1 00:00:00,080 --> 00:00:02,720 Hi, everyone. This is Lucas Voss with Becker's 2 00:00:02,720 --> 00:00:04,480 Healthcare. Thanks so much for tuning in to 3 00:00:04,480 --> 00:00:07,440 the Becker's Healthcare podcast series. Fantastic to have 4 00:00:07,440 --> 00:00:10,820 you. An exciting topic today leading through uncertainty, 5 00:00:10,960 --> 00:00:12,820 how ASCs can strengthen 6 00:00:13,359 --> 00:00:14,625 cash flow and stay 7 00:00:15,405 --> 00:00:17,405 ahead. And joining me for today's discussion, very 8 00:00:17,405 --> 00:00:19,644 excited to have them both, is Tim Fuchs, 9 00:00:19,644 --> 00:00:22,925 chief growth officer, and Amanda Whitener, senior director 10 00:00:22,925 --> 00:00:25,885 of client development, both at Nimble Solutions. Tim 11 00:00:25,885 --> 00:00:27,164 and Amanda, it's so great to have you. 12 00:00:27,164 --> 00:00:28,225 Thanks for being here. 13 00:00:28,550 --> 00:00:30,070 Thanks for having us. Thanks, Lucas. Yeah. I 14 00:00:30,070 --> 00:00:31,989 wanna start off with introductions for our audience 15 00:00:31,989 --> 00:00:34,149 that might not know you yet. Tim, we'll 16 00:00:34,149 --> 00:00:35,210 start with you here. 17 00:00:35,909 --> 00:00:37,989 Great. Thanks, Lucas. So Tim Fuchs, chief growth 18 00:00:37,989 --> 00:00:38,489 officer 19 00:00:39,109 --> 00:00:41,609 for Nimble, and I've been here for 20 00:00:42,315 --> 00:00:44,255 nearly ten years and our organization 21 00:00:45,354 --> 00:00:48,635 is a RCM company that has around roughly 22 00:00:48,635 --> 00:00:51,135 1,200 clients in all 50 states. 23 00:00:51,594 --> 00:00:53,914 We grew our business focusing on the ASC 24 00:00:53,914 --> 00:00:56,075 market but as we began to grow that 25 00:00:56,075 --> 00:00:57,854 we started being asked to do 26 00:00:58,350 --> 00:01:01,070 the clinic side of things and anesthesia. So 27 00:01:01,070 --> 00:01:03,729 we really focus on being an outpatient surgical 28 00:01:03,869 --> 00:01:07,090 RCM focused organization, being able to support 29 00:01:07,549 --> 00:01:09,950 our clients from an enterprise wide view, whether 30 00:01:09,950 --> 00:01:11,329 that's their surgery center, 31 00:01:11,894 --> 00:01:14,394 their practice, or their anesthesia group. 32 00:01:14,935 --> 00:01:16,694 We don't do acute care work on the 33 00:01:16,694 --> 00:01:19,114 hospital side. We really focus on that outpatient 34 00:01:19,174 --> 00:01:21,655 market, and it's great to be connected with 35 00:01:21,655 --> 00:01:24,055 you today. And we also have Amanda Whitener, 36 00:01:24,055 --> 00:01:26,474 who is a senior director of client development 37 00:01:26,534 --> 00:01:28,939 here at Nimble. And Amanda, we'll let you 38 00:01:28,939 --> 00:01:31,100 jump in here too. Sure. Thank you, Tim. 39 00:01:31,100 --> 00:01:33,260 Thank you, Lucas. Yeah. As Tim stated, my 40 00:01:33,260 --> 00:01:35,340 name is Amanda Whitener, senior director of client 41 00:01:35,340 --> 00:01:37,740 development here at Nimble. Been in the RCM 42 00:01:37,740 --> 00:01:39,420 space and the health care space over a 43 00:01:39,420 --> 00:01:41,814 decade now. Most of that time being spent 44 00:01:41,814 --> 00:01:42,554 with Nimble. 45 00:01:43,015 --> 00:01:44,234 I love this industry. 46 00:01:44,774 --> 00:01:46,075 ASC is ever changing, 47 00:01:46,774 --> 00:01:48,554 and working for a group that 48 00:01:49,174 --> 00:01:51,974 stays apprised of those changes and disseminates it 49 00:01:51,974 --> 00:01:54,530 to the the industry accordingly is always 50 00:01:54,909 --> 00:01:57,090 just very exciting and very rewarding. 