Angela Mattioda – Ensuring Profitability by Verifying Eligibility | This Week in Surgery Centers
Here’s what to expect on this week’s episode. 🎙️
If you perform surgery without properly verifying the patient’s eligibility, your hopes for reimbursement or revenue are dead in the water.
But the process of eligibility verification has a lot of moving parts:
• Does the patient have active insurance?
• Does the patient’s insurance cover the surgery?
• Did the insurance company verify the patient’s eligibility and coverage?
• Did you verify the patient’s identity?
• Is prior authorization needed? If yes, has it been obtained?
• And the list goes on.
Angela Mattioda is the SVP of RCM Solutions & Client Experience at Surgical Notes, and she is an RCM expert for the ASC industry. Angela sees firsthand the current processes and struggles that the industry has with the entire eligibility verification process. Today she’s sharing common challenges, technology’s role, tips for avoiding revenue loss, and more. A few highlights:
⭐ Proper verification will help with case costing and upfront collections
⭐ Automation is available, and your practice management software should interface with clearinghouses
⭐ You should be rechecking benefits on the DOS to avoid under or over-charging
⭐ Work closely with referring physicians to streamline the prior authorization process
Find the full episode on Apple Podcasts, Spotify, or YouTube to hear all the details.
Episode Transcript
0:00
welcome to this week in surgery centers
0:03
if you’re in the ASC industry then
0:06
you’re in the right place every week
0:08
we’ll start the episode off by sharing
0:10
an interesting conversation we had with
0:11
our featured guests and then we’ll close
0:13
the episode by recapping the latest news
0:15
impacting surgery centers we’re excited
0:18
to share with you what we have so let’s
0:20
get started and see what the industry’s
0:22
been up to
0:23
[Music]
0:27
hi everyone here’s what you can expect
0:30
on today’s episode Angela matiota is the
0:33
senior vice president of RCM Solutions
0:36
at surgical notes and we caught up with
0:38
her to talk all about the role
0:40
eligibility verification plays in
0:42
ensuring profitability during our
0:45
discussion with Angela we dive into
0:46
common challenges the role technology
0:48
plays authorizations avoiding Revenue
0:51
loss and more
0:53
in our news recap we’ll cover Uber’s
0:56
same-day prescription delivery open Ai
0:59
and ehrs for reason surgery centers are
1:02
struggling to meet margins right now and
1:04
of course end the new segment with the
1:06
positive story about Virginia’s plans to
1:09
tackle the nursing shortage
1:11
now before we get into the episode I
1:13
wanted to personally invite any of our
1:16
listeners who are going to the ASCA
1:17
conference in Louisville from May 17th
1:20
to the 20th to stop by HST Pathways
1:24
Booth during Exhibit Hall hours I’ll
1:27
actually be chatting with people right
1:29
in the booth to be on an upcoming
1:31
podcast episode that will Air in late
1:33
May so if you want to share your
1:35
expertise with our listeners it will
1:38
only take a few minutes of your time so
1:40
come find me at hscpathways at Booth 519
1:43
we have a big Booth right in the middle
1:45
of the floor you can’t miss it so I hope
1:48
everyone enjoys the episode and here’s
1:50
what’s going on this week in surgery
1:51
centers
1:53
[Music]
1:57
Angela welcome to the show
1:59
thank you nice to be here thank you for
2:01
inviting me
2:03
excited for it can you give our
2:05
listeners a quick overview of your
2:07
background in the ASC industry
2:09
sure so I have been in the ASC industry
2:13
for going on 25 years
2:15
uh my entire RCM career has been
2:18
specific to surgery centers
2:21
uh I’ve been with surgical notes for
2:24
about six years now and
2:27
currently working in a lot of different
2:30
facets for the company including
2:31
onboarding operations business analytics
2:35
Clan experience uh and that kind of goes
2:39
hand in hand with my background too for
2:41
the 25 years I’ve kind of had my hand uh
2:44
in all the facets of RCM related to ASCS
2:49
fantastic so deep deep Rec around on
2:52
revenue cycle and RCM and so I thought
2:55
that would be you know a great great
2:57
topic to hit on here today
2:59
and when we think about the overall RCM
3:01
process and life cycle you know up front
3:04
one of The Upfront pieces is obviously
3:06
eligibility verification for the patient
3:09
and that seems pretty important because
3:11
if that’s wrong or not captured it can
3:14
lead to Downstream impacts on the
3:16
ability to collect
3:18
um and so I wanted to ask you about that
3:20
in terms of how do you think about
3:23
eligibility verification you know and
3:26
and why is it so important to the
3:28
overall RCM process
3:32
while the eligibility verification
3:34
really is the first step
3:37
um after scheduling the case uh it
3:40
determines the viability uh whether or
3:42
not the patient is eligible uh with
3:46
current effective dates of insurance it
3:49
also allows you the ability to determine
3:51
the estimated payment based off the
3:55
scheduled codes uh and going into case
3:59
costing
4:00
uh is it a high cost case and will they
4:03
recover those costs uh as far as the
4:07
estimation goes and taking it even
4:09
further of course is going into the
4:12
patient collections up front
4:14
uh the importance of providing the
4:16
patient with those options and
4:18
collecting that so that you’re not
4:20
chasing it on the back end
4:23
got it and how are asc’s
4:27
doing this today are there some
4:28
different different ways that that ASCS
4:31
you know conduct eligibility
4:33
verification
4:34
there’s so many different ways in it and
4:37
it does have an impact whether or not
4:39
the center is out of network or in
4:42
network when a center is at a network
4:45
it’s really important to pick up the
4:48
phone and call the insurance
4:50
uh even if you look at their eligibility
4:53
online you can determine that they do
4:55
have uh current Insurance uh benefits
4:59
but it doesn’t tell you the type of
5:02
patient policy for example in mnrp
5:06
policy which is through United
5:07
Healthcare that indicates that it’s
5:10
going to pay Medicare rates or a
5:13
percentage of Medicare rates but when
5:16
you’re in network then you have a whole
5:19
array of software out there available to
5:21
the ASCS you can do it through waystar
5:24
which is a very common prominent
5:27
Clearinghouse they do the eligibility
5:30
and benefit verification as well
5:33
uh and then there’s also specialized
5:36
software that not only does Real Time
5:39
benefit verification and patient
5:42
estimates of responsibility but has the
5:45
ability to also reach out automatically
5:49
via text or email to patients and track
5:52
the percentage of patients that are
5:55
looking at that communication and
5:57
receive a professional estimate through
5:59
that text link
6:01
got it so you mentioned
6:04
you know I think think a couple
6:06
different ways to do it right you said
6:08
Hey in the the add a network scenario
6:11
you really got a call and there’s not a
6:13
there’s not a lot of automation or
6:15
