Unlocking the Power of GI Revenue Cycle Metrics: Insights and Strategies from Nader Samii
Q: For ASCs that perform gastroenterology procedures, what are some essential gastroenterology revenue cycle metrics to track?
Nader Samii: Before we dive deep into the revenue cycle, there are several operational metrics that are critical to achieving strong financial performance for gastroenterology ASCs. These include operating room (OR) utilization rates; time per procedure; overhead as a percentage of total expenses; staffing costs as a percentage of total expenses; and inventory, amongst others. These metrics can help ensure you run an efficient operation and maximize every dollar, which is particularly important for gastroenterology since it is a higher volume and lower reimbursing specialty.
From a revenue cycle standpoint, I would suggest looking at your managed care contracts evaluating cash per case by payer and by procedure. In addition, other key GI metrics include days to bill (factoring in the possible delay due to waiting on pathology reports), clean claim rates, denial rates and denial reason codes. Understanding your denials will allow you to identify and fix potential issues in your workflow. Focusing on improving each of these metrics will ultimately lead to maximizing your cash flow.
Q: What are a few metrics that ASCs performing gastroenterology may be overlooking?
NS: Patient complaints should be closely tracked. Creating the ideal patient experience is of vital importance. Complaints with gastroenterology often concern screening colonoscopies that become diagnostic, thus requiring patients to incur expenses. If you receive a high volume of such complaints, consider developing stronger communication with patients around how the process works to help avoid mismanagement of expectations and “surprise” bills.
Also, it is critical to evaluate your percentage of zero-pay claims, which are those claims that fail to generate any payment. If your percentage begins to rise, figure out why as you cannot afford to take on cases that do not pay.
OR utilization rate is important for gastroenterology for volume and reimbursement reasons. 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.
Q: As ASCs with gastroenterology are working to recover from the disruption in their revenue cycle caused by the pandemic, what metrics should they more closely monitor?
NS: I would suggest a daily check of OR utilization rate and number of procedures you perform. You want to determine if your number of procedures declined compared to historical averages due to protocol changes necessitated by COVID-19 that require allocating more time to completing processes. What impact are changes having on your center, and what options exist to overcome them? Can you add hours to your days of operations? Add a day to your typical week? Monitor metrics such as cancellation rates, daily billed cases and daily billed charges and compare them to historical averages as well.
You also want to understand your pipeline for upcoming visits. You need to know what revenue is going to come in and what your expenses will be as centers continue to operate in this “new normal.” With this information, you can better project future revenue, which will help you make the educated decisions about where to adjust operations to best ensure short- and long-term success.
Nader Samii is chief executive officer of National Medical Billing Services in St. Louis, Missouri.