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Mike Tompkins – The Magic of Automatic Payment Posting
86 Plays1 year ago
Mike Tompkins is a Client Services Manager at in2itive, and we had a chance to talk through the intricate world of payment posting in ASCs, mainly focusing on commercial payers. If this is still a manual process for you and you are spending time reconciling payments on the backend of your billing system, then you’ll learn a lot in this episode about how automating those processes can improve the accuracy and efficiency of the entire billing process and get you paid faster.
In our news recap, we’ll cover some preliminary findings from Avanza Healthcare Strategies’ Hospital Leadership ASC Survey, what HCA shared at their investor day, how to prepare for OAS CAHPS, and, of course, end the news segment with a positive story about a nurse who saved a man’s life on the side of the road.
Articles Mentioned:
ASC ownership is shifting: What leaders need to know
HCA outlines plans to expand market share by 2030
Patient Experience Survey to Become Mandatory Soon
Approved OAS-CAHPS Survey Vendors
NJ ICU Nurse Joyce Park Saves Life of Car Accident Victim
Brought to you by HST Pathways.
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Transcript
Introduction to Podcast
00:00:01
Speaker
Welcome to This Week in Surgery Centers. If you're in the ASC industry, then you're in the right place. Every week, we'll start the episode off by sharing an interesting conversation we had with our featured guest, and then we'll close the episode by recapping the latest news impacting surgery centers. We're excited to share with you what we have, so let's get started and see what the industry's been up to.
Guest Introduction: Mike Tompkins
00:00:27
Speaker
Hi, everyone. Here's what you can expect on today's episode. Mike Tompkins is a Client Services Manager at Intuitive, and we had a chance to talk through the intricate world of payment postings for ASCs, particularly focusing on commercial payers.
00:00:45
Speaker
So if this is still a manual process for you and you are spending time reconciling payments on the backend of your billing system, then you will likely learn a lot in this episode about how automating those processes can improve the accuracy and efficiency of the entire billing process and most importantly, get you paid faster.
News Recap Overview
00:01:05
Speaker
In our news recap, we'll cover some preliminary findings from Avonsa Healthcare Strategies Hospital Leadership ASC Survey.
00:01:14
Speaker
what HCA shared at their investor day, how to prepare for OAS caps, and of course, end the new segment with a positive story about a nurse who saved a man's life on the side of the road. Hope everyone enjoys the episode and here's what's going on this week in Surgery Centers.
Mike's Background and Role
00:01:36
Speaker
Mike, welcome to the show. Thank you. Thank you so much for having me.
00:01:42
Speaker
Mike, can you tell us a little bit about your background in the ASC industry? Sure. So my name is Michael Tompkins. I'm a client services revenue manager at Intuitive Business Solutions. I've been with Intuitive just under three years. Intuitive is a boutique style company who focuses on revenue cycle management services, as well as consulting. We are a little bit, when I say boutique, we focus more on service and process optimization. So it's definitely a major technology focus right now for us.
00:02:10
Speaker
Great. So on our show, Mike, we've talked about different aspects of the revenue cycle on different episodes.
Challenges of Manual Payment Posting
00:02:16
Speaker
In this week with you, we want to drill in specifically into payment posting and specifically the commercial payor side of payment posting. Can you walk us through this process from your experience, how it works?
00:02:30
Speaker
Sure. So on the manual side, this can be pretty tedious and most surgery centers, it is a process of gathering by logging into your clearinghouse, downloading all the rivets and advices that are in your deposit for the day, possibly going to a lockbox or a mailbox to gather correspondence and then organizing everything to be entered into your system manually. So then you're going to go into your practice management software.
00:02:54
Speaker
enter in each transaction and often you have to go to each individual patient ledger, which can take quite a bit of time and can create a little bit of administrative burden as well. Yep. And that's more cumbersome or more time intensive than I would have expected. Yes. Depending on your size of your center as well, sometimes you're entering in $100,000 a day and to do that on an individual basis can really slow you down.
00:03:19
Speaker
And do you have a good feel for what percentage of the market, what percent of ASCs have a time intensive manual process like you've just described? I don't have a percentage. I would say that the percentage of software that requires you to do the manual would probably be greater than 60%. Wow. So it depends on really the software that you're using. Okay. So you've got a good percentage of ASCs out there that have some highly manual steps in this commercial payor process.
