming projects when we needed to gather performance data, whether it was for a root-cause analysis of our revenue cycle management or a response to financial questions from our board members.

The analytics program we now use lets us identify issues that lead to holdups in how long it takes to bill a payer. That’s helpful, but revenue cycle management is about more than quickly sending out bills and getting paid sooner. You need to know how many dollars you receive compared to how much you had expected to receive. Faster billing and collection processes don’t do much good if your claims denials are going up and insurers are paying you less because you aren’t capturing the right codes. To make sure you’re billing insurers correctly, consider working with an additional outside firm that audits your bills every six months to make sure your staff is coding cases properly.

This is the kind of deep bench you need. The RCM company, the analytics firm and the outside auditor help your leadership team stay on top of productivity metrics and help them resolve issues that can lead to losses in revenue. This larger team can help you look at real-time data from the analytics program to perform root-cause analyses in order to find out, for example, how a missed code took place. You can look at cases as a continuum to determine if you didn’t get an element of care pre-authorized correctly or if something changed intraoperatively and the first intervention was approved, but the second one was not.

Analytics can also help you solve issues with scheduling cases. If you think some surgeons take longer to operate than their colleagues, you can search case times by specific surgeons, dates and procedures to determine how long patients were in the OR and how long the surgeries took. Analytics can also help you drill down to common causes of delayed case starts.

This information can lead to productive discussions that result in effective solutions. You can work with surgeons to perhaps help them operate more efficiently, allowing you to create schedules that fill your facility with more revenue-generating cases. You can also determine whether surgeons, members of the OR team or issues with patients or equipment prevent cases from starting on time, and take corrective action.

Positive impact

Our revenue cycle strategy boils down to looking at issues from several different perspectives to determine where a blip occurred, figuring out what broke down and determining how to fix it. For example, we just went live with a new automated insurance verification system that’s integrated into our current business management software. It alerts our team if part of a claim needs further action. Having these kinds of cues in place allows us to catch problems early on and focus on resolving them right away.

If you’re always looking at the back end of the revenue cycle — constantly chasing how much money you’re owed — you’ll always be behind the eight-ball. Working closely with your employees, partnering with an RCM firm and tapping into the power of analytics allows you to focus on fixing the front end. This type of thinking lets you truly understand how your surgery center’s business office is operating and make smart adjustments that will boost the bottom line. OSM

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