ASC Billing: Lost and Found
Situation Overview:
•The ASC client recently lost its internal Revenue Cycle Manager (RCM). CFO retires soon afterwards. External RCM manager brought in to bill and collect for the center. Simultaneous to onboarding new RCM company, ASC modernizes to HST for patient accounting, relying on internal leadership from the Practice to support these changes
•Over the next 6 months, Accounts Receivables balloons to >3x monthly revenues, requiring new injections of cash from the Partners to finance operations. AR remained stubbornly high despite stabilization of cash flow. New RCM company has significant turnover and ASC is financially distressed. Legacy AR deemed uncollectible.
Solution & Results
•Mosaic is engaged by the ASC to determine what options exist to help save the center. Understanding the Center’s cash flow sensitivity, Mosaic aligns incentivization by engaging with the ASC on a risk share basis.
•AR Management – Mosaic engages directly with RCM manager to re-focus priorities and optimize collections workflow
•Missed Billing Opportunities – Mosaic audits billing for the last 12 months for billable / claims recoverable opportunities
•Case Costing – Mosaic develops a customized case costing tool for the center to appropriately screen cases but also collect coinsurances / deductibles copays more accurately than in the past
•Within 4 months, AR is reduced by >30%. In addition, >$150k in missed billing opportunities found, with $50k collected and remaining items under appeal. Incidence of self pay balances reduced by nearly 50% as local team clearer on what to collect up front and how to identify payors more accurately
Center is now cashflow positive with Partners receiving repayments of their loans