software that you can use
6:18
for the in network I assume you can
6:20
still call right but but
6:23
um and we see some customers that are
6:24
doing that but more automation becomes
6:27
available via Clearinghouse or via
6:30
um you know patient estimation and
6:32
insurance verification kind of software
6:34
tools right right and even the practice
6:37
management software nowadays available
6:40
to ASCS can interface with the
6:44
Clearinghouse and do those estimations
6:47
as well and verify the benefits real
6:50
time yep I’m curious
6:53
um
6:54
with your guys customer base
6:56
you know looking at the end Network side
6:59
what’s kind of the mix in terms of
7:01
people that are using software for
7:03
insurance verification for for versus
7:05
folks that are calling
7:07
for for I would say it’s probably about
7:12
50 to 60 percent that is utilizing some
7:16
type of software
7:18
and others will utilize picking up the
7:22
phone or they will go directly to the
7:26
payer portals themselves
7:28
okay
7:31
got it and so we talked a little bit
7:34
about eligibility verification
7:37
in terms of the coverage one of the
7:39
things that I see centers talk about is
7:42
how often they check or ping the
7:45
insurance regarding the coverage and is
7:47
it still current before the procedure
7:49
what’s your kind of guidance or best
7:51
practice there
7:54
really depends
7:55
eyes of the center but common the most
7:59
the most day one to two weeks out from
8:02
date of service
8:03
and that gives you a little bit of room
8:06
also so that you’re handling any add-ons
8:09
uh you know within a 24-hour period
8:12
because there’s always going to be
8:14
add-ons
8:15
when you do it one to two weeks ahead of
8:18
time it and you’re using a software and
8:20
it’s kind of one of the benefits of the
8:22
software is the real time benefit
8:25
verification check so that when the
8:28
patient comes in on date of service or
8:31
even one to two days before you can
8:33
recheck those benefits it not only
8:36
you’re looking at is the patient still
8:39
eligible but you’re rechecking their
8:42
deductibles and what has and has not
8:45
been met because likely when a patient’s
8:49
coming in they have other claims their
8:51
doctor visits for example that are going
8:54
through the insurance and so their
8:57
deductible decreases it helps to avoid
8:59
over collecting and doing more I do
9:03
prefer over collecting estimating on the
9:06
high side and being in a position of
9:08
refunding on the back end but if you can
9:11
prevent that where you can then it’s
9:14
good practice to do that as well well
9:16
so it sounds like checking with
9:17
insurance more often
9:19
through the benefit of software really
9:21
is allowing
9:23
providers to get more tight more
9:25
accurate on their patient estimates
9:27
that’s correct if they’re doing phone
9:30
calls they don’t tend to recheck
9:32
benefits if they are utilizing software
9:34
that makes it easier to click of a
9:37
button then then we see an uptick and
9:40
where they uh those estimates and
9:42
upfront deposits are more on track to
9:46
what is real time
9:48
got it
9:50
um
9:51
so so curious Angela what’s your you
9:53
mentioned hey 60 of the industry or
9:56
centers are kind of using software to
9:58
help automate this process 40 or not
10:01
sounds like there’s a lot of benefit to
10:04
using a tool maybe what are some common
10:07
reasons that you see why centers may
10:09
still do it manually you know why why do
10:11
folks still like to call or maybe what
10:14
pitfalls do folks encounter when they
10:16
think about adopting a software solution
10:19
they may not be familiar uh some with
10:24
smaller case volumes centers that do
10:26
maybe a hundred cases or less per month
10:30
uh may not have as much of a need for
10:34
this type of software so that’s that’s
10:36
one because the the higher the volume
10:40
the more impact it is the more time
10:43
consuming uh it takes you know your
10:46
front office to do all those different
10:48
facets not only manage the intake when
10:51
the patient is checking in but they have
10:54
that responsibility to also stay on top
10:56
of the cases that are scheduled one to
10:58
two weeks out in the add-ons
11:00
so I think you know it’s more of
11:03
knowledge of knowing that there is good
11:06
software out there
11:07
uh you know some of these centers that
11:09
aren’t going to the conferences when you
11:11
go to the conferences you see this you
11:13
know these booths uh left and right I
11:16
mean they’re they’re pretty prominent
11:17
and there’s some really great uh great
11:20
products out there so I think that
11:23
that’s more of it because I do you know
11:26
talk to our clients I know and promote
11:28
these types of softwares especially if
11:31
they’re a higher volume Center sure
11:36
and what about
11:38
authorizations because this seems to be
11:40
a thorn in the side some of our
11:42
customers that I talk to because it can
11:44
be a time intensive
11:46
process you know what are your best
11:48
practices or tips and tricks around
11:50
Prior authorizations
11:52
how authorizations like you said I mean
11:55
there’s there are a lot of potential
11:58
issues that can come up with
12:00
authorizations I consider the
12:03
authorizations to be one of the more
12:07
recent games that the insurance is
12:10
playing over the last year and what they
12:14
what they are doing is they’re putting
12:16
in these time statutes that they you
12:20
have to update authorizations within
12:23
four days seven days 14 days from data
12:26
service
12:27
or you uh can be penalized 50 or the
12:32
case will be denied and if it’s denied
12:35
because of that some of these payers
12:37
it’s really difficult to overturn those
12:40
denials
12:41
so with the authorization one one thing
12:44
with the software that’s used for
12:47
eligibility uh and patient estimation
12:51
that is the one area that is still
12:54
lacking is the authorizations there’s
12:57
improvements over time yeah but it’s
13:00
still lacking
13:02
so this is an area that in general the
13:04
technology still hasn’t fully automated
13:07
this authorization side and so it sounds
13:11
like centers are still having to call
13:13
for for prior authorizations and so
13:16
given it’s a manual step
13:18
what can Sinners do to make it more
13:21
efficient or you know make make sure
13:24
that they’re that they’re not calling
13:27
for authorizations that they don’t need
13:28
to collect for example you know how are
13:31
people managing this
13:32
so first is uh working with the
13:37
provider’s office
13:39
I would say it’s most common for the
13:42
provider’s office to uh call for the
13:45
authorizations initially because they’re
13:48
authorizing the surgeon’s case and if
13:51
they’re going to authorize the surgeon’s
13:52
case they should be authorizing the case
13:54
being performed at the center they’re
13:56
referred to
13:58
so if they’re already on the phone then
14:01
knock it out at the same time and really
14:03
when it comes to the surgery center
14:05
ideally they’re just verifying that yes
14:09
here’s the authorization we have the
14:12
authorization number it’s for the
14:14