00:03:49
Speaker
What are the challenges with this? What are the cons of this approach? I think time is a big piece. With everything that they're doing, it's an individual manual process. Generating each transaction can take quite a bit of time. It also leaves room for errors. In the payment posting world, every single penny counts. So if you are off by keying a variance at a transaction date or a dollar amount, and you have to go search for that, it can cause quite a bit of confusion at month end trying to balance and close out your remits.
00:04:18
Speaker
Yep. And based on that, based on errors, this could even impact the AR that you're able to collect, right? In terms of the volume of dollars collected. Right. And when you're talking about the overall health of your organization, the collections and the dollars are really one of your key factors there too. So it's very important to have everything as accurate as possible.
00:04:37
Speaker
Got it. So if you were to put yourself in the shoes of an ASC that does commercial payment posting in-house, right? An ASC that's doing revenue cycle in-house, they're doing it on their own. Do you have any sense of how long this could take on a monthly basis, the payment posting process? Like if they've got a manual process, how many minutes or hours could that take a month?
00:04:59
Speaker
It can take the full amount of working hours in a month. So if you have an average of, let's say 22 business days, they're working eight hour days every day, it can consume their entire day. So you can see an average of, you know, two to 3000 transactions entered in manually could take the full 160 hours that they had allotted for their work month. So this could be a whole FTE that's posting these things in there manually. Wow. Depending on your volume. Yes.
00:05:25
Speaker
Okay.
Benefits of Automated Payment Posting
00:05:26
Speaker
But it sounds like there's a silver lining. You said approximately 60% of the market has manual steps. That means a certain percentage of the market's doing it in a more automated manner. Is that right?
00:05:37
Speaker
Yeah. So there's the new automated payment posting process. So if you're not familiar, it's your practice management software pulling in the electronic remittance file or an 835 electronic file, and it's going to read it automatically for you. So it will take the payments per accounts, create those payments in your system and apply them automatically. So from there, your employee or your, your billing team member is really only going to have to go verify that it all went in correctly.
00:06:04
Speaker
possibly add some contractual adjustments, maybe a sequestration adjustment, and then they can create all of those transactions from one consolidated screen. And from there, it's going to leave quite a few variance issues or room for any kind of errors. So their accuracy rate is going to improve. As well, they're going to be able to do more because they're not having to enter in as much manually.
00:06:26
Speaker
Yep. So that definitely makes sense on the accuracy side, right? Take the manual steps out. You get a much more accurate process. On the time side, you mentioned this could be a full FTE doing manual posting. What would this FTE do in a world where they don't have to do the manual posting anymore? So we can move our focus. We can work on credit balance refunds. We can work on reviewing the contractuals that are coming in. Are we having to, are our contracts loaded in our software correctly or are we doing
00:06:55
Speaker
additional adjustments during that automated process that we can streamline and correct on the back end. There's also other items you can do for follow up, helping with denials, working on the correspondence from the insurance. Often they want medical records or they're doing audits or anything like that. So you can really move your focus on the revenue side versus what's already been collected and just recording it.
00:07:16
Speaker
Yep. That makes sense. So the automated approach sounds much better, Mike.
Transitioning to Automation
00:07:21
Speaker
And so if you're an AFC listener out there and say, Hey, I think we're doing it more on the manual side today. What would you need to think through? What would your next steps be to switch over to a more automated process?
00:07:32
Speaker
Well, your technology and your software is going to be the first part. I would always look at what I currently have and what's offered as well, reaching out to your training portals or anyone that you work with at the current software and technology companies, seeing what's available and what's included in the packages that you're provided. And then connecting in with the other parts of your technology, like your clearinghouse and making sure it's all compatible. Cause often surgery centers are finding that there's all this technology included in subscriptions they're paying for, that they just have no ideas available to them.
00:08:03
Speaker
Yup, yup. And what have you seen, because I'm sure that you guys at Intuitive had customers that you've helped go from doing all this work in-house and doing kind of the manual processes, and then you guys help alleviate a lot of that burden. What have you seen in terms of the benefits, either from staff satisfaction or physician satisfaction? What are some of the benefits that surgery centers could expect from taking this burden off of their team?
00:08:31
Speaker
Yeah, so I think one of the biggest feedbacks that you get from your staff is there's not enough time to do all of the tasks in a day. So by alleviating some of the administrative burdens of gathering and organizing all these documentation, it's automatically pulled in for you. So you're taking tasks and steps off of their day to day.
