This Week in Surgery Centers: Hilary Sondik – Key RCM Reports to Track in 2024

Hilary Sondik – Key RCM Reports to Track in 2024

There are thousands of reports your ASC could run – but what are the key reports you should be running to optimize your RCM processes and cash flow?

Hilary Sondik is the Executive Vice President of Operations at Surgical Notes, and today, she is breaking down the key RCM reports you should be reviewing daily, weekly, monthly, quarterly, and annually. The insights you extract from these reports will empower ASCs to make data-driven decisions, identify opportunities for revenue generation, and reinvest in their operations. Here’s a high-level overview of what we covered:

• Daily: Centers should focus on daily schedule checks, ensuring benefits verification and order placements. Also, tracking daily charges and reconciling them is crucial.

• Weekly: Centers should perform weekly billing reconciliations, assessing volumes of bills submitted, rejections, and reasons behind them. Regularly monitoring AR and its productivity is also essential.

• Monthly: It’s essential to examine the total AR balance, payments, adjustments, and financial class analysis monthly. Identifying trends in bad debt and aged accounts is crucial for sustained financial health.

• Quarterly: Over a quarter, cumulative data can highlight gradual increases or decreases in key areas like bad debt, aged accounts, and clean claim rates, providing insights for operational adjustments.

• Annual: Year-end is the time for revisiting contracts, reviewing your chargemaster, and reassessing pricing strategies. Analyzing year-over-year data helps in setting future goals and budget planning.

Find the full episode on Apple Podcasts, Spotify, or YouTube to hear all the details.

Episode Transcript

00:05.39
Surgical Notes / Hilary Sondik
Okay, thank you I’m excited to be here today.

00:13.64
Surgical Notes / Hilary Sondik
Yeah, absolutely so my name is Hilary Sondik and I’ve been in the healthcare care revenue cycle field for over twenty years started out actually in the healthcare care legal field and moved into operations of revenue cycle been in all aspects front middle back. Um. Um, the hospital side and most recently certainly on the ASC side specifically and been both a vendor and in-house so kind of have ah a variety of perspectives if you will good.

00:42.20
HST Pathways / Erica Palmer
Good that always helps. Um so surgical notes recently released a report on next generation ASC analytics in action which I’m excited to dive into with you today. What was the inspiration behind this report.

00:57.10
Surgical Notes / Hilary Sondik
So I think a couple different things. Certainly we as a company have spent a lot of our time and resources developing our own analytics right? And so both to drive our workflow and to help monitor and track performance of our clients. And help them in turn make business decisions and so I think it’s seen kind of what we create it but then on the flip side as we’ve onboarded new clients really seen a gap in this and seeing that centers you know often don’t have robust or even. Even some minimal kind of metrics around their revenue cycle understandably so right? you know an Asc has a lot to focus on just working on their clinical operations and so I think it was the the flip side of just what else we can share um with centers around. Why it’s important to track your performance and how you can do that so I’m excited to be able to dive a little deeper into what we focus on and how maybe looking at this can help a center make decisions.

02:08.10
HST Pathways / Erica Palmer
Yeah I think that’s great. It’s one of the questions we get um all the time as well. Is you know what reports come standard but then also what other reports should I be running and how often and where do I start.

02:22.32
Surgical Notes / Hilary Sondik
Well and I think you know a center is often looking at a lot of reporting already right? But they’re looking at their case Mix. They’re trying to understand um their staffing and so reports in general are not something that would be foreign to them. But I think really focusing in when we’re talking about reporting. On revenue cycle right on your daily cash on your charges your build your unbuild all these things it it can become very overwhelming and there are a lot of parts to it. Um, and so then it becomes an issue of well like who can do that here who who has that expertise who has the resources to spend and so it’s understandable. Why sometimes that often doesn’t happen. Um, again I go back to a lot of what is the bread and butter of a center and it’s their.

02:54.35
HST Pathways / Erica Palmer
Is is.