51 00:01:57,390 --> 00:01:58,849 I'm very blessed to be 52 00:01:59,229 --> 00:01:59,629 here, 53 00:02:00,030 --> 00:02:02,189 with this group and, looking forward to having 54 00:02:02,189 --> 00:02:04,909 this conversation today. One more thing really quick 55 00:02:04,909 --> 00:02:06,909 too. I should mention that, we 56 00:02:07,585 --> 00:02:09,764 our clients really represent every 57 00:02:10,305 --> 00:02:12,784 ownership structure in the ASC space. We work 58 00:02:12,784 --> 00:02:13,284 with 59 00:02:13,824 --> 00:02:16,625 independent groups, health systems. We touch most of 60 00:02:16,625 --> 00:02:17,685 the management companies 61 00:02:18,385 --> 00:02:18,784 and, 62 00:02:19,264 --> 00:02:23,400 private equity firms, corporate organizations, MSOs, etcetera. So 63 00:02:23,799 --> 00:02:26,840 we've got about 20% of the ASC market 64 00:02:26,840 --> 00:02:28,599 in some form or fashion working with us, 65 00:02:28,599 --> 00:02:30,060 so we have a lot of great 66 00:02:30,360 --> 00:02:32,360 experience that we can bring to this conversation 67 00:02:32,360 --> 00:02:32,860 today. 68 00:02:33,319 --> 00:02:34,759 And I'm excited to hear about some of 69 00:02:34,759 --> 00:02:36,360 that because we're going to touch on it 70 00:02:36,360 --> 00:02:38,514 for sure. And it's on in our title 71 00:02:38,514 --> 00:02:39,014 too, 72 00:02:39,635 --> 00:02:42,194 of our conversation today, cash flow. And, Tim, 73 00:02:42,194 --> 00:02:43,814 I wanna start off with you here. 74 00:02:44,435 --> 00:02:45,335 Why is 75 00:02:45,635 --> 00:02:46,135 accelerating 76 00:02:46,514 --> 00:02:47,254 cash flow 77 00:02:47,794 --> 00:02:49,495 so important right now 78 00:02:49,955 --> 00:02:51,574 in the environment we're in? 79 00:02:52,370 --> 00:02:55,090 Yeah. Absolutely. So, yeah, with reimbursement pressure right 80 00:02:55,090 --> 00:02:56,310 now, rising costs, 81 00:02:56,770 --> 00:02:58,150 and shifting case mix, 82 00:02:58,689 --> 00:03:01,169 ASCs can't afford to be reactive. So the 83 00:03:01,169 --> 00:03:03,270 centers that win are the ones that continuously 84 00:03:03,489 --> 00:03:03,989 monitor 85 00:03:04,885 --> 00:03:08,004 that financial performance. They pinpoint those issues early 86 00:03:08,004 --> 00:03:09,305 and and adjust quickly. 87 00:03:09,925 --> 00:03:12,245 And, here's a couple areas where they can 88 00:03:12,245 --> 00:03:13,385 really stay ahead. 89 00:03:13,764 --> 00:03:16,405 And I would say really focusing on data 90 00:03:16,405 --> 00:03:18,344 and understanding data, not just 91 00:03:18,689 --> 00:03:20,289 waiting a month to do it, but on 92 00:03:20,289 --> 00:03:22,689 a daily basis and understanding how to take 93 00:03:22,689 --> 00:03:23,909 that, analyze it, 94 00:03:24,289 --> 00:03:26,449 and react to it is really important. You 95 00:03:26,449 --> 00:03:28,870 really should be looking at your daily cash 96 00:03:29,250 --> 00:03:32,055 and where that acceleration is coming from or 97 00:03:32,215 --> 00:03:34,614 where opportunity is to increase that. And you 98 00:03:34,614 --> 00:03:35,754 can do that by 99 00:03:36,055 --> 00:03:38,534 really tracking your denial trends by payer and 100 00:03:38,534 --> 00:03:39,034 CPT. 101 00:03:39,734 --> 00:03:40,634 Your authorized 102 00:03:41,254 --> 00:03:42,794 versus unauthorized cases. 103 00:03:43,334 --> 00:03:44,794 Cash per case by specialty. 104 00:03:45,389 --> 00:03:47,709 Really looking at your AR aging. And then 105 00:03:47,709 --> 00:03:49,949 your net collection rate too is really important. 106 00:03:49,949 --> 00:03:51,709 And your outcome there is really that you're 107 00:03:51,709 --> 00:03:54,370 spotting revenue leaks before they become write offs. 108 00:03:54,829 --> 00:03:56,590 And another big part of that too is 109 00:03:56,590 --> 00:03:58,930 really establishing a tight front end process. 110 00:03:59,664 --> 00:04:00,465 70% 111 00:04:00,465 --> 00:04:03,025 of downstream revenue issues start before the patient 112 00:04:03,025 --> 00:04:05,264 enters the building, which is a fascinating stat 113 00:04:05,264 --> 00:04:05,424 that, 114 00:04:06,224 --> 00:04:08,324 a lot of people don't aren't aware of. 115 00:04:08,384 --> 00:04:11,664 So ASCs must have an automated eligibility and 116 00:04:11,664 --> 00:04:12,644 benefits review, 117 00:04:13,460 --> 00:04:15,939 really have a bulletproof process when it comes 118 00:04:15,939 --> 00:04:17,319 to authorization workflows, 119 00:04:17,939 --> 00:04:20,339 