00:08:49
Speaker
which is going to improve their satisfaction and as well increase their tenure. And when you're talking on a physician side, most physicians are invested in their surgery centers. So they want to see all of the revenue returned to them as quickly as possible. So by posting those payments faster to your primary payer, you can move on to your secondary, tertiary, or move it to your patient balance. Get those claims out the door, send the statements to the patients, and in turn, get those collections turned around faster. Great.
00:09:18
Speaker
That's the name of the game, right? Is reducing AR and getting those AR days down so you get faster cash. Exactly. Get closer to those, those prescription doctors that get paid within five minutes of sending a claim. So you're in an pharmacy and they're paid before you leave the door. Nice. Okay. And so Mike, we've been talking about commercial payments, right? Payor payments, insurance company payments in that side of the house.
00:09:44
Speaker
Oftentimes now, these days though, that doesn't make up the total portion of the surgery bill because you've still got patient payments. And that can be in some cases up to a third of the total cost. What about those patient responsibility payments? Are you seeing those come in manual today or do those come in in a more automated manner?
00:10:06
Speaker
Yeah, so if you're utilizing the same credit card portals from 10, even five years ago, it's possible that you're not able to do the same features as with the commercial payers. But that part, that goes back into making sure you know what your technology offers. So ensuring that the clearinghouse you use offers that technology and that the practice management software that you use will accept it.
00:10:27
Speaker
So it is an available feature, but it is actually pretty limited right now and recently started growing. I do know that we've started using it in HST, but I haven't found that option in many of the other practice management softwares we use. Got it. Okay. And final question for you, Mike. And we do this every week with our guests. What's one thing our surgery centers can do this week to improve their performance?
00:10:50
Speaker
To improve performance research, start looking at what's available, what you already have that you don't know you have. Often we sign subscription agreements with our software. We're in a contract or some sort of agreement and it will list out all of the options that you have. I know with clearing houses, you can have different pieces of plans. So there may be portions in there that you have that you're already paying for that you don't know of.
00:11:13
Speaker
or that you want to pay for and you want to add on because you can see the benefit and the cost savings for your center. So doing that research and talking to whoever you have in contact at your surgery centers with those technology partners, making sure that they're in constant contact and aware of any updates available for you. Excellent. Mike, thanks so much for joining us today. Yeah, thank you so much for having us. You have a great day.
00:11:39
Speaker
As always, it has been a busy week in healthcare, so let's jump right in.
Survey Highlights and Industry Trends
00:11:44
Speaker
Avonza Healthcare Strategies just released their annual Hospital Leadership ASC survey on November 8th, and Becker's ASC did a recap of four statistics to know from their report. The report compiles feedback from hospital CEOs, presidents, financial leaders, operational leaders regarding their current relationships with ASCs and their future plans.
00:12:09
Speaker
So here are the four stats that Becker's pulled from the report. 48% of respondents said their organization has at least one ASC in 2023, which is up from 41% in 2019. 47% of hospitals and health systems have an affiliation or ownership interest in multiple freestanding ASCs.
00:12:35
Speaker
64% of respondents prefer owning at least 50% of the ASC partnership. And then 29% of respondents said that their ASCs were owned solely by hospitals and health systems, which is an increase from 18% in 2021.
00:12:54
Speaker
Now, the great news is if you want more insight into these numbers and want to dive a little deeper, Joan Dentler, who is the founder of Avanza Healthcare Strategies, will actually be on the podcast next week on November 21st to talk all about the report and share the significance of these findings and what they mean for the near-term future for the ASC industry. So if you don't subscribe to the podcast, now is a great time to do so so that you don't miss next week's episode.
00:13:24
Speaker
In our next story, HCA Healthcare has big plans to expand their market share by 2030. So HSC hosted their first Investor Day in 20 years and shared a ton of interesting information about how they plan to expand. So here are a few of the numbers that I thought were the most eye-opening.
00:13:46
Speaker
So first, HCA has $5.3 billion earmarked for projects to be completed in the next two years. Roughly half of those funds, so $2.7 billion, are dedicated to expanding and renovating existing facilities. And then approximately $1 billion is being set aside for new inpatient facilities with another $1 billion dedicated to fund outpatient facilities.
00:14:16
Speaker
And on the outpatient front, they hope that each inpatient hospital will have 20 outpatient locations in the next few years. HCA is also investing billions of dollars into expanding its emergency and high acuity service lines, targeting a 29% market share in healthcare services by the end of the decade.