correct procedure make sure that it’s
14:16
for the correct Surgery Center because
14:18
that that happens some providers work in
14:21
multiple centers
14:22
so that’s something that they need to
14:24
make sure to check too
14:26
so this is one of these areas
14:29
yeah sorry I was just gonna say this
14:31
sounds like one of the those areas that
14:33
that does require kind of coordination
14:34
or communication between the practice
14:37
and and the and the ASC facility yes
14:40
absolutely one benefit now with the
14:43
authorizations is the ability uh more
14:47
and more to do it on the payer portals
14:50
and so that does that does help and and
14:53
there’s even some that require you they
14:55
won’t do it over the phone uh and I
14:58
think for me I think it’s even better uh
15:01
you do it over the the pair portals it’s
15:04
quicker you have a tracking number you
15:07
can follow up on the status of it versus
15:09
picking up the phone you can get through
15:11
a lot you know a lot more quicker when
15:14
you’re doing it through the portal so I
15:16
would always recommend checking and if
15:20
you are in charge of doing the insurance
15:22
verification and authorization they can
15:25
keep keep a matrix with the payers and
15:28
whether or not they do have that portal
15:30
and so you can always just look over on
15:33
your Matrix and say Yep this one I’m
15:34
going on the portal and reduce the
15:36
number of calls and hold time got it so
15:40
that’s a good kind of medium step not
15:42
not fully automated but but at least not
15:44
calling so okay great
15:47
and
15:49
um
15:49
one thing that sometimes happens in
15:51
surgeries I believe is the procedure
15:54
might change a little bit from the
15:56
initial
15:57
plan right what happens when after the
16:00
procedure you know the team’s looking at
16:02
at the charges and codes and they’re
16:05
different than what you got you know
16:07
authorization for
16:10
to put on a matrix for the insurance
16:14
verification team uh when the code
16:18
changes from schedule to final coding
16:21
there are some payers that won’t allow
16:24
you to add on a code or do a retro
16:26
authorization they just require you to
16:30
handle it on the back end through an
16:32
appeal and that’s okay just because it
16:35
denies initially for authorization
16:37
it’s unless they have a timed statute
16:40
then you’re fine you should not lose
16:43
Revenue because of those types of
16:45
denials uh and then for payers like
16:49
Cigna is an example you have 14 days
16:53
from date of service to update that
16:55
authorization and so with that
16:59
uh it’s really important to have that
17:02
communication with your revenue cycle
17:04
team whether or not it’s in-house or you
17:07
have a partner doing your revenue cycle
17:10
that communication that uh the person
17:13
that’s entering the charges they see
17:15
what’s scheduled
17:17
and they also have the coding sheet so
17:19
they see the final coding and they also
17:22
have the ability to see that it was
17:23
authorized and so they should be the
17:26
ones to communicate when there is a
17:28
change of codes and if it’s a payer that
17:30
requires you to update it immediately
17:34
yeah
17:36
great
17:37
well final question for you here Angela
17:39
this is something we ask all of our
17:40
guests every week
17:41
what is one thing our listeners can do
17:43
this week to improve their surgery
17:45
centers
17:48
uh well I would say keeping it related
17:52
to this specific topic I would say to
17:56
have strong policies
17:58
around collecting up front
18:02
um having the ability to give the
18:04
patients options whether or not it be
18:07
funding or payment plans uh financial
18:12
hardship whatever those policies may be
18:16
but do your patients a favor give them a
18:21
professional and as close as accurate
18:24
estimation
18:26
upfront collect that estimation uh and
18:30
that just helps the patient I know if
18:32
I’m going in to have surgery I want to
18:34
know how much I’m going to be out of
18:37
pocket
18:38
and I expect to pay that up front
18:40
right and it should be you know the same
18:43
across the board for for other you know
18:45
other centers just focus on patient
18:48
satisfaction and providing them what
18:51
they need so that they can pay up front
18:53
and then that will help reduce Revenue
18:55
leakage on the back end yeah it makes
18:57
total sense so give them an accurate
18:59
estimate up front
19:00
and then and then collect it by what’s
19:02
the best practice should centers be
19:04
asking their patients to pay by data
19:07
service
19:09
pay by or at data service you know at
19:13
the time of service is okay
19:15
uh if they don’t pay then at least have
19:19
that pre-service Financial call uh if
19:23
the you know to tell the patient what
19:25
they owe and what is what is the
19:28
expectation you know provide them with a
19:30
link to pay online through credit card
19:32
is the patient saying they’ll bring a
19:34
check with them uh on the date of
19:37
service did you set up a payment plan uh
19:40
and if you do set up a payment plan set
19:42
up an auto payment plan
19:45
don’t don’t uh just make a note to say
19:48
for the RCM team on the back end to set
19:51
up a payment plan depending on whatever
19:54
the balance is on the back ends get
19:56
those payment plans set up up front yep
19:59
and it seems that seems like good good
20:02
practice and and common sense
20:05
um but there’s still a lot of centers
20:07
that don’t do that they don’t require
20:08
their patients to even pay at data
20:11
service do you have a sense of why what
20:12
are the common objections
20:15
the most the most common reason for
20:19
centers that I have experience with it’s
20:22
their demographics
20:23
it always comes down to demographics
20:25
it’s the types of of patients it could
20:28
be Medicaid patients or an older
20:32
demographic uh more strained financially
20:37
demographic uh that they tend to be a
20:41
little bit more forgiving uh the other
20:44
reason would be not having those
20:47
policies not reviewing it not kpis key
20:51
perform key performance metrics aren’t
20:55
just for on the back end are Collections
20:58
and volume and charges and AR it also
21:02
should include your upfront collections
21:04
uh you know those types of uh kpis are
21:08
really critical too so they should
21:10
include those
21:11
so sometimes it’s just kind of a lack of
21:13
visibility
21:15
you know kind of into the ability focus
21:17
on other things uh within the surgery
21:20
center uh you know not getting feedback
21:24
from the team doing the RCM could be
21:27
also a reason that they don’t realize
21:29
you know that there is more urgency to
21:33
improving those processes up front
21:36
sure
21:38
well Angela thanks so much for joining
21:40
us today really really enjoyed the
21:41
conversation yeah thank you
21:47
[Music]
21:49
thank you as always it has been a busy
21:51
week in healthcare so let’s Jump Right
21:53
In Uber Health which is self-described
21:56
as the non-emergency medical
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transportation arm of the company
22:00
announced a new partnership with Nimble