03:09.70
Surgical Notes / Hilary Sondik
Focusing on their operations which is their clinical care as it should be so again hopefully looking at some of this will be helpful and so before you get to kind of that end game of like what you know KPI should we be monitoring I like to start back kind of at the beginning of like on a daily basis. What could and should we be looking at um to ensure that we’ve kind of got our our finger on the pulse. Um, and so when I think of kind of daily metrics right? What how do we know day in and day out. We’re doing what we should be doing well number one is are you looking at your schedule and when. You’re looking at your schedule. It’s not just about who’s coming in and what time and having the or rooms prep you know, certainly that’s a piece of it. But it’s who’s scheduled are the benefits verified are the Austin place and of those who is maybe not coming right? Who’s already canceled and kind of understanding.

04:01.24
HST Pathways / Erica Palmer
Yeah here.

04:06.40
Surgical Notes / Hilary Sondik
Of your whole group. Let’s say you’re supposed to have 50 visits today. Oh but you actually only have thirty that showed up why is that right? and are there things in that that you can learn from from a business perspective to help you and so again I say you know that’s a daily reconciliation of. What had we scheduled and who canceled and why and often we find some of the reasons for the cancellations could have been prevented and that’s what we’re looking for right? How do you use these metrics and what you’re looking at to help your business and so if you don’t have canceled cases then you haven’t spent resources and time and opened up. Um, supplies and have rooms prepped when you don’t need to ah so it’s it’s something that can be simple and you can create a process you know to do but you do have to do that kind of on a daily basis same thing with you know, then at the end of the day. Did you get all your charges in. So everything you did do are you going to be able to charge for it and make sure you have those charges on that account right? So that when it goes out. It’s going to be coded and built. Um, so again, these sound like pretty simple things but you would be surprised at just you know. And things that get overlooked right in the course of a day. Um, and so I think if you were to kind of make ah a stop chart for yourself on on a daily basis. It would be scheduled daily charges and then daily banking right? making sure you’re pulling in your daily cash and reconciling that to ensure hey yeah.

05:34.82
Surgical Notes / Hilary Sondik
This is what got deposit in my bank today and these are the remits we have to post against it. What’s missing you know again, it’s filling in those blanks of what happens every day but what are we missing from the day that we should have had is the easiest way I can explain it.

05:50.30
HST Pathways / Erica Palmer
Yeah, no that I think that makes a ton of sense and you know starting the day with the schedule and ending with the charges and and claims I think that makes perfect sense and I love the way you guys? um, have also broken this out by frequency because I think. That makes it kind of a very straightforward checklist where people can go through and say okay every day I’m doing this every week I’m doing this? Um, Okay so those are the 3 reports. We’re looking at.

06:11.49
Surgical Notes / Hilary Sondik
It if it builds on each other you know I was gonna say it just kind of builds on each other right? If you’re doing that every day then come at the end of the week when you’re reconciling your bank statement for that week it’s it’s pretty easy because you’ve already done the legwork of finding the missing remits from. Wednesday and Thursday right? and um so I think I think those are those are helpful helpful tools

06:38.70
HST Pathways / Erica Palmer
Yeah, and no no pit when you start running that weekly report of I don’t know what I’m going to find because you’ve been monitoring it every day. Um.

06:43.80
Surgical Notes / Hilary Sondik
Right? right? You been monitoring it exactly and then when you start talking about weekly. There’s some other ones we’d add in right? So maybe you every every day you’re not looking at your um. Billing reconciliation. But for the week you’re looking okay for the volumes of this week what bills did I submit at the end of the week which ones what got submitted what rejected when I submit it like didn’t go through word accept it. Why is that how can we fix that right? because the idea is the cleaner. The process. Quicker the cash comes in so tracking your volumes of Bill Submitted number of rejections that you know we consider that like a weekly billing reconciliation. Um, so I think that’s a key if we move from daily to weekly. That’s a key weekly um reconciliation to do. Along with your weekly banking which again builds from that daily you’re doing so that really shouldn’t be that time consuming and then moving on to kind of your weekly reporting for your AR and this is you know, really a combination of how are you managing. The team that’s working your ar. Maybe it’s one person. Maybe it’s 3 you know, but in this but the important piece is an AR your account’s receivable is something that you do have to have your finger on the pulse and since it’s typically people that are.