and then having an accurate patient estimates and 120 00:04:20,339 --> 00:04:22,980 a pre service payment strategy because the patient 121 00:04:22,980 --> 00:04:24,899 is ever becoming a bigger portion of the 122 00:04:24,899 --> 00:04:27,634 payer, and in a tight financially counseling process 123 00:04:27,634 --> 00:04:29,634 too for those high deductible patients. So really 124 00:04:29,634 --> 00:04:31,634 the outcome there is you're gonna have fewer 125 00:04:31,634 --> 00:04:33,974 denials, faster payments, and less bad debt. 126 00:04:34,435 --> 00:04:36,514 And then you really need to understand your 127 00:04:36,514 --> 00:04:38,055 your case mix and your profitability 128 00:04:38,514 --> 00:04:39,334 by surgeon. 129 00:04:40,379 --> 00:04:43,259 So not all cases or surgeons drive the 130 00:04:43,259 --> 00:04:44,560 same financial outcomes. 131 00:04:44,939 --> 00:04:46,879 So ASCs should be tracking 132 00:04:47,420 --> 00:04:50,319 your profit margin by surgeon, your implant profitability, 133 00:04:50,460 --> 00:04:51,360 OR utilization, 134 00:04:52,220 --> 00:04:55,279 and really understanding your high cost outlier cases 135 00:04:56,595 --> 00:04:59,154 and breaking that out by specialty too. So 136 00:04:59,154 --> 00:05:01,154 you're really looking for that you can optimize 137 00:05:01,154 --> 00:05:02,055 your block time, 138 00:05:02,914 --> 00:05:05,875 renegotiate supply costs, and really grow profitable service 139 00:05:05,875 --> 00:05:06,375 lines. 140 00:05:07,394 --> 00:05:10,350 Amanda, I I wanna dive into what Tim 141 00:05:10,350 --> 00:05:11,790 just outlined a little bit more in terms 142 00:05:11,790 --> 00:05:14,110 of the how, right, and how we're doing 143 00:05:14,110 --> 00:05:16,449 this. Right? What are some of those strategies 144 00:05:16,509 --> 00:05:19,329 that you're looking at that you recommend ASCs 145 00:05:19,389 --> 00:05:22,449 adopt to then, again, accelerate cash flow 146 00:05:22,750 --> 00:05:25,414 to where it is profitable to what Tim 147 00:05:25,414 --> 00:05:26,235 just outlined? 148 00:05:27,574 --> 00:05:29,974 Yeah. And so that's a great question. And 149 00:05:29,974 --> 00:05:32,154 and, Tim, that that was a great outline. 150 00:05:32,294 --> 00:05:34,954 I would say two key avenues to accelerate 151 00:05:35,095 --> 00:05:35,834 cash flow 152 00:05:36,294 --> 00:05:38,490 are developing strategies for 153 00:05:38,970 --> 00:05:41,310 managed care contracting and coding integrity. 154 00:05:42,329 --> 00:05:44,490 Those are two topics we we speak on 155 00:05:44,490 --> 00:05:46,750 quite a bit. With regards to contracts, 156 00:05:47,769 --> 00:05:49,370 this is something we at Nimble place a 157 00:05:49,370 --> 00:05:52,009 huge emphasis on. We actually want our clients 158 00:05:52,009 --> 00:05:54,345 to be very knowledgeable with regards to their 159 00:05:54,345 --> 00:05:54,845 contracts. 160 00:05:56,105 --> 00:05:58,425 We engage with many ASCs nationwide, and I 161 00:05:58,425 --> 00:05:59,645 would say a common denominator 162 00:06:00,105 --> 00:06:00,764 is they, 163 00:06:01,225 --> 00:06:03,324 well, in fact, around 95 plus percent 164 00:06:03,785 --> 00:06:06,504 don't have complete copies of their contracts when 165 00:06:06,504 --> 00:06:08,045 we initially engage them, 166 00:06:08,745 --> 00:06:09,245 which 167 00:06:10,120 --> 00:06:12,759 immediately tells me a few things. One, their 168 00:06:12,759 --> 00:06:15,240 contracts are likely out of date. So that 169 00:06:15,240 --> 00:06:17,400 to me means less than par fee schedules, 170 00:06:17,400 --> 00:06:19,639 which is a huge opportunity for improvement of 171 00:06:19,639 --> 00:06:21,100 cash by way of payer negotiations. 172 00:06:21,879 --> 00:06:25,095 Our clients should know our facility should know, 173 00:06:25,794 --> 00:06:28,454 where they stack up against industry and, standards 174 00:06:28,915 --> 00:06:29,415 and 175 00:06:29,794 --> 00:06:30,774 are their costs 176 00:06:31,154 --> 00:06:33,414 being covered by their allowed amounts. 