Learn how to identify and improve your ambulatory surgery center's revenue cycle management efforts and cash flow in this column from Caryl Serbin of Serbin Medical Billing for ASCA's ASC Focus magazine.

1. THE ASCA JOURNAL | JUNE/JULY 2020 | ascfocus.org
STAYING CURRENT
with ANSI/AAMI ST79
What ASCs need to know
FDA UPDATES EXTENDED
USE DRUGS LIST TO MEET
COVID-19 DEMANDS
JOINING FORCES AGAINST
COVID-19 PANDEMIC
GREEN YOUR OR
EMBRACE CHANGE
COVID-19SEE PAGES 6,
14 AND 16

2. 22 ASC FOCUS JUNE/JULY 2020 |ascfocus.org
DOING BUSINESS
The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.
monthly comparison of case totals;
CPT codes per case; write-offs and
refunds; and the average number of
days it takes to receive reimburse-
ment (i.e., days in A/R). The amount
of data examined and the multiple
manipulations of this data available
make this report one of the most use-
ful for gauging revenue cycle per-
formance. Since the A/R summary
report can effectively display data
in multiple ways, it is a great tool to
pinpoint where revenue leaks occur.
The “aging by payer” report provides
important payer-related information. It
measures this data by total balance owed
by each payer and allocates payer bal-
ances into 30-, 60-, 90- and over 150-
day groups. This information also is
compared to previous months to identify
outstanding payer balances according
to age. Such comparisons support faster
recognition of slower payer reimburse-
ment trends and identification of staff
performance shortcomings.
Two reports that identify A/R
fluctuations caused by case mix are
“volume by payer” and “volume by
specialty.” These reports can iden-
tify reasons why collections are
declining while the center’s caseload
remains unchanged. The volume by
payer report illustrates each payer’s
percentage of your caseload. Volume
by specialty provides an overview
of each specialty’s percentage of
the caseload.
Learning from and Acting
on the Data
Understanding the data provided by
these reports and converting it to
practical use is an important part of
the EOM process.
The A/R summary report identi-
fies possibilities for total A/R varia-
tions, which can point to additional
Maximize the Value of End-of-Month Reports
Identify and improve your center’s revenue cycle management efforts and cash flow
BY CARYL SERBIN
YourASC’s end-of-month
(EOM) reports serve mul-
tiple purposes. They help
your accountant with tax
purposes and your ASC’s
governing body in understanding the
center’s performance. These reports
also could be used to improve the effi-
ciency of your revenue cycle manage-
ment (RCM) team and cash flow.
These reports can play an impor-
tant role in identifying billing and
payer trends and problems, providing
your RCM team with vital information
to stem negative effects on the reve-
nue stream. Many ASCs, however, fail
to use their EOM reports to evaluate
more than accounts receivable (A/R).
While the aging of A/R is essential in
assessing financial health, it is not the
only important information to glean
from appropriate EOM reports. These
reports can pinpoint weak areas in staff
performance and be used to measure
revenue cycle functions through reg-
ular auditing, which is an often-over-
looked management task.
Areas of Focus
When exploring the many EOM
reports available to your ASC via its
software, the following are notewor-
thy for helping identify areas needing
further examination. Please note that
report names might vary by software.
The “A/R summary” report, roll-
ing on a 12-month basis, provides
vital A/R-related information, such
as growth or decrease in total A/R
over a specified period. It also breaks
this information down into other crit-
ical measures. These include charges
and collections per case; gross and
net collections; net revenue per day;
Reprinted with permission from the Ambulatory Surgery Center Association.

