Hi, everyone. This is Lucas Voss with Becker's
Healthcare. So great to have you, and thanks
for tuning in to the Becker's Healthcare podcast
series.
Today, we're talking about how ASCs can strengthen
revenue integrity and financial performance through better documentation,
CDI practices,
and strategic
partnerships.
And I'm so excited to have two guests
on today's podcast, Elaine Dunn, chief administrative officer
of Nimble Solutions, and Jessica Thurston, vice president
client development of Nimble Solutions. Elaine and Jessica,
thanks for being here today. It's so great
to have you. Thanks so much. Thanks, Lucas.
Yeah. It's awesome to have you. We'll start
with introductions here for our audience. Elaine, why
don't you kick us off? Could you share
a little bit about yourself and and your
work in health care?
Yeah. So Elaine Dunn, chief administrative officer,
at Nimble.
Just by way of background, I've been in
health care my,
entire adult life.
I won't name the years,
but have worked really across the entire health
care ecosystem, started off as a clinician, and
then have been in the revenue cycle space
and and very specifically in the revenue integrity
space for the last fifteen years.
It's great to have you. Jessica, we'll go
with you next. Thanks, Lucas. Pleasure to be
here. I've been working in the business side
of health care at some capacity for over
seventeen years,
though I didn't always necessarily know the terminology
revenue cycle management.
The physicians have always been I have always
really involved,
the revenue workflow in some some capacity.
So, starting off in durable medical equipment space,
working on patient financial clearance, managing patient eligibility,
benefits, authorizations, and pre certs
to scheduling registration and collections for private practice.
My time here at Nimble has been spent
mostly in client success and development, collaborating with
existing and prospective clients to optimize the revenue
cycle.
What do you mean, Jessica? Learning about the
RCM is the most fun thing.
Great. Right? Exactly.
Well, Elaine, I I wanna start with you
on this here. Interested investment in ASCs
continues to grow across the landscape. Healthcare landscape.
We're seeing this. At the same time, a
lot of these organizations are are grappling with
declining physician reimbursements,
evolving regulations, of course, and and certainly rising
care demands as well.
In this environment,
how have expectations and best practices around revenue
integrity evolved?
Yeah. And, you know, I I think that
we take a pretty broad,
I would say, take on revenue
integrity because it is so critical to the
financial health of an an ASC.
And I think historically, it has been overlooked
or underinvested
in, particularly,
again, in the ASC space.
So for us, you know, we define revenue
integrity as all of those actions, you know,
the processes,
the technology
that are needed to translate
that physician's
clinical actions
into a financial transaction.
And then, you know, I think when you
look at it from that perspective,
the evolution and and really where ASCs need
to think about sort of those core elements
of a strong revenue integrity program
is, as
Jessica had mentioned, you know, all of your
pre service clinical and financial
clearance actions, making sure, you know, proactively,
we're clearing all of those requirements for that
service to be paid,
clinical documentation
integrity,
charge capture,
you know, not just kind of that tactical
aspect
of posting a charge, but are you capturing
everything
that you should rightfully
be getting paid for and doing that at
the right price.
And then coding compliance and accuracy,
is a huge element of revenue integrity that
sometimes we don't always think about it in
that context.
And then I would say, you know, last
and and certainly not least is
sort of
the evolution and sort of the sophistication
in both the data integrity and our coding
and billing workflows
in our information system. So thinking about those
EMR and billing platforms and how they can
really be a tool to advance revenue integrity
in the surgery center.
Yeah. Absolutely.
Jessica, I'd love to come to you on
this as well. Again, you've mentioned in your
intros with the work a lot of the
work that you're doing with clients.
What are some of those best practices for
you, the expectations? What are you seeing leaders
overlook in terms of critical pieces?
Would love to get your thoughts on this
as well. Yeah. I just wanna stress the
importance of analytics.
A critical lagging indicator to monitor the revenue
integrity program for a surgery center is actually
cash per case. Mhmm. Cash per case can,
you know, further be analyzed by specialty
physician
and even individual payer.
And a factor that can be overlooked is
analyzing all possible procedure code combinations that make
up that surgical case, and that includes the
implants,
instead of just viewing that individual CBT procedure
code.
Yeah. Absolutely. It it makes a lot of
sense. I mean, you you mentioned that, and
Elaine mentioned it as well. There's there's so
many elements to this, as a critical critical
piece.
Moving on here a little bit more in
detail about some of these things that you've
mentioned, how can ASCs
think about the medical record documentation and the
importance of clinical documentation
integrity? We might refer to this as CDI
as well. So clinical documentation integrity processes
and education. How can ASCs be thinking about
the medical record documentation and the importance of
those
processes in education?
Elaine, we'll start with you.
