RCM Keeps Cash Flowing For Surgery Center

By Katie Wike, Contributing Writer

When the staff at Carolina Center for Specialty Surgery found themselves at the mercy of their revenue cycle management (RCM) software, they decided it was time for an upgrade — this time to a technology with the speed and support they needed.

Opened in 2006, Carolina Center for Specialty Surgery is an ambulatory surgery center that predominantly performs neurosurgical spine procedures and also offers pain management procedures. Approximately 20 to 30 credentialed physicians (e.g., orthopedic physicians, podiatrists, urologists, and OB/GYNs) regularly practice at the Charlotte, NC, facility.

With that many physicians practicing under one roof, billing was difficult enough without the staff wrestling with the technology needed to pay the bills. Claims are submitted electronically to a clearinghouse, where they are “scrubbed” or checked for errors before the clearinghouse is able to forward the claim to the specified payor through HIPAA-secure lines. Having a technology that easily connects the facility to the clearinghouse and then the payor is essential for keeping out of the red.

But the center’s previous technology lacked support the staff needed to process claims. For example, when claims were rejected, the software provided little explanation of the problem. The staff also wanted a faster way to search past claims and compare an account in the Practice Management System to the old clearinghouse. Although this technology and process were working, Business Office Manager, Sarah Moffat recognized that improvements could be made, and she started to research a new solution.

Finding A New RCM Solution
Moffat learned the center’s current information management solution, AMKAI Enterprise (AMKAI Office and AMKAI Charts), had a recommended RCM (revenue cycle management) partner — ZirMed — that serves nearly 200,000 physicians. After some additional research into other providers, the facility ultimately adopted ZirMed in June 2012. “I didn’t have to do anything except let them know who our biggest payors are and sign off on paperwork and give our facility billing information. I was really pleased that I didn’t have to deal with any of the insurance companies myself,” said Moffat.

ZirMed also was able to test claims submissions. Staff could upload a batch of test claims and see if they were accepted. If not, the program could provide reasons as to why the claim didn’t pass the test.

Automatic Billing And Claims Guidance Satisfy Both Patient And Provider
According to Moffat, the ZirMed software offers navigation tabs that help users find what they are searching for with just one or two mouse clicks. The program opens to a dashboard, and if there are any remittance problems, users will receive an alert on the dashboard. Also, it instantly tells the user if there is a need to do any payor and provider name-matching in order for claims to be processed appropriately. It also alerts users to any claim warnings or rejections that require attention.

Another feature Moffat praises is guidance for fixing rejected claims. When claims are rejected, there is an option users can click on that will tell them exactly why the claim was rejected and how to fix it. “In layman’s terms, it explains how to make sure the claim is not rejected again. It shows us how to fix it ourselves or we can defer to the program’s dashboard,” she explains.

After the installation, staff noticed the new system saving them time. “It drastically decreased the amount of time we used to spend working in the clearinghouse. For example, a claims rejection now takes 1 to 2 minutes to correct, whereas it used to take us upwards of 45 minutes to complete,” says Moffat. “It has greatly improved our ability to spend time on other things.” The staff now has more time to work on AR follow-up on claims that had been submitted in the past. They can take more time to speak with patients on the phone or to call insurance carriers to check on the status of a claim.

Carolina Center for Specialty Surgery calls its patients to explain what will be covered by insurance and what they should expect to pay out of pocket. “Health is one thing; finances are another. We like to make sure they’re wellinformed on both aspects,” says Moffat. “Patients nowadays have higher and higher deductibles. It’s getting difficult for some patients to justify having a surgery knowing how much money they’re going to be responsible for.” The advantage of having ZirMed in this situation is the ZPay option. Using ZPay, patients can pay their bills online any time, and they can even set up aut omati c payments. Moffat says patients have been very receptive to this feature. And because payments are being made online, the center can post them within a day of when they are received.

Mailing bills to patients is easier now, too. The Print Services option in ZirMed allows staff to upload a file with patient names, addresses, and account balances and automatically mail statements to patients. Previously, the center did all the printing of statements. “We would have to buy our own statement paper, and we would have to make sure those statements were printed on a special printer. Then we would have the USPS fold the statements into the envelopes and mail them to the patients,” Moffat explains. “One of my staff who was responsible for statements said her 30- or 45-minute process has probably been dwindled down to about 5 or 10 minutes with the new system.”

When it comes to coding and the upcoming transition to ICD-10, Moffat says ZirMed is helping the center stay ahead of the game. The coding tools have been a helpful earlylearning tool for the coder at the center. She is able to test coding claims in the ICD-10 format and practice claims submissions.