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RX and script drop to provide same-day
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prescription delivery to patients across
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the U.S and even including those in
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rural areas patients can request
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prescription delivery through their
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health care provider or Pharmacy and
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Uber health will connect them to Nimble
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rx’s network of pharmacies patients will
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you would if you were waiting for a ride
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or if you were stocking your food as
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it’s being delivered from the restaurant
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to your front door
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as Healthcare Providers and patients
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have increasingly turned to telemedicine
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and other virtual Health Care Solutions
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the option for a same-day prescription
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delivery is not only extremely
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convenient but also eliminates the need
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for patients to leave their home if they
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are sick and you know pose no risk of
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exposing their Community to whatever
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they may have going on this is not
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Uber’s first Venture into the healthcare
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space as they already provide
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transportation services to Health Care
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Providers and patients and they also
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partner with prescription discount card
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company GoodRx to offer discounted rides
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to patients so the service is available
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immediately and both companies expect
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the partnership to expand in the future
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and if you have tried Uber health
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please leave a comment on HST Pathways
23:28
LinkedIn post I would love to hear your
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experience I don’t know anybody who has
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tried it yet but would love to hear what
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it was like if it worked and all that
23:37
good stuff in our Second Story hymns
23:40
2023 took place last week and there is
23:43
all sorts of news coming out of the show
23:45
announcements being made epic and
23:48
Microsoft announced that they will
23:50
integrate open ai’s upcoming gpt4
23:53
language model into epics EHR
23:57
the integration uh will allow ehrs to
24:00
process and analyze unstructured data
24:02
such as clinical notes free text fields
24:04
and patient feedback with greater
24:07
accuracy and efficiency the goal of
24:09
course is to help clinicians make more
24:12
informed decisions and ultimately
24:14
improve patient outcomes
24:16
now the announcement marks a significant
24:19
step forward for the healthcare
24:20
industry’s use of AI in clinical
24:22
decision making I feel like at least
24:25
every other week I’m sharing a story
24:27
about some sort of of AI artificial
24:31
intelligence that is being woven into
24:34
every facet of the healthcare industry
24:36
so this really shouldn’t come as a
24:38
surprise but it still always feels
24:41
shocking
24:42
um so the ability to process and analyze
24:45
vast amounts of unstructured data has
24:47
been a challenge for healthcare
24:48
providers and the gpt4 integration would
24:52
help overcome that hurdle
24:54
now epic and Microsoft emphasize their
24:57
commitment to patient privacy and
24:59
security which is obviously the number
25:01
one concern here and they shared that
25:05
gpt4 will only have access to data with
25:08
patient consent and that all data will
25:10
be de-identified to protect patient
25:12
privacy
25:13
so gpt4 is expected to be released in
25:16
2024 and then the integration with
25:19
epic’s EHR system is expected to follow
25:21
shortly after in our third story
25:24
according to an article from Becker’s
25:26
ASC there are four major reasons surgery
25:29
centers are struggling to meet their
25:31
margins right now
25:33
the first is still supply chain issues
25:36
so ASCS are having a hard time securing
25:40
necessary supplies and if they can
25:42
secure what they need the increased
25:44
prices make it difficult to do so
25:47
um in a you know financially responsible
25:49
way Michelle Islander is an
25:52
administrator in Iowa and she shared
25:55
that there are many times that we have
25:57
to order a higher price item due to the
25:59
back order of the regular used item and
26:02
she noted that it’s common that they
26:03
need to order for multiple vendors just
26:05
to get what they need
26:07
the second will come as no surprise
26:09
Staffing surgery centers spend an on
26:12
average 2.2 million on employee salary
26:15
and wages which accounts for about 21.3
26:18
percent of net revenue the third is an
26:22
increase in publicly insured patients
26:25
um so an admin in New Jersey shared that
26:27
the increasing number of patients with
26:29
publicly funded insurance plans whether
26:31
that’s Medicare Medicaid can be
26:34
challenging from an economic standpoint
26:36
this often happens with Podiatry and
26:38
Orthopedic patients with unexpected
26:40
implants that exceed Medicare
26:42
reimbursement for that procedure the
26:45
fourth is declining private
26:47
reimbursement so ASE leaders are having
26:50
trouble securing reimbursements from
26:52
commercial payers that are rising at the
26:54
same price of inflation an admin in
26:56
Connecticut shared that even with
26:58
inflation running at five to eight
27:00
percent currently commercial payers are
27:03
only willing to increase contract
27:04
reimbursement rates by two to three
27:06
percent which obviously results in
27:08
margin compression and can ultimately
27:10
lead to negative cash flow situations
27:14
so you’re probably thinking that’s great
27:16
thanks for sharing our problems with us
27:18
but I thought it was helpful because you
27:21
might be struggling to figure out where
27:23
the leak is coming from and maybe you
27:25
aren’t sure what hidden expenses are
27:26