177 00:06:33,875 --> 00:06:35,819 So they wanna look at their Medicare rates, 178 00:06:36,060 --> 00:06:37,520 look at their fee schedules, 179 00:06:38,220 --> 00:06:40,000 perform routine case costing, 180 00:06:40,939 --> 00:06:42,540 and they need to have their contracts to 181 00:06:42,540 --> 00:06:43,439 do that effectively. 182 00:06:44,379 --> 00:06:46,939 Two, if they don't have complete copies of 183 00:06:46,939 --> 00:06:49,814 their contracts, it tells me it's likely those 184 00:06:49,814 --> 00:06:52,454 centers' billing teams aren't referencing the contracts when 185 00:06:52,454 --> 00:06:53,735 they're doing their day to day work. And 186 00:06:53,735 --> 00:06:55,035 this is so important. 187 00:06:55,814 --> 00:06:57,735 So one thing they may be doing, like 188 00:06:57,735 --> 00:06:59,735 let's say they're posting payments, they may be 189 00:06:59,735 --> 00:07:02,535 applying a percent of Medicare when confirming EOB 190 00:07:02,535 --> 00:07:03,990 payments or working AR. 191 00:07:04,629 --> 00:07:06,470 So that's if they know that the payers 192 00:07:06,470 --> 00:07:08,550 allowed a percent of Medicare and if they 193 00:07:08,550 --> 00:07:10,490 know that percentage for each payer. 194 00:07:10,949 --> 00:07:12,490 But what about implant nuances? 195 00:07:13,269 --> 00:07:15,289 What about carved out case rates? 196 00:07:15,829 --> 00:07:18,475 Those two things, implants and carve outs, have 197 00:07:18,475 --> 00:07:21,294 massive cash implications if not handled properly. 198 00:07:21,834 --> 00:07:23,834 And the team should have access to full 199 00:07:23,834 --> 00:07:25,754 contracts to know that level of detail when 200 00:07:25,754 --> 00:07:27,194 they're doing their day to day work, such 201 00:07:27,194 --> 00:07:28,574 as AR or payment posting. 202 00:07:29,035 --> 00:07:31,189 The third thing it tells me is if 203 00:07:31,189 --> 00:07:33,850 they don't have complete copies of their contracts, 204 00:07:34,069 --> 00:07:36,550 that their charge master could actually be out 205 00:07:36,550 --> 00:07:38,550 of date. And this is their fees that 206 00:07:38,550 --> 00:07:40,310 are their charges that are loaded into their 207 00:07:40,310 --> 00:07:41,689 practice management system. 208 00:07:42,230 --> 00:07:43,220 And this is where we run into a 209 00:07:43,220 --> 00:07:43,339 lot of issues with lesser than language in 210 00:07:43,339 --> 00:07:43,930 contracts, where the payers actually articulate in 211 00:07:44,230 --> 00:07:44,504 the 212 00:07:50,584 --> 00:07:51,404 billed charges 213 00:07:51,705 --> 00:07:54,125 or the actual contractually allowed amount, 214 00:07:54,904 --> 00:07:55,884 whatever is lesser. 215 00:07:56,264 --> 00:07:59,384 So it's important to also perform routine charge 216 00:07:59,384 --> 00:08:00,125 master analysis 217 00:08:00,470 --> 00:08:03,050 to ensure charges are consistent across payers, 218 00:08:03,590 --> 00:08:06,650 but sufficient to account for each fee schedule. 219 00:08:07,670 --> 00:08:09,449 Something else I mentioned is coding. 220 00:08:09,990 --> 00:08:12,710 Coding gives both an opportunity to maximize cash. 221 00:08:12,710 --> 00:08:13,210 So 222 00:08:13,634 --> 00:08:14,834 example would be, 223 00:08:15,314 --> 00:08:17,555 procedures that are dictated in the operative report 224 00:08:17,555 --> 00:08:19,555 but aren't appended to the initial claim. We 225 00:08:19,555 --> 00:08:20,535 see it. It happens. 226 00:08:21,314 --> 00:08:23,794 The other opportunity is to keep the cash 227 00:08:23,794 --> 00:08:25,735 the center gets by remaining compliant. 228 00:08:26,115 --> 00:08:28,055 So it's important to have 229 00:08:28,449 --> 00:08:31,110 your coding solution routinely audited. 230 00:08:31,569 --> 00:08:33,570 One coding mistake I mean, I'm sure everyone 231 00:08:33,570 --> 00:08:35,809 knows this one coding mistake could cost thousands 232 00:08:35,809 --> 00:08:36,549 of dollars. 