3. ASC FOCUS JUNE/JULY 2020 |ascfocus.org 23
DOING BUSINESS
in number of codes per case indi-
cate the need for a coding audit and
coder education.
■ A decrease in gross or net col-
lections causes an increased A/R
total. This might indicate payer
trends in claim processing or poor
collector productivity. If investiga-
tion of payer trends—payer aging
report—fails to identify backlogs
in claim processing, perform a col-
lection audit, concentrating on out-
standing claims over 90 days to
determine timeliness of collection
efforts. Audit results might signify
a need for an improved tickler sys-
tem, provision of appropriate aged
A/R reports to collectors and/or
additional collector education.
■ An obvious increase in monthly
patient refund amount might reveal
an upfront collections issue. Audit
the timeliness and adequacy of
insurance verification, patient
financial counseling and/or up-
front collections processes. Share
the results with staff.
An increase in payer refunds might
indicate an issue with posting third-
party payer reimbursements. Deter-
mining whether to audit the charge
posting or payment posting process
depends on whether write-offs are
completed at the time of billing or
reimbursement. The payment post-
ing audit should include examina-
tion of the number, dollar amount and
reason(s) for write-offs. The aging
by payer report measures total A/R
by sorting the total balance due into
separate buckets by payer and age of
the account(s). To determine patient
balance amount, separate patient and
third-party payer A/R. If the majority
of over 90 days is patient balances,
audit upfront collection policies and
procedures, including those for pay-
ment plans, patient statements and
bad debt. Share the findings with staff
to determine any need for changes
in policies and procedures and/or
additional education.
ENDOSCOPY SUPPORT PRODUCTS
ENVIRON-MATE
®
DM6000 SERIES
CALL US BEFORE YOU BUILD 800-201-3060OR REMODEL!
DM6000
Utility/SPD
DM6000-2
Endoscopy
No
more
canisters!
reports that might reveal the exact
cause(s). Run the physician utiliza-
tion report to identify a decrease in
caseload by specific provider(s) and
determine if it is an ongoing trend.
Intermittent or single-month case-
load decrease might mean the pro-
vider is on vacation. If the caseload
decline trends over several succeed-
ing months, the provider might be
performing cases elsewhere. Contact
the provider to ascertain the reason
for this decrease.
The following examples demon-
strate how RCM functions can impact
the results of A/R as a measurement
of your ASC’s performance:
■ AchangeinthenumberofCPTcodes
assigned to each case might indicate
a need to investigate whether the
center’s specialty mix has changed
(volume by specialty report). If no
significant change is detected, inves-
tigate your coding process.
■ A decrease in CPTs per case might
be the result of erroneous bundling
of procedures by an inexperienced
coder. Conversely, inappropriate
unbundling of procedure codes can
increase CPTs per case. Signifi-
cant and continuing fluctuations
Reprinted with permission from the Ambulatory Surgery Center Association.

4. 26 ASC FOCUS JUNE/JULY 2020 |ascfocus.org
The volume by payer report, or
payer mix, might identify an increased
number of cases from a lower-pay-
ing payer and decreased caseload
from higher-reimbursing payers. If a
substantial decrease is found in the
amount of cases from a specific payer,
contact the payer representative to
determine the reason(s). Payer mix
variables might cause the following:
1. decreased total A/R due to cases
with lower reimbursement/higher
write-offs—e.g., Medicaid—re-
placing higher reimbursing pri-
vate payer cases;
2. increased aged A/R due to an in-
crease in slow-paying cases, e.g.,
workers’ compensation, liability,
out-of-network; and
3. decreased A/R due to a de-
crease in caseload from a high-
reimbursement payer. Follow up
with the appropriate provider or
payer to ascertain reason(s) for a
change in case mix.
The volume by specialty report
reveals how changes in caseload by
specialty might causeA/R fluctuations.
If there is no appreciable decrease in
total cases, review the case mix by
specialty report. If a significant drop
is detected in the number of cases per-
formed by a high-volume orthopedic
surgeon, and your scheduler is filling
open schedule blocks with gastroenter-
ology cases, this will cause a dramatic
decrease in your total A/R and cash
flow. Contact the orthopedic surgeon
to identify the reason for the decreased
caseload. If you determine that you
will permanently lose the cases, mar-
ket to other high-volume, high-reim-
bursement providers.
Prioritizing EOM Reports
EOM reports provide valuable informa-
tion that can help identify and improve
your center’s RCM efforts. Research all
applicable reports available in your soft-
ware to identify those reports that pro-
vide insight into your specific revenue
stream challenges. Once identified,
review these reports on an ongoing basis
to determine if auditing and staff edu-
cation efforts result in positive changes
in your ASC’s financial health.
Caryl Serbin, RN, is president and
founder of Serbin Medical Billing in
Fort Myers, Florida. Write her at caryl@
serbinmedicalbilling.com.
DOING BUSINESS
Reprinted with permission from the Ambulatory Surgery Center Association.