Q&A with Jessica Nelson and Yunette Ruiz
Jessica Nelson, Vice President of Revenue Cycle Services (RCS), and Yunette Ruiz, Revenue Cycle Manager, for Surgical Information Systems (SIS), recently hosted a webinar where they looked back at the biggest ASC revenue cycle news and trends from 2021 and looked forward to the revenue cycle issues most likely to affect ASCs in 2022. The audience was highly engaged and asked many questions during and after the webinar.
Below are the highlights of those questions and responses provided by Jessica and Yunette, edited for readability. To view the webinar on-demand, please visit the SIS Resource Library.
Q: I am looking to ramp up my pre-service patient collections process, but I'm afraid if I ask for payment in full, it will turn patients away or we'll receive negative survey results. What recommendations do you have to approach these types of conversations with patients?
Jessica Nelson: It's good that you're thinking about how patients may perceive how your team communicates about collections. Something that can help you prepare for these potentially difficult conversations is to develop scripts and/or talking points for those individuals who are working with your patients directly on upfront collections. Include common responses to pushback or clarifying questions that are asked during the conversation.
If you're not already offering payment plan options, you may want to consider doing so. While patient responsibility is increasing overall, this option can help reduce stress for those patients who may struggle to make a single, large payment by spreading their payments out over time. Using an online payment portal where payments can be set up for automatic processing is best practice for payment plans.
Q: I have a few CPT codes that were added for 2022 but are not already considered in my commercial payer contracts. Does that mean I won't get paid for them at all?
JN: No, but I would hold off on scheduling them until you have had the opportunity to reach out. If these are codes newer to Medicare's ASC Covered Procedures List, then I would consider contacting your provider representatives and/or any contacts you have at your payers. This is a great opportunity to either renegotiate contracts and/or see if you could get those codes added, whether they're added to a grouper fee schedule or considered for carve-out. The key is to reach out to your provider reps as soon as you can to get those conversations started.
Q: How do I know if my ASC is eligible to participate in the Outpatient and Ambulatory Surgery CAHPS (OAS CAHPS) survey? What administration modes may be utilized for OAS CAHPS?
Yunette Ruiz: These are two great questions. If you're still not participating in OAS CAHPS, you'll want to learn about it and know what is expected of you by 2025. This is when ASC participation in OAS CAHPS is expected to be mandatory, as per the Medicare 2022 final payment rule for ASCs.
To participate in OAS CAHPS, an eligible ASC must meet a few criteria. You must be performing procedures that are within the OAS CAHPS eligible range of CPT codes. You should be Medicare certified and have a CCN (CMS certification number). You'll be billing under the ASC payment system, participating in the ASC quality reporting program, and should have an agreement on file with CMS.
As for how OAS CAHPS is administered, there are currently three modes that can be utilized. It can be done by mail only, telephone only, or by mail with a telephone follow-up. There is some testing underway on administering OAS CAHPS via a web-based method, but until it is fully tested and documented, it's not going to be a viable participation option.
Q: What are some top revenue cycle key performance indicators (KPIs) that successful ASCs are tracking?
YR: This would include your accounts receivable (A/R) over 90 days, which tells you what is in your A/R. Ideally, you want to collect everything as soon as possible. If you're seeing that some claims are aging further than 90 days, you want to look at whether there any denial trends that may indicate a red flag. What is causing these claims to age? Are you approaching any type of timeliness limits to be able to appeal some of these denials? Make sure that you address those as soon as possible because the more days that go by, the less chance you may collect on these accounts. It's really important to be monitoring that KPI.
Next, you want to be looking more broadly at your days in A/R. How long is it taking you to receive payment for claims and then your net collections? Are there any fluctuations? If there haven't been any changes to your volume or the types of procedures you're performing and you're noticing a reduction in your collections, that's also a red flag. You want to take a closer look at your A/R and see what might be causing reduction.
Finally, your days to bill is going to be correlated directly with your days in A/R because the faster you get those bills out the door and the lower you have your days to bill, the faster you're going to see the turnaround in payment for those claims.