Q&A with Gabriella DeSantis, Revenue Cycle Manager, from the Surgical Information Systems Revenue Cycle Services Team
Gabriella DeSantis, Revenue Cycle Manager, for Surgical Information Systems (SIS), recently hosted a webinar on "Turning Data Into Action: KPIs and Benchmarking for ASCs." During the program, she discussed strategies for collecting, analyzing, and comparing ASC data using software and analytics tools to drive performance. She also highlighted how to set meaningful surgery center revenue cycle goals, measure success, and improve staff accountability.
The audience was engaged and asked great questions during the Q&A portion of the program. Below are the highlights of those questions and responses, edited for readability. The webinar can be viewed on-demand.
A: The frequency really depends on your type of goals. Weekly evaluations work well for quick, short-term goals. Monthly evaluation is helpful for project-based or medium-term goals. That's going to allow you to reflect on what was working and what's not working and then adjust accordingly. Quarterly evaluations are great for long-term goals and strategic planning. Let's say you want your accounts receivable (A/R) over 90 to be less than 15%. You may want to look at that as a quarterly goal.
Annual evaluations are also important for reviewing big-picture progress, reflecting on lessons learned, celebrating major wins, and setting new goals.
A: That depends on your team's performance. If a team member is not meeting expectations, you might need to audit their work weekly or even daily. If your staff is consistently accountable, monthly or quarterly audits may be more appropriate. I also recommend weekly or biweekly check-ins with team members as well as quarterly reviews to keep everyone focused.
For auditing your data, monthly tends to be a best practice, but depending on your goals and expected turnaround times, you might pivot to weekly or quarterly.
A: The industry standard for ASCs is a denial rate between 5% and 10%. A denial rate under 5% is excellent as it indicates efficient billing and coding processes. Rates over 10% may signal issues with documentation, coding, eligibility verification, or payer contracts. Keep in mind that your denial percentage is calculated by dividing total denied claims by total submitted claims. Also, for certain specialties or cases, payers might request documentation more often, which can raise your denial rate.
A: Organize A/R criteria to account for your team's size and skill set. If team members specialize in certain payers, assigning by payer makes sense. Some may excel at aging claims and digging into appeals while others may excel at working newer claims. In this scenario, you could consider splitting by claim age.
My personal preference is an even split that allows everyone to work across all payers and claim types and buckets. This makes coverage easier if staff changes. You wouldn't necessarily have to scramble to train another team member on a different payer or on how to write an appeal.
Using shared A/R trackers or dashboards are a great way to help team members monitor their own progress. These trackers might include data such as service date, balance, assigned rep, last action date, and claim status. Trackers are super helpful for an A/R team and management for ongoing monitoring.
A: Everyone responds to different incentives, but financial rewards — like bonuses, gift cards, or merit-based raises — are always popular. That said, simple recognition can go a long way too. A shout-out during a team meeting, a thank-you note, or an "employee of the month" poster can be powerful motivators.
One less common but highly valued incentive is schedule flexibility. If someone exceeds expectations, consider rewarding them with a four-day workweek or shorter Fridays without using paid time off. These small perks can have a big impact.
A: Start by checking if your software allows automated report generation. Many systems can send reports straight to your email or provide dashboards with the data you need. Look into revenue cycle management software with built-in auditing tools, such as rules or alerts within your clearinghouse for claim scrubbing to help catch denials on the front end.
You can also rely on artificial intelligence (AI) and analytics tools, which run continuously in the background and help automate tasks like checklists and spot audits. For example, you can create automated emails to remind your staff to complete a mini audit for themselves or pull that information for you. That way, you can take some work off your plate.
Keep in mind that you do not need to audit everything. You could simply take 10 claims from the month and review those. If there are patterns, you should see them, even with a smaller sample size.