actually draining you or industry Trends
27:29
um that are causing you
27:31
to be struggling to meet your numbers so
27:34
I just wanted to share what others in
27:35
the ASC have found to be the root cause
27:38
and to end our new segment on a positive
27:40
note Valley Health the Virginia hospital
27:42
and Health Care Association and
27:45
Shenandoah University are working to
27:47
tackle the Region’s nursing shortage
27:49
through a program that will enhance the
27:51
training of aspiring nurses and create a
27:54
sustainable pipeline of new Health Care
27:56
Professionals I know that is always top
27:58
of mind for everybody right now
28:00
the next gen nurses program it’s called
28:03
draws upon the expertise of semi-retired
28:07
and retiring nurses to help train the
28:09
next generation of nurses before they
28:11
leave the profession the program intends
28:14
to create a reliable source of new
28:15
nurses in the Shenandoah Valley so
28:18
congrats to everyone involved in
28:20
assuming the problem will be the sorry
28:22
the pro the program will be a success
28:24
perhaps it can be rolled out in other
28:27
areas of the country as well and that
28:29
news story officially wraps up this
28:31
week’s podcast thank you as always for
28:34
spending a few minutes of your week with
28:36
us make sure to subscribe or leave a
28:38
review on whichever platform you’re
28:40
listening from I hope you have a great
28:42
day and we will see you again next week
28:45
you’re so alone
28:47
[Music]
welcome to this week in surgery centers
0:03
if you’re in the ASC industry then
0:06
you’re in the right place every week
0:08
we’ll start the episode off by sharing
0:10
an interesting conversation we had with
0:11
our featured guests and then we’ll close
0:13
the episode by recapping the latest news
0:15
impacting surgery centers we’re excited
0:18
to share with you what we have so let’s
0:20
get started and see what the industry’s
0:22
been up to
0:23
[Music]
0:27
hi everyone here’s what you can expect
0:30
on today’s episode Angela matiota is the
0:33
senior vice president of RCM Solutions
0:36
at surgical notes and we caught up with
0:38
her to talk all about the role
0:40
eligibility verification plays in
0:42
ensuring profitability during our
0:45
discussion with Angela we dive into
0:46
common challenges the role technology
0:48
plays authorizations avoiding Revenue
0:51
loss and more
0:53
in our news recap we’ll cover Uber’s
0:56
same-day prescription delivery open Ai
0:59
and ehrs for reason surgery centers are
1:02
struggling to meet margins right now and
1:04
of course end the new segment with the
1:06
positive story about Virginia’s plans to
1:09
tackle the nursing shortage
1:11
now before we get into the episode I
1:13
wanted to personally invite any of our
1:16
listeners who are going to the ASCA
1:17
conference in Louisville from May 17th
1:20
to the 20th to stop by HST Pathways
1:24
Booth during Exhibit Hall hours I’ll
1:27
actually be chatting with people right
1:29
in the booth to be on an upcoming
1:31
podcast episode that will Air in late
1:33
May so if you want to share your
1:35
expertise with our listeners it will
1:38
only take a few minutes of your time so
1:40
come find me at hscpathways at Booth 519
1:43
we have a big Booth right in the middle
1:45
of the floor you can’t miss it so I hope
1:48
everyone enjoys the episode and here’s
1:50
what’s going on this week in surgery
1:51
centers
1:53
[Music]
1:57
Angela welcome to the show
1:59
thank you nice to be here thank you for
2:01
inviting me
2:03
excited for it can you give our
2:05
listeners a quick overview of your
2:07
background in the ASC industry
2:09
sure so I have been in the ASC industry
2:13
for going on 25 years
2:15
uh my entire RCM career has been
2:18
specific to surgery centers
2:21
uh I’ve been with surgical notes for
2:24
about six years now and
2:27
currently working in a lot of different
2:30
facets for the company including
2:31
onboarding operations business analytics
2:35
Clan experience uh and that kind of goes
2:39
hand in hand with my background too for
2:41
the 25 years I’ve kind of had my hand uh
2:44
in all the facets of RCM related to ASCS
2:49
fantastic so deep deep Rec around on
2:52
revenue cycle and RCM and so I thought
2:55
that would be you know a great great
2:57
topic to hit on here today
2:59
and when we think about the overall RCM
3:01
process and life cycle you know up front
3:04
one of The Upfront pieces is obviously
3:06
eligibility verification for the patient
3:09
and that seems pretty important because
3:11
if that’s wrong or not captured it can
3:14
lead to Downstream impacts on the
3:16
ability to collect
3:18
um and so I wanted to ask you about that
3:20
in terms of how do you think about
3:23
eligibility verification you know and
3:26
and why is it so important to the
3:28
overall RCM process
3:32
while the eligibility verification
3:34
really is the first step
3:37
um after scheduling the case uh it
3:40
determines the viability uh whether or
3:42
not the patient is eligible uh with
3:46
current effective dates of insurance it
3:49
also allows you the ability to determine
3:51
the estimated payment based off the
3:55
scheduled codes uh and going into case
3:59
costing
4:00
uh is it a high cost case and will they
4:03
recover those costs uh as far as the
4:07
estimation goes and taking it even
4:09
further of course is going into the
4:12
patient collections up front
4:14
uh the importance of providing the
4:16
patient with those options and
4:18
collecting that so that you’re not
4:20
chasing it on the back end
4:23
got it and how are asc’s
4:27
doing this today are there some
4:28
different different ways that that ASCS
4:31
you know conduct eligibility
4:33
verification
4:34
there’s so many different ways in it and
4:37
it does have an impact whether or not
4:39
the center is out of network or in
4:42
network when a center is at a network
4:45
it’s really important to pick up the
4:48
phone and call the insurance
4:50
uh even if you look at their eligibility
4:53
online you can determine that they do
4:55
have uh current Insurance uh benefits
4:59
but it doesn’t tell you the type of
5:02
patient policy for example in mnrp
5:06
policy which is through United
5:07
Healthcare that indicates that it’s
5:10
going to pay Medicare rates or a
5:13
percentage of Medicare rates but when
5:16
you’re in network then you have a whole
5:19
array of software out there available to
5:21
the ASCS you can do it through waystar
5:24
which is a very common prominent
5:27
Clearinghouse they do the eligibility
5:30
and benefit verification as well
5:33
uh and then there’s also specialized
5:36
software that not only does Real Time
5:39
benefit verification and patient
5:42
estimates of responsibility but has the
5:45
ability to also reach out automatically
5:49
via text or email to patients and track
5:52
the percentage of patients that are
5:55
looking at that communication and
5:57
receive a professional estimate through
5:59
that text link
6:01
got it so you mentioned
6:04
you know I think think a couple
6:06
different ways to do it right you said
6:08
Hey in the the add a network scenario
6:11
you really got a call and there’s not a
6:13