233 00:08:37,250 --> 00:08:38,549 It seems it seems 234 00:08:39,169 --> 00:08:39,669 kinda 235 00:08:40,049 --> 00:08:42,625 like a smaller issue, but even one misplaced 236 00:08:42,764 --> 00:08:45,424 59 modifier, this is a modifier now, 237 00:08:45,804 --> 00:08:49,245 could lead to an inquisitive payer initiating a 238 00:08:49,245 --> 00:08:51,485 full on audit that could lead to costly 239 00:08:51,485 --> 00:08:54,019 take back. So making sure to have certified 240 00:08:54,019 --> 00:08:56,419 coders for each specialty is huge. Here at 241 00:08:56,419 --> 00:08:58,179 Nimble, we have over 380 242 00:08:58,179 --> 00:09:00,279 coders. Our coders are certified, 243 00:09:00,980 --> 00:09:02,980 and we make sure we support every specialty. 244 00:09:02,980 --> 00:09:05,939 It's very important to have certifications for every 245 00:09:05,939 --> 00:09:07,319 specialty that you're performing. 246 00:09:08,095 --> 00:09:08,335 Finally, 247 00:09:09,294 --> 00:09:12,414 I would include, kind of to to hearken 248 00:09:12,414 --> 00:09:14,835 back to what Tim was saying, just streamlined 249 00:09:14,894 --> 00:09:16,914 RCM processes from start to finish. 250 00:09:17,375 --> 00:09:19,855 Prior auths continue to be a talking point 251 00:09:19,855 --> 00:09:22,274 in our space with the the payer complexity 252 00:09:22,580 --> 00:09:25,240 supporting the the requirement for prior auths. 253 00:09:25,700 --> 00:09:27,700 So while we're waiting for changes in those 254 00:09:27,700 --> 00:09:30,820 requirements to occur, we need to be diligent 255 00:09:30,820 --> 00:09:32,120 in our front end processes. 256 00:09:32,820 --> 00:09:34,200 We need to know our contracts, 257 00:09:34,745 --> 00:09:36,745 obtain prior auths, sometimes for a range of 258 00:09:36,745 --> 00:09:37,245 codes, 259 00:09:37,625 --> 00:09:39,164 collect patient balances upfront, 260 00:09:39,544 --> 00:09:41,784 code what's dictated on the operative report, no 261 00:09:41,784 --> 00:09:43,804 more, no less. There comes that compliance. 262 00:09:44,345 --> 00:09:46,904 Keep charges consistent and pay close attention to 263 00:09:46,904 --> 00:09:49,860 the line item requirements, such as NDC numbers 264 00:09:49,860 --> 00:09:52,740 for drug codes. We wanna strive for 95 265 00:09:52,740 --> 00:09:55,959 plus percent clean claims on first pass. 266 00:09:56,500 --> 00:09:58,740 Post payments based on contractual allowed amounts, you 267 00:09:58,740 --> 00:10:00,199 need your contracts to do that. 268 00:10:00,500 --> 00:10:02,835 Follow-up on AR until every penny due the 269 00:10:02,835 --> 00:10:04,355 center is delivered by the payer. You need 270 00:10:04,355 --> 00:10:06,355 your contracts to do that as well. And 271 00:10:06,355 --> 00:10:07,875 have a great rapport with the patients on 272 00:10:07,875 --> 00:10:10,034 the back end, so that you can continue 273 00:10:10,034 --> 00:10:12,115 to obtain any additional balance that remains, which 274 00:10:12,115 --> 00:10:13,894 hopefully, at that point, isn't much. 275 00:10:14,629 --> 00:10:16,149 Yeah. So many different things to pay attention 276 00:10:16,149 --> 00:10:17,910 to, which I I'm glad you outlined, at 277 00:10:17,910 --> 00:10:20,070 least of it just being, able to understand 278 00:10:20,070 --> 00:10:22,070 all of this and understanding the contracts, right, 279 00:10:22,070 --> 00:10:23,509 that you started off with, which is so 280 00:10:23,509 --> 00:10:24,009 important. 281 00:10:24,389 --> 00:10:26,230 Tim, I wanna shift back to something that 282 00:10:26,230 --> 00:10:28,470 we started our conversation with, right, is we're 283 00:10:28,470 --> 00:10:31,284 in this environment that is vastly different than 284 00:10:31,284 --> 00:10:32,965 it was ten years ago. It's changing so 285 00:10:32,965 --> 00:10:35,365 much. There's so many different dynamics that are 286 00:10:35,365 --> 00:10:38,644 happening right now. How can ASC stay on 287 00:10:38,644 --> 00:10:42,164 top of factors impacting their financial performance right 288 00:10:42,164 --> 00:10:42,664 now? 289 00:10:43,549 --> 00:10:45,389 Yeah. Some of those factors are are really 290 00:10:45,389 --> 00:10:45,889 interesting, 291 00:10:46,429 --> 00:10:48,750 right now. Like implants and supplies, for instance, 292 00:10:48,750 --> 00:10:51,970 are up eight to 20% depending on specialties. 