08:08.31
Surgical Notes / Hilary Sondik
Making the calls to insurance that are working on accounts to say. Okay, why didn’t this get paid. Why is this hung up. Oh I got to you know what? documents is the insurance company asking for on this one, you really need to know what that staff is doing on a daily basis and have some type of workflow that you’re directing them on. And so when we talk about weekly reporting on the ar. It’s definitely looking at your accounts, but it’s also the people doing it so productivity right? Like what is the workflow that they’re going to be doing so you know again every week. What accounts are getting touched and worked on to drive cash into your center. Versus what should be worked on the next week and so forth so that’s a little bit more of a a people and a process measurement. Um, as opposed to just measuring. You know the outcomes. But um I think that’s a really key piece and again I say whether you have one person. Or you know a team that are are working the ar it’s important that um you measure their their work product and have guiderails for their productivity. So at the end of the month you see success in your ar.

09:12.58
HST Pathways / Erica Palmer
Sure and you’ve mentioned people who ideally should be kind of managing this or or looking at these reports.

09:23.45
Surgical Notes / Hilary Sondik
Yeah, and that’s a great question because you know I I do realize all centers are not the same. We always talk about how every new center we get. It’s It’s all unique, right? and a lot of that goes to the size and so can you put somebody who is what we would call like a business office manager. Overseeing your your your business office. That’s your schedule your front end your eligibility your ah banking and your cash collections. Well as well as your AR follow up and. You know for those centers that can that’s huge and then that’s the person that would be the key person I would say that would be overseeing all of these reporting requirements but sometimes centers are smaller and they’ve kind of got you know a jack of all trade trying to check people in and then in between call insurance and and that’s when it does you know, get more challenging and.

09:54.41
HST Pathways / Erica Palmer
Is he.

10:13.27
Surgical Notes / Hilary Sondik
And I understand that I would say the person who is responsible for communicating to the administrator around these specific revenue. Cycle functions is really who should be kind of watching this and it’s the administrator then who should be saying okay every day I should kind of get this data. You know? um. Every day I get you know how many patients we had scheduled how many showed up every week I’m going to see how many bills we submitted how many rejects we got and so Forth. So I think um, again, those are just some guide rails to think about.

10:44.90
HST Pathways / Erica Palmer
Yeah, that’s helpful and of course cross training too. We’re always trying to promote that as you know yes, there might be 1 person who does it all usually. But in case that person wins a lottery. We need a a backup.

10:53.38
Surgical Notes / Hilary Sondik
Right. Got to have a backup plan right? always have to have a backup point and and with that goes documenting your processes. Yeah.

11:03.67
HST Pathways / Erica Palmer
Yes, all right? Let’s switch to yes that’s an excellent excellent point as well. Let’s switch to monthly what are we running on a monthly. Um and you could blend quarterly in with that as well. If it makes sense.

11:18.13
Surgical Notes / Hilary Sondik
Yeah, so I think monthly some of it’s similar right? You want to see all your payments for the month you want to see also all the claims you submitted so all the bills for the month your your total case volume for the month but when we start talking about monthly. You also want to understand all those payments you got what adjustments did you have to take and these could be contractual adjustments. These could be other Maybe you have um, self-paid discount policy you provide but what adjustments again because that should be something that again month over month. You should be seeing. Um, kind of steady and if you have an uptick or a downtick that would be a cause to say hm I wonder what’s happening what’s driving this increase or decrease and that’s really the key with whatever you’re measuring monthly is that you develop this month over month view right. Because that’s how you’re going to understand your center’s performance and really get insight into you know what is happening? Do you have seasonality in your visits or in your payments. Do you have different docs doing different types of procedures at different times of the year or again monitoring your docks.