there’s not a lot of automation or
6:15
software that you can use
6:18
for the in network I assume you can
6:20
still call right but but
6:23
um and we see some customers that are
6:24
doing that but more automation becomes
6:27
available via Clearinghouse or via
6:30
um you know patient estimation and
6:32
insurance verification kind of software
6:34
tools right right and even the practice
6:37
management software nowadays available
6:40
to ASCS can interface with the
6:44
Clearinghouse and do those estimations
6:47
as well and verify the benefits real
6:50
time yep I’m curious
6:53
um
6:54
with your guys customer base
6:56
you know looking at the end Network side
6:59
what’s kind of the mix in terms of
7:01
people that are using software for
7:03
insurance verification for for versus
7:05
folks that are calling
7:07
for for I would say it’s probably about
7:12
50 to 60 percent that is utilizing some
7:16
type of software
7:18
and others will utilize picking up the
7:22
phone or they will go directly to the
7:26
payer portals themselves
7:28
okay
7:31
got it and so we talked a little bit
7:34
about eligibility verification
7:37
in terms of the coverage one of the
7:39
things that I see centers talk about is
7:42
how often they check or ping the
7:45
insurance regarding the coverage and is
7:47
it still current before the procedure
7:49
what’s your kind of guidance or best
7:51
practice there
7:54
really depends
7:55
eyes of the center but common the most
7:59
the most day one to two weeks out from
8:02
date of service
8:03
and that gives you a little bit of room
8:06
also so that you’re handling any add-ons
8:09
uh you know within a 24-hour period
8:12
because there’s always going to be
8:14
add-ons
8:15
when you do it one to two weeks ahead of
8:18
time it and you’re using a software and
8:20
it’s kind of one of the benefits of the
8:22
software is the real time benefit
8:25
verification check so that when the
8:28
patient comes in on date of service or
8:31
even one to two days before you can
8:33
recheck those benefits it not only
8:36
you’re looking at is the patient still
8:39
eligible but you’re rechecking their
8:42
deductibles and what has and has not
8:45
been met because likely when a patient’s
8:49
coming in they have other claims their
8:51
doctor visits for example that are going
8:54
through the insurance and so their
8:57
deductible decreases it helps to avoid
8:59
over collecting and doing more I do
9:03
prefer over collecting estimating on the
9:06
high side and being in a position of
9:08
refunding on the back end but if you can
9:11
prevent that where you can then it’s
9:14
good practice to do that as well well
9:16
so it sounds like checking with
9:17
insurance more often
9:19
through the benefit of software really
9:21
is allowing
9:23
providers to get more tight more
9:25
accurate on their patient estimates
9:27
that’s correct if they’re doing phone
9:30
calls they don’t tend to recheck
9:32
benefits if they are utilizing software
9:34
that makes it easier to click of a
9:37
button then then we see an uptick and
9:40
where they uh those estimates and
9:42
upfront deposits are more on track to
9:46
what is real time
9:48
got it
9:50
um
9:51
so so curious Angela what’s your you
9:53
mentioned hey 60 of the industry or
9:56
centers are kind of using software to
9:58
help automate this process 40 or not
10:01
sounds like there’s a lot of benefit to
10:04
using a tool maybe what are some common
10:07
reasons that you see why centers may
10:09
still do it manually you know why why do
10:11
folks still like to call or maybe what
10:14
pitfalls do folks encounter when they
10:16
think about adopting a software solution
10:19
they may not be familiar uh some with
10:24
smaller case volumes centers that do
10:26
maybe a hundred cases or less per month
10:30
uh may not have as much of a need for
10:34
this type of software so that’s that’s
10:36
one because the the higher the volume
10:40
the more impact it is the more time
10:43
consuming uh it takes you know your
10:46
front office to do all those different
10:48
facets not only manage the intake when
10:51
the patient is checking in but they have
10:54
that responsibility to also stay on top
10:56
of the cases that are scheduled one to
10:58
two weeks out in the add-ons
11:00
so I think you know it’s more of
11:03
knowledge of knowing that there is good
11:06
software out there
11:07
uh you know some of these centers that
11:09
aren’t going to the conferences when you
11:11
go to the conferences you see this you
11:13
know these booths uh left and right I
11:16
mean they’re they’re pretty prominent
11:17
and there’s some really great uh great
11:20
products out there so I think that
11:23
that’s more of it because I do you know
11:26
talk to our clients I know and promote
11:28
these types of softwares especially if
11:31
they’re a higher volume Center sure
11:36
and what about
11:38
authorizations because this seems to be
11:40
a thorn in the side some of our
11:42
customers that I talk to because it can
11:44
be a time intensive
11:46
process you know what are your best
11:48
practices or tips and tricks around
11:50
Prior authorizations
11:52
how authorizations like you said I mean
11:55
there’s there are a lot of potential
11:58
issues that can come up with
12:00
authorizations I consider the
12:03
authorizations to be one of the more
12:07
recent games that the insurance is
12:10
playing over the last year and what they
12:14
what they are doing is they’re putting
12:16
in these time statutes that they you
12:20
have to update authorizations within
12:23
four days seven days 14 days from data
12:26
service
12:27
or you uh can be penalized 50 or the
12:32
case will be denied and if it’s denied
12:35
because of that some of these payers
12:37
it’s really difficult to overturn those
12:40
denials
12:41
so with the authorization one one thing
12:44
with the software that’s used for
12:47
eligibility uh and patient estimation
12:51
that is the one area that is still
12:54
lacking is the authorizations there’s
12:57
improvements over time yeah but it’s
13:00
still lacking
13:02
so this is an area that in general the
13:04
technology still hasn’t fully automated
13:07
this authorization side and so it sounds
13:11
like centers are still having to call
13:13
for for prior authorizations and so
13:16
given it’s a manual step
13:18
what can Sinners do to make it more
13:21
efficient or you know make make sure
13:24
that they’re that they’re not calling
13:27
for authorizations that they don’t need
13:28
to collect for example you know how are
13:31
people managing this
13:32
so first is uh working with the
13:37
provider’s office
13:39
I would say it’s most common for the
13:42
provider’s office to uh call for the
13:45
authorizations initially because they’re
13:48
authorizing the surgeon’s case and if
13:51
they’re going to authorize the surgeon’s
13:52
case they should be authorizing the case
13:54
being performed at the center they’re
13:56
referred to
13:58
so if they’re already on the phone then
14:01
knock it out at the same time and really
14:03
when it comes to the surgery center
14:05
ideally they’re just verifying that yes
14:09
here’s the authorization we have the
14:12
authorization number it’s for the
