Selecting the right
revenue cycle management (RCM) company as your business partner can be a difficult decision. After
all, RCM is a complicated business and vital to the financial health of
an ASC. In this time of increasing costs coupled with tightening reimbursement,
anything short of a high-functioning revenue cycle will negatively affect
the financial viability of a center. Even small issues with RCM efficiency
and performance can drive up case costs and/or leave money on the table,
turning profitable procedures into money losers.
An RCM company well-versed in ASC business operations helps to ensure that
a center is paid promptly and correctly while minimizing claims rejections
and eliminating revenue leakage and bad debt write-offs. There are many
pieces of information to gather when interviewing RCM companies.
Here are 15 questions to ask of prospective companies and the answers you
should expect to receive.
1. Are all employees based in the United States? Answer you are looking for: "Yes." There are many advantages of having U.S.-based employees.
For instance, the use of local employees can help ensure employees are
knowledgeable about their local industry and market. It can also help
with accountability and quality, while direct oversight will better ensure
the process is streamlined and working appropriately.
2. Will my ASC receive an assigned, dedicated team?
Answer you are looking for: "Yes." If this is not the case, ask about how the work is assigned.
It may be problematic when different team members are working your accounts.
Team members should know each client's intricacies, contracts, payment
structures, and billing rules.
3. Does the team have specific experience with ASCs? Answer you are looking for: "Yes." It is critical to have a team with specific ASC experience.
ASCs operate differently from other healthcare organizations, such as
hospitals and medical groups, so their RCM is different than other types
of coding, billing, and collections. An experienced team will know the
industry challenges and have experience navigating those challenges.
4. Do all team members have experience working with my ASC's practice
management system? Answer you are looking for: "Yes." You want a team with experience with your specific practice
management system as well as with other software systems, including those
used by your clearinghouse, online payer websites, and Medicare.
5. Will my team be capable of working all specialties and payers, including
Medicare and Medicaid? Answer you are looking for: "Yes." To effectively work different specialties requires specific
knowledge on their types of procedures. Such knowledge enables a team
to recognize issues immediately, know how to resolve those issues, and
provide information to the center on how to avoid those issues in the
future. As for payers, Medicare and Medicaid have very specific and sometimes
challenging regulations. Payer rules and regulations can differ depending
on if you are out-of-network or in-network and/or which state your facility resides.
6. Are all coders certified, and do they receive ongoing education to stay
current with all industry, state, and federal regulations/changes?
Answer you are looking for: "Yes." It is critical that coders are fully compliant and experienced
with coding for ASCs.
7. What is the average charge lag?
Answer you are looking for: "Charges will be submitted within 24-48 hours of receiving complete
8. What is your accounts receivable (A/R) policy?
Answer you are looking for: "All cases will be reviewed and worked within 30 days, and an established
audit process is in place to ensure quality and timeliness of the follow-up."
9. What is the timeframe for initial follow-up and each subsequent follow-up? Answer you are looking for: "Our initial follow-up is completed within 14–21 days to ensure
the claim is on file and in processing. Subsequent follow-up is based
on the specifics of the case and could be daily or weekly; however, each
case is worked within 30 days."
10. How do you ensure the accounts are followed up timely and correctly? Answer you are looking for: "We have a process in place to monitor the workflow and complete audits
to ensure the timeliness and quality of the follow-up."
11. What ASC experience do A/R staff members possess? Answer you are looking for: "Our A/R staff has specific experience with the ASC revenue cycle,
dealing with various specialties and payers." Ask about their process
for negotiations and how they handle denials and appeals.
12. What do you consider an acceptable percentage of A/R over 90 days? Answer you are looking for: "If you are all in-network, your A/R over 90 days should be under
15%. If you have workers' compensation, personal injury, and out-of-network
payers, it is acceptable to be a little higher." Find out what process
they put in place if the A/R is over the threshold. Find out how they
monitor the metrics.
13. Does your team have the knowledge to access current contracts and help
negotiate better contracts? Answer you are looking for: "Yes." The team should have experience in performing in-depth
analysis to help negotiate the best rates and determine if carve-outs
are appropriate. The team should also have access to benchmarking data
to compare reimbursement rates to other ASCs in your geographical location.
14. What reporting and analytics will my ASC receive? Answer you are looking for: "You will receive detailed reporting of your monthly production as
well as a dashboard to evaluate at your key performance metrics."
The RCM company should have business intelligence analytics to support
the data provided to clients.
15. Does your company offer assistance preparing board reports and/or developing
customized reports specific to our facility? Answer you are looking for: "Yes." The company should have the experience and knowledge
to put together detailed presentations that will assist in your board
meetings. The company should also have the ability to customize reports
based on your specific needs.
Every RCM company is different, varying by the types of services provided,
quality of those services, and qualifications of personnel. While review
of a company's website and marketing collateral may identify some
of these differentiators, ASCs should still take the time to speak with
representatives from each company. Use these conversations to address
questions that remain unanswered following review of company information
and gain an understanding of the corporate culture.
While much of an RCM company's services do not require personal interactions
with their employees, expect to receive excellent customer service when
such interactions are necessary. The right RCM company will function as
a partner with their accounts and ensure client needs are a top priority.
Do you have additional questions about selecting an RCM partner? Want to
know why Surgical Notes is the RCM partner of choice for ASCs nationwide?
Contact us today. We welcome the opportunity to speak with you and tell you why we believe our
SNBilling RCM service is the right one for your ASC!