Yeah. I think first and foremost, ASCs really
need to view CDI
as a strategic priority for their center. I
think investing and reviewing the accuracy, the specificity
of your documentation,
and and how it supports reimbursement
requirements
has multiple benefits from preventing denials and third
party compliance audits by, you know, ensuring that
medical necessity is supported before the claim even
goes out the door. I think it's also
important to support quality initiatives. You know, essentially,
what CDI is helping you do is create
consistent medical records kind of across your patient
base and across
providers for accurate data capture.
Mhmm. And then, you know, I would say
through the provider education
that comes with CDI around compliant documentation practices,
you can also start to see some reductions
in your days to bill and and ultimately,
you know, cash acceleration
because you're having fewer coding deficiencies
that you're having to work through.
Yeah. Absolutely. Jessica, anything to add here? Yeah.
I'll just add that I think, clinical documentation
integrity has traditionally been a focus more for
the hospitals.
But we're seeing increased scrutiny in the ambulatory
surgery center space as more complex procedures continue
to migrate from hospitals to ASCs.
Yeah.
Elaine, I'd looked at you mentioned the process
a little bit. You you talked about the
process itself. Are there any examples or success
stories that you can think of that illustrate
how this approach have made a meaningful impact
and anything that stands out for you in
your work?
Yeah. I I think a couple examples,
come top of mind. And and the first
is that,
you know, proactive reviews around
making sure that the documentation
can support a a covered diagnosis
for the procedure. So, you know, are your
coders kind of looking beyond
just the operative note to see, is there
any additional documentation,
for example, in history and physical that they
can query and pull in to get that
additional detail to support coding to the highest
level of specificity
as just payer policies become more and more
stringent
on looking for those very specific diagnoses.
And then the I think the second example
that I would just, point out is or
is around rack audit prevention efforts. You know,
we're seeing a significant increase in rack audits
hitting ASCs,
specifically
total joints, pain procedures, you know, high volume
procedures for our surgery centers.
And so ensuring that documentation
through CDI can support that Medicare criteria
proactively
to absolutely
reduce your risk,
to rack audits and negative audit findings, and
and we've seen that consistently across our provider
base.
You both touched on on so many different
aspects This
is certainly a process that folks need to
be aware of. They need to understand those
critical elements that we've touched on in our
conversation.
I'd love to look ahead a little bit.
What's one strategy or mindset you would encourage
ASC leaders to adopt now or today to
strengthen their financial outcomes over the next few
years? Jessica, would love to start with you
on this.
Yeah. I mean, no doubt that,
negotiating payer contracts is a key component of
the financial success of surgery centers.
I just wanna underscore that the initial offering
from the provider representative does not have to
be the final offer. Mhmm. And, really understanding
your payer reimbursement methodology is important for payment
integrity review and accurate reporting while also understanding
your payer guidelines
will help ensure accurate coding and billing practices.
Yeah. Elaine, anything to add here?
I I think it's just really adopting a
mindset of revenue integrity.
So, you know, to me, you think about
how a patient's schedule encounter eventually
becomes cash to the center,
doing the walk
every step of that process to make sure
do we have the right, you know, people,
processes, technology
to optimize cash per case? That's really what
revenue integrity is.
Yeah. Absolutely.
Elena, Jessica, thanks so much for being here.
I I wanted to to give the floor
to you,
so to speak. Is there anything else that
we haven't covered that you'd really like to
mention that our audience, needs to know? Any
final thoughts you'd like to share?
Jessica, starting with you here. Yeah. Just to
reiterate the importance of understanding your pair contracts.
A perfect example with the, CMS proposed,
recent updates, do you have any commercial insurance
payers who follow Medicare guidelines?
And are you maintaining your payer fee schedules,
properly in your practice management system for accurate
adjustments in reporting?
Read the fine print. Right? That's what Exactly.
Exactly.
Elaine, anything else to add here?
No. Just, you know, Jessica mentioned briefly just,
you know, the Medicare rules. So the, proposed
OPPS
ASC rule just just came out within the
last few days. We're busy pouring over that,
but I think the exciting headline is is
that proposing, you know, about 547
new codes to be eligible to be covered
in the ASC.
So that means a broader range of procedures
across
more specialties, higher complexity
procedures going into your ASCs. So just need
to be prepared to kinda accurately,
and compliantly
capture code and and bill for those new
services. So we're excited to see kind of
the the increase in the footprint of ASCs,
and and I think that proposed rule,
is is a good fit forward to that
initiative.
That just means we have to record another
episode, I feel like, a follow-up to discuss
all of that. I think that makes perfect
sense. Well, Elaine and Jessica, thanks so much
for being here again. What a great conversation.
Thank you to both.
Thank you so much. Thank you.
And we also want to thank our podcast
sponsor, Nimble Solutions. You could tune in to
more podcasts from Becker's Healthcare by visiting our
podcast page at beckershospitalreview.com.