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Hi, everyone. This is Lucas Voss with Becker's

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Healthcare. So great to have you, and thanks

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for tuning in to the Becker's Healthcare podcast

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series.

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Today, we're talking about how ASCs can strengthen

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revenue integrity and financial performance through better documentation,

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CDI practices,

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and strategic

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partnerships.

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And I'm so excited to have two guests

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on today's podcast, Elaine Dunn, chief administrative officer

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of Nimble Solutions, and Jessica Thurston, vice president

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client development of Nimble Solutions. Elaine and Jessica,

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thanks for being here today. It's so great

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to have you. Thanks so much. Thanks, Lucas.

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Yeah. It's awesome to have you. We'll start

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with introductions here for our audience. Elaine, why

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don't you kick us off? Could you share

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a little bit about yourself and and your

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work in health care?

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Yeah. So Elaine Dunn, chief administrative officer,

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at Nimble.

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Just by way of background, I've been in

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health care my,

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entire adult life.

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I won't name the years,

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but have worked really across the entire health

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care ecosystem, started off as a clinician, and

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then have been in the revenue cycle space

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and and very specifically in the revenue integrity

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space for the last fifteen years.

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It's great to have you. Jessica, we'll go

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with you next. Thanks, Lucas. Pleasure to be

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here. I've been working in the business side

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of health care at some capacity for over

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seventeen years,

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though I didn't always necessarily know the terminology

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revenue cycle management.

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The physicians have always been I have always

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really involved,

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the revenue workflow in some some capacity.

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So, starting off in durable medical equipment space,

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working on patient financial clearance, managing patient eligibility,

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benefits, authorizations, and pre certs

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to scheduling registration and collections for private practice.

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My time here at Nimble has been spent

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mostly in client success and development, collaborating with

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existing and prospective clients to optimize the revenue

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cycle.

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What do you mean, Jessica? Learning about the

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RCM is the most fun thing.

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Great. Right? Exactly.

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Well, Elaine, I I wanna start with you

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on this here. Interested investment in ASCs

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continues to grow across the landscape. Healthcare landscape.

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We're seeing this. At the same time, a

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lot of these organizations are are grappling with

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declining physician reimbursements,

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evolving regulations, of course, and and certainly rising

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care demands as well.

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In this environment,

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how have expectations and best practices around revenue

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integrity evolved?

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Yeah. And, you know, I I think that

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we take a pretty broad,

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I would say, take on revenue

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integrity because it is so critical to the

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financial health of an an ASC.

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And I think historically, it has been overlooked

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or underinvested

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in, particularly,

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again, in the ASC space.

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So for us, you know, we define revenue

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integrity as all of those actions, you know,

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the processes,

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the technology

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that are needed to translate

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that physician's

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clinical actions

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into a financial transaction.

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And then, you know, I think when you

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look at it from that perspective,

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the evolution and and really where ASCs need

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to think about sort of those core elements

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of a strong revenue integrity program

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is, as

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Jessica had mentioned, you know, all of your

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pre service clinical and financial

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clearance actions, making sure, you know, proactively,

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we're clearing all of those requirements for that

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service to be paid,

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clinical documentation

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integrity,

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charge capture,

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you know, not just kind of that tactical

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aspect

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of posting a charge, but are you capturing

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everything

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that you should rightfully

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be getting paid for and doing that at

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the right price.

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And then coding compliance and accuracy,

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is a huge element of revenue integrity that

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sometimes we don't always think about it in

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that context.

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And then I would say, you know, last

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and and certainly not least is

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sort of

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the evolution and sort of the sophistication

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in both the data integrity and our coding

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and billing workflows

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in our information system. So thinking about those

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EMR and billing platforms and how they can

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really be a tool to advance revenue integrity

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in the surgery center.

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Yeah. Absolutely.

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Jessica, I'd love to come to you on

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this as well. Again, you've mentioned in your

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intros with the work a lot of the

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work that you're doing with clients.

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What are some of those best practices for

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you, the expectations? What are you seeing leaders

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overlook in terms of critical pieces?

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Would love to get your thoughts on this

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as well. Yeah. I just wanna stress the

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importance of analytics.

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A critical lagging indicator to monitor the revenue

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integrity program for a surgery center is actually

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cash per case. Mhmm. Cash per case can,

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you know, further be analyzed by specialty

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physician

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and even individual payer.

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And a factor that can be overlooked is

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analyzing all possible procedure code combinations that make

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up that surgical case, and that includes the

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implants,

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instead of just viewing that individual CBT procedure

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code.

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Yeah. Absolutely. It it makes a lot of

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sense. I mean, you you mentioned that, and

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Elaine mentioned it as well. There's there's so

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many elements to this, as a critical critical

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piece.

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Moving on here a little bit more in

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detail about some of these things that you've

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mentioned, how can ASCs

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think about the medical record documentation and the

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importance of clinical documentation

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integrity? We might refer to this as CDI

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as well. So clinical documentation integrity processes

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and education. How can ASCs be thinking about

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the medical record documentation and the importance of

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those

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processes in education?

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Elaine, we'll start with you.