12:29.80
Surgical Notes / Hilary Sondik
Ah, pto kind of request and kind of seen and you’d be surprised that once you start putting these metrics week over week month over month and then eventually year over year what you can learn from it and then how you can really leverage your operations to address. Things that you could have control over that. Maybe you previously didn’t think you did because you actually just didn’t know what was happening right? because you weren’t looking at that data. Um some other key things when we start looking at it month over month and as on the monthly basis is you want to be able to see your total ar balance right? so. Um, compare is that going up or down are you actually collecting or does it just keep growing and unfortunately aging which is never a good thing so knowing what your total ar balance is at the end of the month is definitely a key as well as looking at your ar by financial class. Seen are you seeing a growth in a certain payer or unfortunately you know are you seeing a growth in like self-pay and why is that and you know again, how might you be able to address that um, that’s something that is really important because again depending on your the contracts you may or may not have. It’s going to drive a lot of what how you’re getting reimbursed and that’s kind of a must something you need to know and and understand um and then from there you could actually take and and say okay so what are my ar days. What is like what is my monthly cash. Should we start setting up.

14:01.30
Surgical Notes / Hilary Sondik
Kpis right? to like teach our staff to say okay, we want to try to drive. We’re we’ve been collecting over. Let’s say the last six months an average of 300000 and so we certainly don’t want to go below that. But what. What? what? if we set a metric to say like let’s target getting to three fifty how are we going to get that $50000 extra is that something that’s sitting out on our ar that we could just work to to drive in is that meaning we’ve got to add more case volumes and can we do that and how many could we add. It starts to open up a lot of of you know questions and thoughts of like again how to manage your business and how to drive more revenue into your center. Um, and so for me I think even if you just picked a few metrics. It’s like establishing those and being diligent of doing those like I said daily weekly monthly and then month over month because it’s once you start developing that pattern that’s going to give you the insight that we’re looking for.

14:58.20
HST Pathways / Erica Palmer
Yes, yep, that makes sense and what about quarterly what should we be doing quarterly.

15:05.58
Surgical Notes / Hilary Sondik
So you know I think the month over month is still something you’re looking at quarterly. But then I think as a quarterly you’re adding in even even more things you’re looking at what was your bad debt. You know month over month. Maybe it’s not sticking out as much. But once you look at it quarterly.

15:22.62
HST Pathways / Erica Palmer
Um, it is.

15:24.33
Surgical Notes / Hilary Sondik
And you’re starting to say well wait a minute if we want to finish the year strong. We’ve got to really tackle this denial issue because we can’t We cannot continue to have this drive up our you know our bad debt reserves or our denial rate.

15:29.92
HST Pathways / Erica Palmer
This is.

15:39.73
Surgical Notes / Hilary Sondik
We see. It’s climbing. You know so sometimes in a single month. It may not stand out but when you see it month over month. It’s for a quarter or for two quarters it’s like okay this is not going away. In fact, it’s growing and maybe it’s only growing slightly but the growth we can’t sustain if it continues to do this for another quarter. So. Again, it’s it’s like I said it’s bad debt. It’s looking at payments over ninety. So your aged accounts out there. How much of that are you driving in again. It’s a way to set a goal and say hey we want to attack this aging ar we want to get this money in and looking at that and figuring out ways to improve upon that. Um, so I think. While all of them are ripe for that. It’s it’s really looking at the ones that take more time to effectuate change that you want to be able to make sure slight increases don’t look so bad. But when you look at them over a quarter. Um, they can be significant um another another piece of this is also. Not to forget in your billing world. We’re talking a lot about ar but is your clean claim rate right? like again if we want to get claims going out to get cash in the cleaner. The claim that’s going out so that goes back like I was saying you know you’re looking at your weekly build. What rejects are there and then kind of building on that. But if you build up your clean claim rate quarter a recorder you may ah you may see hey we get a lot of rejects the first quarter of the year well you know maybe we’re not doing a good job checking verifying benefits because people’s you know insurance tends to change. Did we just kind of assume because they had been here. Maybe this.