293 00:10:52,269 --> 00:10:53,329 Staffing and anesthesia, 294 00:10:54,110 --> 00:10:55,490 we see a lot of, 295 00:10:55,870 --> 00:10:58,514 this and and the Beckers updates on a 296 00:10:58,514 --> 00:10:59,335 daily basis. 297 00:10:59,714 --> 00:11:00,934 ASCs are really, 298 00:11:02,434 --> 00:11:02,934 feeling 299 00:11:03,315 --> 00:11:06,274 the highest wage pressure in industry right now 300 00:11:06,274 --> 00:11:07,894 with this anesthesia piece 301 00:11:08,514 --> 00:11:09,414 to ASCs. 302 00:11:10,355 --> 00:11:13,095 And it's really challenging for them navigating that. 303 00:11:13,539 --> 00:11:17,480 We're seeing technology and and compliance costs continue 304 00:11:17,620 --> 00:11:18,840 to to go up, 305 00:11:19,379 --> 00:11:21,559 and and ASCs can simply not afford, 306 00:11:22,580 --> 00:11:25,299 some a slow billing process or slow AR 307 00:11:25,299 --> 00:11:27,080 cycles with these increasing 308 00:11:27,855 --> 00:11:30,014 areas that are really going up. So, and 309 00:11:30,014 --> 00:11:32,355 then two, payers are slowing down on purpose. 310 00:11:32,894 --> 00:11:35,315 They're having more prior auth requirements, 311 00:11:35,695 --> 00:11:38,434 more clinical reviews, higher denial rates, 312 00:11:39,054 --> 00:11:42,095 and longer reconsideration and appeal cycles, which is 313 00:11:42,095 --> 00:11:43,154 making it really 314 00:11:43,830 --> 00:11:47,690 challenging for surgery centers to navigate those markets. 315 00:11:48,149 --> 00:11:50,710 So when we're looking at that, and also 316 00:11:50,710 --> 00:11:52,250 too competition is fierce. 317 00:11:53,190 --> 00:11:55,670 New surgeons are going to have their choices 318 00:11:55,670 --> 00:11:58,009 between surgery centers and what they're doing, 319 00:11:58,334 --> 00:12:01,534 looking at marketing, etcetera. So the the challenge 320 00:12:01,534 --> 00:12:03,294 to bring in top talent is there as 321 00:12:03,294 --> 00:12:06,254 well, and and so it's really this creating 322 00:12:06,254 --> 00:12:08,274 this kind of perfect storm for 323 00:12:08,894 --> 00:12:09,394 really, 324 00:12:10,200 --> 00:12:12,840 being able the ASCs that can navigate that 325 00:12:12,840 --> 00:12:14,679 in a better fashion and do it with 326 00:12:14,679 --> 00:12:17,660 data can can be more successful. So 327 00:12:18,279 --> 00:12:19,100 really accelerating 328 00:12:19,799 --> 00:12:22,460 your cash breaks this cycle before it harms 329 00:12:22,919 --> 00:12:26,105 your operation. So we want to make sure 330 00:12:26,105 --> 00:12:26,504 that, 331 00:12:27,545 --> 00:12:28,524 you're really 332 00:12:29,304 --> 00:12:31,545 looking at all the areas that are going 333 00:12:31,545 --> 00:12:35,144 to impact this. So we're looking at financial 334 00:12:35,144 --> 00:12:37,225 education for not just you, but your surgeons. 335 00:12:37,225 --> 00:12:39,144 So you wanna give feedback to those surgeons 336 00:12:39,144 --> 00:12:42,080 on case profitability and making sure they understand 337 00:12:42,080 --> 00:12:42,899 their costs 338 00:12:43,360 --> 00:12:45,940 and what, what we can do to streamline 339 00:12:46,000 --> 00:12:47,779 those cases to make them as profitable 340 00:12:48,320 --> 00:12:49,840 as they can be. You want to make 341 00:12:49,840 --> 00:12:52,320 sure that you're continually training your staff on 342 00:12:52,320 --> 00:12:54,799 documentation standards to prevent denials. A lot of 343 00:12:54,799 --> 00:12:56,544 that up front work comes from making sure 344 00:12:56,544 --> 00:12:58,164 that those folks at the front end 345 00:12:58,465 --> 00:12:59,284 are doing 346 00:12:59,745 --> 00:13:01,585 a good job and doing that in real 347 00:13:01,585 --> 00:13:03,184 time, not waiting for the end of the 348 00:13:03,184 --> 00:13:05,504 month. They're waiting for your data to come 349 00:13:05,504 --> 00:13:07,845 out, really making sure that you're 350 00:13:08,470 --> 00:13:10,470 jumping on that on a daily basis. And 351 00:13:10,470 --> 00:13:13,289 then two, leverage outsource expertise when needed. 