14:14
correct procedure make sure that it’s
14:16
for the correct Surgery Center because
14:18
that that happens some providers work in
14:21
multiple centers
14:22
so that’s something that they need to
14:24
make sure to check too
14:26
so this is one of these areas
14:29
yeah sorry I was just gonna say this
14:31
sounds like one of the those areas that
14:33
that does require kind of coordination
14:34
or communication between the practice
14:37
and and the and the ASC facility yes
14:40
absolutely one benefit now with the
14:43
authorizations is the ability uh more
14:47
and more to do it on the payer portals
14:50
and so that does that does help and and
14:53
there’s even some that require you they
14:55
won’t do it over the phone uh and I
14:58
think for me I think it’s even better uh
15:01
you do it over the the pair portals it’s
15:04
quicker you have a tracking number you
15:07
can follow up on the status of it versus
15:09
picking up the phone you can get through
15:11
a lot you know a lot more quicker when
15:14
you’re doing it through the portal so I
15:16
would always recommend checking and if
15:20
you are in charge of doing the insurance
15:22
verification and authorization they can
15:25
keep keep a matrix with the payers and
15:28
whether or not they do have that portal
15:30
and so you can always just look over on
15:33
your Matrix and say Yep this one I’m
15:34
going on the portal and reduce the
15:36
number of calls and hold time got it so
15:40
that’s a good kind of medium step not
15:42
not fully automated but but at least not
15:44
calling so okay great
15:47
and
15:49
um
15:49
one thing that sometimes happens in
15:51
surgeries I believe is the procedure
15:54
might change a little bit from the
15:56
initial
15:57
plan right what happens when after the
16:00
procedure you know the team’s looking at
16:02
at the charges and codes and they’re
16:05
different than what you got you know
16:07
authorization for
16:10
to put on a matrix for the insurance
16:14
verification team uh when the code
16:18
changes from schedule to final coding
16:21
there are some payers that won’t allow
16:24
you to add on a code or do a retro
16:26
authorization they just require you to
16:30
handle it on the back end through an
16:32
appeal and that’s okay just because it
16:35
denies initially for authorization
16:37
it’s unless they have a timed statute
16:40
then you’re fine you should not lose
16:43
Revenue because of those types of
16:45
denials uh and then for payers like
16:49
Cigna is an example you have 14 days
16:53
from date of service to update that
16:55
authorization and so with that
16:59
uh it’s really important to have that
17:02
communication with your revenue cycle
17:04
team whether or not it’s in-house or you
17:07
have a partner doing your revenue cycle
17:10
that communication that uh the person
17:13
that’s entering the charges they see
17:15
what’s scheduled
17:17
and they also have the coding sheet so
17:19
they see the final coding and they also
17:22
have the ability to see that it was
17:23
authorized and so they should be the
17:26
ones to communicate when there is a
17:28
change of codes and if it’s a payer that
17:30
requires you to update it immediately
17:34
yeah
17:36
great
17:37
well final question for you here Angela
17:39
this is something we ask all of our
17:40
guests every week
17:41
what is one thing our listeners can do
17:43
this week to improve their surgery
17:45
centers
17:48
uh well I would say keeping it related
17:52
to this specific topic I would say to
17:56
have strong policies
17:58
around collecting up front
18:02
um having the ability to give the
18:04
patients options whether or not it be
18:07
funding or payment plans uh financial
18:12
hardship whatever those policies may be
18:16
but do your patients a favor give them a
18:21
professional and as close as accurate
18:24
estimation
18:26
upfront collect that estimation uh and
18:30
that just helps the patient I know if
18:32
I’m going in to have surgery I want to
18:34
know how much I’m going to be out of
18:37
18:38
and I expect to pay that up front
18:40
right and it should be you know the same
18:43
across the board for for other you know
18:45
other centers just focus on patient
18:48
satisfaction and providing them what
18:51
they need so that they can pay up front
18:53
and then that will help reduce Revenue
18:55
leakage on the back end yeah it makes
18:57
total sense so give them an accurate
18:59
estimate up front
19:00
and then and then collect it by what’s
19:02
the best practice should centers be
19:04
asking their patients to pay by data
19:07
service
19:09
pay by or at data service you know at
19:13
the time of service is okay
19:15
uh if they don’t pay then at least have
19:19
that pre-service Financial call uh if
19:23
the you know to tell the patient what
19:25
they owe and what is what is the
19:28
expectation you know provide them with a
19:30
link to pay online through credit card
19:32
is the patient saying they’ll bring a
19:34
check with them uh on the date of
19:37
service did you set up a payment plan uh
19:40
and if you do set up a payment plan set
19:42
up an auto payment plan
19:45
don’t don’t uh just make a note to say
19:48
for the RCM team on the back end to set
19:51
up a payment plan depending on whatever
19:54
the balance is on the back ends get
19:56
those payment plans set up up front yep
19:59
and it seems that seems like good good
20:02
practice and and common sense
20:05
um but there’s still a lot of centers
20:07
that don’t do that they don’t require
20:08
their patients to even pay at data
20:11
service do you have a sense of why what
20:12
are the common objections
20:15
the most the most common reason for
20:19
centers that I have experience with it’s
20:22
their demographics
20:23
it always comes down to demographics
20:25
it’s the types of of patients it could
20:28
be Medicaid patients or an older
20:32
demographic uh more strained financially
20:37
demographic uh that they tend to be a
20:41
little bit more forgiving uh the other
20:44
reason would be not having those
20:47
policies not reviewing it not kpis key
20:51
perform key performance metrics aren’t
20:55
just for on the back end are Collections
20:58
and volume and charges and AR it also
21:02
should include your upfront collections
21:04
uh you know those types of uh kpis are
21:08
really critical too so they should
21:10
include those
21:11
so sometimes it’s just kind of a lack of
21:13
visibility
21:15
you know kind of into the ability focus
21:17
on other things uh within the surgery
21:20
center uh you know not getting feedback
21:24
from the team doing the RCM could be
21:27
also a reason that they don’t realize
21:29
you know that there is more urgency to
21:33
improving those processes up front
21:36
sure
21:38
well Angela thanks so much for joining
21:40
us today really really enjoyed the
21:41
conversation yeah thank you
21:47
[Music]
21:49
thank you as always it has been a busy
21:51
week in healthcare so let’s Jump Right
21:53
In Uber Health which is self-described
21:56
as the non-emergency medical
21:58
transportation arm of the company
22:00
announced a new partnership with Nimble
22:03
RX and script drop to provide same-day