17:12.39
Surgical Notes / Hilary Sondik
You know the last week of December we’re like oh we don’t need to check this again. Policies or practices you have that? Maybe you’d want to change because of what the data is telling you so you know a lot of this I think it can be overwhelming if you’re like thinking of all these things I’m rattling off. But if you like I said if you really pick a few key things. Um, and focus in on them and work on those until you see some success and then maybe add in others. Um I think that’s that’s important as well. Not to try to take the whole animal and have 15 different things. You’re looking at right focus in on. Maybe your top 5 and again I could say those would be kind of your measuring your total ar balance your total cash your knowing by financial class where your ar is what your monthly payments are in your adjustments and kind of keeping it simple and then after you have two quarters of that adding in maybe some more if it if it feels overwhelming because the worst thing you want to do is just capture data but not be able to act on it. You know, then it’s just kind of you have it but nothing’s happening with it. It’s not It’s not being helpful. Um, so I think that’s important too.

18:24.14
HST Pathways / Erica Palmer
Yeah, totally and I think ah because obviously you know we try to use data in a different way but all the time you know and every facet of our lives are at least work lives and it can be something. That’s a little intimidating to start with.

18:24.43
Surgical Notes / Hilary Sondik
To not overwhelm your settle.

18:31.92
Surgical Notes / Hilary Sondik
I Read the one.

18:40.43
HST Pathways / Erica Palmer
But once you get the ball rolling. It’s such a relief to actually have the data to rely on. Um, you know if someone in the governing body or board or doctor comes to you and they’re like why is XY and z happening to know you can actually turn to your data and reports to find the answer is um.

18:42.97
Surgical Notes / Hilary Sondik
The home.

18:58.58
HST Pathways / Erica Palmer
Very calming and very helpful. So I think all of that is is really great advice. Um, what a.

19:06.62
Surgical Notes / Hilary Sondik
And I think some people also tend um to think oh I’ve got to have some big fancy system right? or I have to have something if you just look at your patient accounting system the one you’re using right? The data you have in there.

19:11.46
HST Pathways / Erica Palmer
The earth.

19:23.00
Surgical Notes / Hilary Sondik
Not only do they have some basic reporting that can help you with this but you can extract a lot into excel to manipulate and take it from there. So I don’t want people to also think oh we have to go and invest a lot of capital in some type of analytics system right? You can start with typically. What you have in your fingertips and and move it on from there if you know what you want to look on look at and what you want to focus on.

19:48.86
HST Pathways / Erica Palmer
Great advice all right. This feels pertinent considering we’re nearing the end of the year but what reports should um, our admins run on an annual basis.

19:52.10
Surgical Notes / Hilary Sondik
Oh.

19:59.51
Surgical Notes / Hilary Sondik
Yeah, so I think again, you would continue to build on all the ones we’ve talked about I think when we talk about year n we’re really talking about. Okay, we’re closing out the year we’re going to start a new one. What are the changes. We anticipate a lot of times the big lifts here come to. Pricing come to your charge master right? and so you really want to be focusing in on. Are you tracking any the last time you did your pricing updates. You really should be looking at doing those kind of once a year and maybe there’s certain new procedures. You’re going to. You’re thinking of doing you want to make sure you have those right? Um, also you could do running Yearend reports to see how some of your highest volume procedures have been performing and been reimbursed and understanding. Okay is this you know. Ah, profitable business line for us. Could it be more profitable and again these are just ideas and things to look at these are areas that we often overlook because we think oh we’re doing this procedure. We’ve got these facts. You know we get paid for them. Great. You know what’s new. What’s different but sometimes it’s just exactly what you’re doing. Are you leveraging as much as you can from it and often you know we see clients that have haven’t renegotiated their contracts in a number of years with payers even though.

