How process makes money for a surgery center

CHALLENGES

• Streamlined RCM process on Day 1
• Availability of patient benefit information
• Prior authorizations 10 days in advance
• Appropriate procedure scheduling
• Technology to transfer demographic data

PROCESS

• Authorizations and benefits/ eligibility done 10 days, 3 days ahead
• Clean-claim submission on day of procedure
• Insurance-based AR follow-up (e.g. Aetna 4 days, BCBS 9 days)
• Tracking insurance payments to patients
• ERA/ ACH payments on same day of deposit
• Patient statements on same day of settlement
• Online bill pay system and automated reminders

RESULTS

• 95% in operational efficiency in audit results
• 94% collection rate (incl. non-par)
• Retrieved $6M+ from patients
• 100% authorization accuracy
• 120+ AR is 6.68% compared to 14% industry average

Negotiation with carriers to increase payment rates from 35% to 82%