22:06
prescription delivery to patients across
22:08
the U.S and even including those in
22:11
rural areas patients can request
22:13
prescription delivery through their
22:15
health care provider or Pharmacy and
22:18
Uber health will connect them to Nimble
22:20
rx’s network of pharmacies patients will
22:23
receive updates on the status of their
22:25
delivery and can track their meds in
22:27
real time through the Uber app just like
22:29
you would if you were waiting for a ride
22:31
or if you were stocking your food as
22:34
it’s being delivered from the restaurant
22:35
to your front door
22:37
as Healthcare Providers and patients
22:39
have increasingly turned to telemedicine
22:42
and other virtual Health Care Solutions
22:43
the option for a same-day prescription
22:46
delivery is not only extremely
22:48
convenient but also eliminates the need
22:50
for patients to leave their home if they
22:52
are sick and you know pose no risk of
22:55
exposing their Community to whatever
22:57
they may have going on this is not
23:00
Uber’s first Venture into the healthcare
23:02
space as they already provide
23:04
transportation services to Health Care
23:07
Providers and patients and they also
23:10
partner with prescription discount card
23:12
company GoodRx to offer discounted rides
23:15
to patients so the service is available
23:18
immediately and both companies expect
23:20
the partnership to expand in the future
23:22
and if you have tried Uber health
23:26
please leave a comment on HST Pathways
23:28
LinkedIn post I would love to hear your
23:30
experience I don’t know anybody who has
23:32
tried it yet but would love to hear what
23:35
it was like if it worked and all that
23:37
good stuff in our Second Story hymns
23:40
2023 took place last week and there is
23:43
all sorts of news coming out of the show
23:45
announcements being made epic and
23:48
Microsoft announced that they will
23:50
integrate open ai’s upcoming gpt4
23:53
language model into epics EHR
23:57
the integration uh will allow ehrs to
24:00
process and analyze unstructured data
24:02
such as clinical notes free text fields
24:04
and patient feedback with greater
24:07
accuracy and efficiency the goal of
24:09
course is to help clinicians make more
24:12
informed decisions and ultimately
24:14
improve patient outcomes
24:16
now the announcement marks a significant
24:19
step forward for the healthcare
24:20
industry’s use of AI in clinical
24:22
decision making I feel like at least
24:25
every other week I’m sharing a story
24:27
about some sort of of AI artificial
24:31
intelligence that is being woven into
24:34
every facet of the healthcare industry
24:36
so this really shouldn’t come as a
24:38
surprise but it still always feels
24:41
shocking
24:42
um so the ability to process and analyze
24:45
vast amounts of unstructured data has
24:47
been a challenge for healthcare
24:48
providers and the gpt4 integration would
24:52
help overcome that hurdle
24:54
now epic and Microsoft emphasize their
24:57
commitment to patient privacy and
24:59
security which is obviously the number
25:01
one concern here and they shared that
25:05
gpt4 will only have access to data with
25:08
patient consent and that all data will
25:10
be de-identified to protect patient
25:12
privacy
25:13
so gpt4 is expected to be released in
25:16
2024 and then the integration with
25:19
epic’s EHR system is expected to follow
25:21
shortly after in our third story
25:24
according to an article from Becker’s
25:26
ASC there are four major reasons surgery
25:29
centers are struggling to meet their
25:31
margins right now
25:33
the first is still supply chain issues
25:36
so ASCS are having a hard time securing
25:40
necessary supplies and if they can
25:42
secure what they need the increased
25:44
prices make it difficult to do so
25:47
um in a you know financially responsible
25:49
way Michelle Islander is an
25:52
administrator in Iowa and she shared
25:55
that there are many times that we have
25:57
to order a higher price item due to the
25:59
back order of the regular used item and
26:02
she noted that it’s common that they
26:03
need to order for multiple vendors just
26:05
to get what they need
26:07
the second will come as no surprise
26:09
Staffing surgery centers spend an on
26:12
average 2.2 million on employee salary
26:15
and wages which accounts for about 21.3
26:18
percent of net revenue the third is an
26:22
increase in publicly insured patients
26:25
um so an admin in New Jersey shared that
26:27
the increasing number of patients with
26:29
publicly funded insurance plans whether
26:31
that’s Medicare Medicaid can be
26:34
challenging from an economic standpoint
26:36
this often happens with Podiatry and
26:38
Orthopedic patients with unexpected
26:40
implants that exceed Medicare
26:42
reimbursement for that procedure the
26:45
fourth is declining private
26:47
reimbursement so ASE leaders are having
26:50
trouble securing reimbursements from
26:52
commercial payers that are rising at the
26:54
same price of inflation an admin in
26:56
Connecticut shared that even with
26:58
inflation running at five to eight
27:00
percent currently commercial payers are
27:03
only willing to increase contract
27:04
reimbursement rates by two to three
27:06
percent which obviously results in
27:08
margin compression and can ultimately
27:10
lead to negative cash flow situations
27:14
so you’re probably thinking that’s great
27:16
thanks for sharing our problems with us
27:18
but I thought it was helpful because you
27:21
might be struggling to figure out where
27:23
the leak is coming from and maybe you
27:25
aren’t sure what hidden expenses are
27:26
actually draining you or industry Trends
27:29
um that are causing you
27:31
to be struggling to meet your numbers so
27:34
I just wanted to share what others in
27:35
the ASC have found to be the root cause
27:38
and to end our new segment on a positive
27:40
note Valley Health the Virginia hospital
27:42
and Health Care Association and
27:45
Shenandoah University are working to
27:47
tackle the Region’s nursing shortage
27:49
through a program that will enhance the
27:51
training of aspiring nurses and create a
27:54
sustainable pipeline of new Health Care
27:56
Professionals I know that is always top
27:58
of mind for everybody right now
28:00
the next gen nurses program it’s called
28:03
draws upon the expertise of semi-retired
28:07
and retiring nurses to help train the
28:09
next generation of nurses before they
28:11
leave the profession the program intends
28:14
to create a reliable source of new
28:15
nurses in the Shenandoah Valley so
28:18
congrats to everyone involved in
28:20
assuming the problem will be the sorry
28:22
the pro the program will be a success
28:24
perhaps it can be rolled out in other
28:27
areas of the country as well and that
28:29
news story officially wraps up this
28:31
week’s podcast thank you as always for
28:34
spending a few minutes of your week with
28:36
us make sure to subscribe or leave a
28:38
review on whichever platform you’re
28:40
listening from I hope you have a great
28:42
day and we will see you again next week
28:45
you’re so alone
28:47
[Music]
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