21:22.71
Surgical Notes / Hilary Sondik
Things have changed circumstances have changed so that’s another piece is knowing what contracts you do have in place when they were created. What were the terms of those and saying you know, maybe it’s time in this new year that we open this up and revisit a few of these things because maybe now we have a different. Different docs different machines. You know there’s so many different things that can come into play and so I really feel strongly that year end should be focused on contracts review annually charge master review pricing and again by tracking these metrics. You’ll be able to understand. How you’re doing in these different procedures and how you’re being reimbursed. Um, so that’s I think when we start comparing. Lastly I think it’s just once you track these monthly that we’re talking about monthly quarterly you then have that for the year and so it’s continuing to do that so you have a year over year baseline right and you can actually set goals to say okay, this is how we did this year this is kind of our um percent of AR that’s been over ninety. We want to reduce that in the next coming year. What plans can be put in place to do that or you know we know we’re not going to hit this cash goal. Our pricing changed. No longer get paid for this service. We’re going to have to eat that you knowt cetera so all right? So where can we make that up or how are we going to make that up or what are we going to do differently so I think it can be a very good exercise for centers to kind of take their month over month data

22:55.94
Surgical Notes / Hilary Sondik
After a year and really kind of try to use it to say how we get a budget and plan for the upcoming year. You know that was a lot.

23:02.60
HST Pathways / Erica Palmer
Yeah, sure, No, it’s all it’s all good. What? um so let’s say they start small but everyone’s ramping up by doing all of the above. What what benefits will this have to your revenue cycle management.

23:11.82
Surgical Notes / Hilary Sondik
And.

23:20.50
HST Pathways / Erica Palmer
Ah, performance.

23:21.13
Surgical Notes / Hilary Sondik
So I again I think the biggest thing is if you don’t measure something we’ve all heard this like how do you know? how you’re doing right? If You’re not able to measure it so by measuring it. You know where your strengths are where your weaknesses are where your are your opportunities. To gain more cash to make more revenue that only gives you more opportunity to reinvest in your center right to buy the next machine you want or whatnot. Um, and so again I think it’s. The power of data and having it is that you can make decisions based on data and not just based on what you think what you feel but it’s very it’s you know it’s going to demonstrate to you How you’ve actually performed over the year and what’s working what’s not and where those opportunities are so. I Think that is the biggest weapon you can have in your toolbox in terms of making business decisions for your center is to have your revenue cycle data measured over time.

24:22.21
HST Pathways / Erica Palmer
Perfect all right Hilary last question we do this every week with our guests. What is 1 thing our listeners can do this week to improve their surgery centers.

24:35.18
Surgical Notes / Hilary Sondik
So I think 1 thing we haven’t talked about that I’m also a big believer in is looking at your supply costs and typically we have modules that can do this for us so you bought hst. It has an you know an implant inventory module. For example. You can measure and under and have sightline into what you paid for an implant what you were able to charge for what you got reimbursed I think looking at something like that in in doing that. Um, if you’re not already doing that will open up a lot of insights to you to determine. Again, are you using the most cost effective type of implant or supply. Um, and that’s that’s key because that can really determine. Maybe there’s something else you could use that’s different. Um, there’s a lot that goes into this I understand with physician preferences and whatnot. But I think it’s very important I’ve seen a lot of centers be able to make a lot of great progress being being able to track what they paid for what they got reimbursed and understanding that. Ah, delta if there is one so I’ll leave you with that.

25:43.58
HST Pathways / Erica Palmer
That is great advice. Thank you so much for coming on Hilary we appreciate it.

25:50.62
Surgical Notes / Hilary Sondik
Thank you! This has been fun.