University Orthopedics Center

Challenge

Billing staff disruptions were hampering UOC’s ability to achieve consistent cash flow and increase revenue.

Solution

Complementing its existing AdvantX™ software, UOC chose SIS Revenue Cycle Services™ (RCS) to outsource billing for its ambulatory surgery center and improve key revenue cycle benchmarks.

Results

• Decreased days to bill
• Reduced accounts receivable days
• Improved collection efficiency
• Increased revenue

“Revenue Cycle Services has helped us decrease AR over 90 days from 41% to 26% and increase net collections by more than 60% so we have more revenue to invest in patient services.”

— Joseph Myers, VP of Surgical Services

Situation

University Orthopedics Center (UOC) in State College, PA offers a complete range of technologically advanced, patient-centric surgical and non-surgical services to provide the greatest potential for successful recovery.

UOC’s ambulatory surgery center (ASC) was a long-time user of AdvantX software to manage its facility and employed an internal team to manage billing. Joseph Myers, VP of Surgical Services, explained some of the challenges with maintaining its own billing department. “We went through a two-year phase of staffing inconsistencies which resulted in revenue peaks and valleys from month to month,” said Myers. “We were under-achieving on benchmarks we use to evaluate department performance and knew we couldn’t continue with that model.”

Why SIS RCS

Responsible for all administrative aspects of the 30-person ASC facility, including financial management, Myers outlined the industry benchmarks against which UOC measures its performance, including: days to bill (DTB), days in accounts receivable (AR), and net collections. In search of a more reliable approach, Myers reached out to SIS to learn about the company’s outsourced services for revenue cycle management. “For the consistent coverage required to get our benchmarks back in line to where they needed to be, we selected SIS RCS,” said Myers. “The transition was seamless and the results are impressive in multiple areas.”

The implementation took approximately 90 days and was completed in September 2014. According to Myers, “It was important to get the necessary processes, policies and procedures in place and fully transition our information to the SIS team up front. There were no declines in revenue or hiccups in claims going out during the transition.”

RCS Delivers

Since service was initiated, UOC has realized significant revenue cycle improvements including:

• Decreased DTB. The faster a claim is submitted to the insurance company, the shorter the time to receive payment. This critical step in the revenue cycle requires well-defined workflows with daily, weekly and monthly measurement to ensure results are in line with expectations. By working with RCS, the average days to bill has decreased by 50%.
• Reduced AR Days. The longer a claim is outstanding, the less likely it is to be paid – and providers need to receive payment for services as quickly as possible. Over a six month period, RCS reduced UOC’s days in AR by over a third, and decreased AR over 90 days from 41% to 26%.
• Increased Revenue. Working with RCS, overall collection efficiency has improved, with the net collections percentage growing by more than 60% over a five-month period. The result? More revenue that UOC can invest in things like new capital equipment, technologies, staff and services to better serve patients.

“We have had a consistent team and the service is outstanding – everyone is professional, easy to work with, very responsive and knowledgeable about the ins and outs of billing.”

Myers cites several factors behind these improvements, including RCS staff expertise across the full revenue cycle and coding that complies with Medicare requirements and other regulations. But, more than that, RCS persistently follows-up on claims to ensure they are being processed and, if denied, provides additional information to the insurance company or submits appeals. RCS also requests payment corrections when insurers make errors.

According to Myers, “RCS does a fantastic job at making sure that claims are processed in a timely fashion and discrepancies are quickly resolved.” UOC also experiences many qualitative benefits with RCS.

“RCS takes one of my stresses away,” states Myers. “We have had a consistent team and the service is outstanding – everyone is professional, easy to work with, very responsive and knowledgeable about the ins and outs of billing. Their emphasis on transparency and communications means that any questions I have are answered quickly.”

Lessons Learned

Based on Myers’ experience, one of the keys to successfully outsourcing billing services is accurately assessing your challenges and needs as an organization and conveying them to the service provider. “RCS worked in partnership with us to understand our expectations and immediate needs,” said Myers. “As a result of this collaboration they were able to knock it out of the park – decreasing DTB, reducing AR and increasing revenue.”

Myers has observed that many ASCs share the same inconsistencies with internal billing staff that create revenue cycle management challenges. “A solution like RCS provides consistent coverage, which leads to greater efficiencies,” Myers explains. “The more streamlined you can make the cycle, the better off you will be – processing more quickly
and receiving payments faster.”

Moving forward, as UOC expands the types of outpatient surgical services it provides, the RCS solution will remain integral to helping UOC grow efficiently and cost effectively. Myers concludes, “RCS has allowed us to put our revenue cycle management challenges behind us so we can focus on expanding the services we provide to patients, particularly in the areas of Same Day Total Joints and Outpatient Spine Surgery.”

“RCS worked in partnership with us to understand our expectations and immediate needs. As a result of this collaboration they were able to knock it out of the park – decreasing DTB, reducing AR and increasing revenue.”