352 00:13:13,830 --> 00:13:14,490 I think 353 00:13:15,110 --> 00:13:17,190 there's a lot of great resources out there 354 00:13:17,190 --> 00:13:19,210 from the front end piece to after 355 00:13:19,590 --> 00:13:22,169 the surgery is performed to understand 356 00:13:23,054 --> 00:13:26,674 how you can, utilize a specialized partner to 357 00:13:26,735 --> 00:13:28,335 to take that to the next level, whether 358 00:13:28,335 --> 00:13:30,115 that's a pre certification team, 359 00:13:30,654 --> 00:13:34,174 contract modeling as as Amanda's mentioned, and those 360 00:13:34,174 --> 00:13:35,794 contracts and being so important. 361 00:13:36,430 --> 00:13:38,750 Implant cost management services, there's a lot of 362 00:13:38,750 --> 00:13:40,750 groups out there that focus on that portion 363 00:13:40,750 --> 00:13:42,509 of your business now and can make that 364 00:13:42,509 --> 00:13:45,149 really successful for you. And then just maybe 365 00:13:45,149 --> 00:13:47,649 looking back and seeing you doing an audit 366 00:13:47,710 --> 00:13:48,850 and seeing where 367 00:13:49,225 --> 00:13:51,865 are the holes to increase the health of 368 00:13:51,865 --> 00:13:53,404 the revenue cycle. So, 369 00:13:54,184 --> 00:13:56,504 centers can have an opportunity to get access 370 00:13:56,504 --> 00:13:59,565 to a ton of expertise and technology that 371 00:13:59,705 --> 00:14:02,024 sometimes they can't just justify by doing it 372 00:14:02,024 --> 00:14:03,789 themselves. And there's a lot of that in 373 00:14:03,789 --> 00:14:05,870 this ASC space that can really take them 374 00:14:05,870 --> 00:14:06,850 to the next level. 375 00:14:07,470 --> 00:14:09,490 So really just making sure top ASCs 376 00:14:10,190 --> 00:14:12,909 really run those structured financial reviews that cover 377 00:14:12,909 --> 00:14:14,985 revenue cycle KPIs, payer trends, 378 00:14:15,464 --> 00:14:17,644 cash forecasting, case mix changes, 379 00:14:18,024 --> 00:14:20,845 your implant spend, your AR over ninety days, 380 00:14:21,384 --> 00:14:23,544 understanding your high risk denials, and then your 381 00:14:23,544 --> 00:14:26,204 underpayments. And so your problems are really identified 382 00:14:26,264 --> 00:14:29,404 early and those leaders stay proactive not reactive 383 00:14:29,464 --> 00:14:31,569 and can take their ASCs to the next 384 00:14:31,569 --> 00:14:32,069 level. 385 00:14:32,689 --> 00:14:34,470 And because this is so multifaceted, 386 00:14:34,850 --> 00:14:37,009 it's fantastic to have you both on because 387 00:14:37,009 --> 00:14:39,250 you bring both bring so much experience and 388 00:14:39,250 --> 00:14:40,149 so many different 389 00:14:40,610 --> 00:14:43,089 aspects to this conversation. I I wanna close 390 00:14:43,089 --> 00:14:43,829 this out 391 00:14:44,209 --> 00:14:44,709 with 392 00:14:45,575 --> 00:14:47,195 your best piece of advice 393 00:14:47,654 --> 00:14:48,475 for ASC 394 00:14:49,414 --> 00:14:49,914 navigating 395 00:14:50,455 --> 00:14:51,754 this uncertainty, 396 00:14:52,134 --> 00:14:54,535 this space, all of these channel challenges that 397 00:14:54,535 --> 00:14:56,315 we've highlighted throughout the conversation. 398 00:14:57,095 --> 00:14:59,299 Amanda, I'd love to start off with you 399 00:14:59,299 --> 00:15:01,779 here. What's your best piece of advice for 400 00:15:01,779 --> 00:15:02,279 ASCs 401 00:15:02,740 --> 00:15:06,419 navigating financial uncertainty right now? Yeah. I mean, 402 00:15:06,419 --> 00:15:08,679 I would say just focus on the fundamentals. 403 00:15:09,299 --> 00:15:12,039 When margins are tight, the little things matter. 