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Yeah. I think first and foremost, ASCs really

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need to view CDI

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as a strategic priority for their center. I

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think investing and reviewing the accuracy, the specificity

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of your documentation,

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and and how it supports reimbursement

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requirements

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has multiple benefits from preventing denials and third

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party compliance audits by, you know, ensuring that

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medical necessity is supported before the claim even

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goes out the door. I think it's also

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important to support quality initiatives. You know, essentially,

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what CDI is helping you do is create

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consistent medical records kind of across your patient

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base and across

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providers for accurate data capture.

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Mhmm. And then, you know, I would say

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through the provider education

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that comes with CDI around compliant documentation practices,

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you can also start to see some reductions

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in your days to bill and and ultimately,

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you know, cash acceleration

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because you're having fewer coding deficiencies

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that you're having to work through.

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Yeah. Absolutely. Jessica, anything to add here? Yeah.

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I'll just add that I think, clinical documentation

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integrity has traditionally been a focus more for

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the hospitals.

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But we're seeing increased scrutiny in the ambulatory

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surgery center space as more complex procedures continue

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to migrate from hospitals to ASCs.

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Yeah.

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Elaine, I'd looked at you mentioned the process

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a little bit. You you talked about the

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process itself. Are there any examples or success

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stories that you can think of that illustrate

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how this approach have made a meaningful impact

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and anything that stands out for you in

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your work?

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Yeah. I I think a couple examples,

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come top of mind. And and the first

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is that,

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you know, proactive reviews around

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making sure that the documentation

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can support a a covered diagnosis

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for the procedure. So, you know, are your

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coders kind of looking beyond

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just the operative note to see, is there

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any additional documentation,

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for example, in history and physical that they

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can query and pull in to get that

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additional detail to support coding to the highest

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level of specificity

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as just payer policies become more and more

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stringent

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on looking for those very specific diagnoses.

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And then the I think the second example

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that I would just, point out is or

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is around rack audit prevention efforts. You know,

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we're seeing a significant increase in rack audits

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hitting ASCs,

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specifically

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total joints, pain procedures, you know, high volume

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procedures for our surgery centers.

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And so ensuring that documentation

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through CDI can support that Medicare criteria

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proactively

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to absolutely

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reduce your risk,

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to rack audits and negative audit findings, and

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and we've seen that consistently across our provider

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base.

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You both touched on on so many different

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aspects This

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is certainly a process that folks need to

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be aware of. They need to understand those

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critical elements that we've touched on in our

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conversation.

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I'd love to look ahead a little bit.

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What's one strategy or mindset you would encourage

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ASC leaders to adopt now or today to

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strengthen their financial outcomes over the next few

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years? Jessica, would love to start with you

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on this.

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Yeah. I mean, no doubt that,

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negotiating payer contracts is a key component of

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the financial success of surgery centers.

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I just wanna underscore that the initial offering

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from the provider representative does not have to

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be the final offer. Mhmm. And, really understanding

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your payer reimbursement methodology is important for payment

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integrity review and accurate reporting while also understanding

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your payer guidelines

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will help ensure accurate coding and billing practices.

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Yeah. Elaine, anything to add here?

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I I think it's just really adopting a

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mindset of revenue integrity.

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So, you know, to me, you think about

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how a patient's schedule encounter eventually

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becomes cash to the center,

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doing the walk

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every step of that process to make sure

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do we have the right, you know, people,

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processes, technology

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to optimize cash per case? That's really what

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revenue integrity is.

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Yeah. Absolutely.

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Elena, Jessica, thanks so much for being here.

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I I wanted to to give the floor

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to you,

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so to speak. Is there anything else that

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we haven't covered that you'd really like to

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mention that our audience, needs to know? Any

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final thoughts you'd like to share?

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Jessica, starting with you here. Yeah. Just to

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reiterate the importance of understanding your pair contracts.

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A perfect example with the, CMS proposed,

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recent updates, do you have any commercial insurance

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payers who follow Medicare guidelines?

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And are you maintaining your payer fee schedules,

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properly in your practice management system for accurate

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adjustments in reporting?

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Read the fine print. Right? That's what Exactly.

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Exactly.

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Elaine, anything else to add here?

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No. Just, you know, Jessica mentioned briefly just,

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you know, the Medicare rules. So the, proposed

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OPPS

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ASC rule just just came out within the

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last few days. We're busy pouring over that,

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but I think the exciting headline is is

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that proposing, you know, about 547

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new codes to be eligible to be covered

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in the ASC.

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So that means a broader range of procedures

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across

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more specialties, higher complexity

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procedures going into your ASCs. So just need

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to be prepared to kinda accurately,

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and compliantly

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capture code and and bill for those new

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services. So we're excited to see kind of

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the the increase in the footprint of ASCs,

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and and I think that proposed rule,

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is is a good fit forward to that

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initiative.

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That just means we have to record another

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episode, I feel like, a follow-up to discuss

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all of that. I think that makes perfect

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sense. Well, Elaine and Jessica, thanks so much

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for being here again. What a great conversation.

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Thank you to both.

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Thank you so much. Thank you.

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And we also want to thank our podcast

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sponsor, Nimble Solutions. You could tune in to

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more podcasts from Becker's Healthcare by visiting our

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