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GI Revenue Cycle Metrics: 3 Ways to Utilize Your Data to Improve Profitability   

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Novel technology within gastroenterology presents exciting opportunities for growth in the outpatient setting as well as improved value-based care for patients.  

Most recently, endoscopic ultrasounds are presenting effective, safe, and minimally invasive patient care, and the world’s first “candy-cane” endoscopy procedure was performed without any incisions.  

Additionally, a patient monitoring device can passively and accurately detect flares for Crohn’s disease before clinical signs appear to decrease misinterpreted symptoms and improve diagnosis accuracy. 

As we embrace advances in GI technology, it’s important to evaluate which new services will help, not hurt, your surgery center’s bottom line. The best way to make informed decisions is to review your current processes to determine how you’re currently driving revenue and what can be improved to increase profitability.  

Here are our top three tips to optimize your ASC’s revenue cycle before taking on new GI services or purchasing new technology. 

1. Focus on Key Operational Metrics

Before we dive deep into the revenue cycle, there are several operational metrics that are critical to achieving strong financial performance for gastroenterology ASCs including:  

  • Operating room (OR) utilization rates 
  • Time per procedure 
  • Overhead as a percentage of total expenses 
  • Staffing costs as a percentage of total expenses 
  • Managing inventory costs  

These metrics can help ensure you run an efficient operation that maximizes every dollar, which is particularly important for gastroenterology since it is a higher volume and lower reimbursing specialty. 

2. Review Managed Care Contracts and RCM Metrics

From a revenue cycle standpoint, your managed care contracts determine how much reimbursement your facility can receive per procedure by payer.  

Benchmarking your rates and confirming your contracts cover the latest GI technology are two ways to ensure you’re optimizing your cash flow on each procedure.  

Other key GI metrics include: 

  • Days to bill: Factor in the possible delay due to waiting on pathology reports 
  • Clean claim rates: How often are your cases coded and billed correctly?  
  • Denial rates and denial reasons: Understanding your denials will allow you to identify and fix potential issues in your workflow.  

Additionally, monitor your percentage of zero-pay claims, which can severely impact revenue. Identifying and resolving the root causes of zero-pay claims is a winning strategy for increasing profitability on GI procedures. 
Focusing on improving each of these metrics will improve the timeliness of your collections and how much revenue you capture per procedure.

3. Pay Close Attention to Patient Experience Metrics

Patient complaints often revolve around unexpected expenses, such as when screening colonoscopies turn into diagnostic procedures.  
To address this, consider: 

  • Developing robust communication strategies to set clear patient expectations. 
  • Tracking and addressing patient complaints promptly to enhance their overall experience. 

To avoid any “surprise” bills, ensure your patients are in-network by verifying coverage and plan benefits. Insurance cards for narrow networks such as employer plans can look identical to major payers, but these narrow networks often have very different guidelines, deductibles, and copays.  

Be sure your staff is aware of specific coding and billing methodologies for narrow networks to avoid claim issues and unanticipated out-of-pocket expenses for patients, especially for any new GI technology or GI procedures.

Final Takeaways: the Post-Pandemic GI Revenue Cycle

As we continue to operate in the “new normal,” many of the costs associated with running a surgical facility are increasing.  

Tracking how much revenue is coming in and comparing that to your expenses will help you determine ways to improve profitability, including: 

  • OR Utilization Rate: OR utilization rate is important for gastroenterology for volume and reimbursement reasons. Assess your OR utilization rate by the number of procedures you perform. If your utilization is not where you want it to be, determine where you can gain efficiencies, such as training your front desk staff, nurses, or surgeons. 
  • Procedure Counts: Monitor metrics such as cancellation rates, daily billed cases, and daily billed charges and compare them to historical averages. Determine if you can expand your facility’s hours or add a day to your work week to increase the amount of cases performed per month. 
  • Upcoming Visits Pipeline: How many patients are currently booked? What are the projected revenue and expenses associated with each appointment? You may want to consider new ways to market your services to potential clients, especially if you’re looking to expand your services or upgrade your surgical technology. Forming partnerships with hospital systems can also improve referral rates and increase your access to new patients. 

Thriving in gastroenterology requires attention to operational excellence, revenue cycle management, and the patient experience. As your surgical organization adapts to new trends and technology, these metrics will help you make informed decisions to ensure short-term and long-term success.  

Earn AAPC continuing education credits for gastroenterology by participating in our Anatomy of Coding educational courses. Register here for upcoming classes.