404 00:15:12,634 --> 00:15:13,995 So you want to make sure your front 405 00:15:13,995 --> 00:15:16,735 end teams are supported and trained, that documentation 406 00:15:16,875 --> 00:15:17,535 is clean 407 00:15:18,075 --> 00:15:20,735 and authorizations are handled right the first time. 408 00:15:21,355 --> 00:15:24,235 When those things are solid, you're not just 409 00:15:24,235 --> 00:15:26,909 improving your cash flow, you're actually building confidence 410 00:15:26,970 --> 00:15:28,509 across your entire organization. 411 00:15:29,289 --> 00:15:30,970 So you can weather the noise because you 412 00:15:30,970 --> 00:15:32,589 know your processes are strong. Right? 413 00:15:32,889 --> 00:15:34,909 And don't be afraid to ask the ASC 414 00:15:34,970 --> 00:15:37,049 specific experts and listen to what they have 415 00:15:37,049 --> 00:15:37,709 to say. 416 00:15:38,089 --> 00:15:40,169 Anybody in this industry knows that it's very 417 00:15:40,169 --> 00:15:40,669 nuanced. 418 00:15:41,024 --> 00:15:41,684 It's different 419 00:15:42,144 --> 00:15:44,545 than HOPD. It's different than clinics. It's it's 420 00:15:44,545 --> 00:15:46,545 it's very different. Even if you've been in 421 00:15:46,545 --> 00:15:48,725 the industry for thirty plus years, it continues 422 00:15:48,785 --> 00:15:49,445 to change. 423 00:15:50,225 --> 00:15:52,144 So knowing that there are specialists for each 424 00:15:52,144 --> 00:15:53,605 step of the revenue cycle, 425 00:15:54,340 --> 00:15:56,740 as well as those who understand the payer 426 00:15:56,740 --> 00:15:59,080 landscape in a way that requires that dedicated 427 00:15:59,139 --> 00:16:00,679 attention to the way they operate, 428 00:16:01,460 --> 00:16:03,540 that's huge. So you wanna lean on your 429 00:16:03,540 --> 00:16:06,340 resources that may have additional expertise in any 430 00:16:06,340 --> 00:16:08,340 area you may be struggling with. And, you 431 00:16:08,340 --> 00:16:10,004 know, don't don't be afraid to ask those 432 00:16:10,004 --> 00:16:12,085 questions no matter how long you've been in 433 00:16:12,085 --> 00:16:12,745 the industry. 434 00:16:13,605 --> 00:16:16,024 Tim, what's your, piece of advice? 435 00:16:16,565 --> 00:16:18,725 I'd echo that too. I'd and I and 436 00:16:18,725 --> 00:16:21,144 I'd stay proactive as I've mentioned, not reactive. 437 00:16:21,720 --> 00:16:23,799 It's easy to feel like you're playing defense 438 00:16:23,799 --> 00:16:26,039 right now, but the ASCs that are thriving 439 00:16:26,039 --> 00:16:28,360 are the ones that stay curious about their 440 00:16:28,360 --> 00:16:29,579 numbers and data, and 441 00:16:29,959 --> 00:16:31,639 the ones that know their data are are 442 00:16:31,639 --> 00:16:33,320 the ones that are ahead. They're watching their 443 00:16:33,320 --> 00:16:35,865 denial patterns, their AR days, their payer mix, 444 00:16:36,424 --> 00:16:38,184 and they're acting on those insights in real 445 00:16:38,184 --> 00:16:38,684 time. 446 00:16:39,065 --> 00:16:41,245 When you treat your data like a conversation 447 00:16:41,464 --> 00:16:43,144 instead of a report, you can spot the 448 00:16:43,144 --> 00:16:45,325 small issues before they turn into big problems. 449 00:16:45,945 --> 00:16:48,264 And honestly, that's what separates the good from 450 00:16:48,264 --> 00:16:50,670 the great, Those who use that uncertainty as 451 00:16:50,670 --> 00:16:52,509 a cue to tighten up, to innovate, and 452 00:16:52,509 --> 00:16:55,389 really to lead with intention. So those are 453 00:16:55,389 --> 00:16:55,889 the 454 00:16:56,269 --> 00:16:57,570 the advice I would give. 455 00:16:58,110 --> 00:17:00,029 Amanda and Tim, it's so great to have 456 00:17:00,029 --> 00:17:01,549 you both. Thank you so much for being 457 00:17:01,549 --> 00:17:03,965 here today. This was awesome. Thank you, Angus. 458 00:17:04,345 --> 00:17:06,345 Yeah. Appreciate you having us. Thank you. Absolutely. 459 00:17:06,345 --> 00:17:07,865 And we also want to thank our podcast 460 00:17:07,865 --> 00:17:09,865 sponsor, Nimble Solutions. You can tune in to 461 00:17:09,865 --> 00:17:12,025 more podcasts from Becker's Healthcare by visiting our 462 00:17:12,025 --> 00:17:15,644 podcast page at beckershospitalreview.com.