00:14:38
Speaker
up from its current market share of 27%. And the reason behind the whole emergency room care strategy is that the hope is that it will drive inpatient admissions and surgeries. So it's always really interesting to see what these healthcare conglomerates have planned and where they're planning to invest their money specifically for us in the outpatient space. And that is going to be a billion dollar investment with a B.
00:15:08
Speaker
For our third story, this is your reminder that OAS CAHPS, the long awaited patient experience survey will become a mandatory component of the ASC quality reporting program in 2025.
OAS CAHPS Survey Requirements
00:15:23
Speaker
So I'm sure you're all aware of this to some degree, but this is just another nudge that it is really time to take this seriously and get moving on this if you have not already.
00:15:35
Speaker
And here's just a quick recap of some of the most common questions regarding OAS caps, because I think a lot of times, you know, things just get lost in the shuffle and there's a lot of different sources of information. But this one's coming from Aska, so we know we can rely on it. So a few things here. You must use one of the 15 approved vendors. So if you have not selected a vendor, now is the time. And I will put a link in the episode notes so you can easily find the list to start doing your own research.
00:16:06
Speaker
The survey itself contains 34 items, including questions about the patient's overall rating of the outpatient surgery facility, their experience with the check-in process, the facility environment, the communication with admin staff and clinical providers, the attention to comfort pain control provision of pre- and post-surgery care information, and then, of course, their overall experience and some patient characteristics as well.
00:16:36
Speaker
This next one is mind boggling to me, but you cannot collect responses through an online survey. You can only do so via mail or telephone. And there's some combos like you can, you know, send it in the mail, do a telephone reminder. So there's some nuances there, but overall you cannot collect responses through an online form, which is truly a misstep on CMS's part, but that is neither here nor there for now.
00:17:03
Speaker
And then this last point I think is important too. ASCs will be required to collect at least 200 completed surveys over a 12-month reporting period. And for facilities that bill fewer than 240 Medicare primary and secondary claims in a year are actually exempt from OAS caps.
00:17:25
Speaker
I always, you know, when I'm thinking about OAS caps, like the survey is long. It's rigid. You could, obviously you can look it up at any time. It'll be within one of the links in the episode notes. You can look at how the hospitals have done this. Hop D's are required in 2024. So there's people who have come before us in this sense, but this doesn't have to be the only patient satisfaction and experience survey that you do. It's extensive. It's going to be expensive just because you have to use an approved vendor.
00:17:54
Speaker
and you have to use mail or you have to use phones. So there's a lot of costs associated with this. And frankly, if, you know, I don't know how insightful and how helpful some of these questions will be and it's long. So I would say, you know, you obviously have to hit your minimum of 200. You absolutely need to do that and get those results submitted. If you and your surgery center like this survey and you want to make it your primary one, of course you can.
00:18:24
Speaker
But it might be more beneficial for surgery centers to do this, check the box, learn from it as much as you can, but then go the more cost-effective route where you have a little bit more control. You can customize your survey. And after you meet your requirement, use a secondary survey to send to the rest of your patients less expensive and more effective. So just my two cents there.
00:18:48
Speaker
And HST does plan to create some content for all of you on how to properly train your staff to prepare for OAS caps because there are some nuances there. So please stay tuned for that. But in the meantime, again, if you do not have a vendor, that is step one. So start doing your research and get the ball rolling.
Heroic Act by ICU Nurse
00:19:06
Speaker
And to end our new segment on a positive note, Joyce Park is an ICU nurse at Hackensack University Medical Center in New Jersey. And she was on her way home from a family dinner when she noticed a car ahead of her swerve off the side of the road and hit a utility pole.
00:19:24
Speaker
So Park found the driver, an 80 year old man unconscious, unfortunately. So Park and her husband pulled the man out of his car and she began performing CPR after realizing that he had no pulse. But after 30 seconds, she was able to resuscitate him.
00:19:40
Speaker
And today the man is alive and well, and she actually had learned that he was driving home from celebrating his 80th birthday with his wife. So thanks to Joyce Park, he will hopefully live to see many more. And just another story about the incredible life-saving work that healthcare workers do every day while both on and off the job.
00:20:01
Speaker
And that news story officially wraps up this week's podcast. Thank you as always for spending a few minutes of your week with us. Make sure to subscribe or leave a review on whichever platform you're listening from. I hope you have a great day and we will see you again next week.