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INTERVIEWED BY ROBERT KURTZ
Nader Samii, the chief executive offi- cer of National Medical Billing Ser- vices in St. Louis, Missouri, has guided the company into its position as one of the largest and most repu- table revenue cycle management com- panies in the ASC market. He leads the company’s strategic direction with an emphasis on exceptional cli- ent services, lean and efficient pro- cesses, cutting-edge technologies and insightful analytics. Below is an excerpt from an interview.
Before we dive deep into the revenue cycle, there are several operational metrics that are critical to achieving strong financial performance for gastroen- terology ASCs. These include oper- ating room (OR) utilization rates; time per procedure; overhead as a percentage of total expenses; staff- ing costs as a percentage of total expenses; and inventory, amongst others. These metrics can help ensure you run an efficient operation and maximize every dollar, which is par- ticularly important for gastroenterol- ogy since it is a higher volume and lower reimbursing specialty. From a revenue cycle standpoint,
I would suggest looking at your man- aged care contracts, evaluating cash per case by payer and by procedure. In addition, other key gastroenter- ology metrics include days to bill— factoring in the possible delay due to waiting on pathology reports—clean claim rates, denial rates and denial reason codes. Understanding your denials will allow you to identify and
Nader Samii
fix potential issues in your workflow. Focusing on improving each of these metrics will ultimately lead to maxi- mizing your cash flow.
NS: Patient complaints should be closely tracked. Creating the ideal patient experience is of vital impor- tance. Complaints with gastroenterol- ogy often concern screening colonos- copies that become diagnostic, thus requiring patients to incur expenses. If you receive a high volume of such complaints, consider developing stronger communication with patients around how the process works to help avoid mismanagement of expecta- tions and “surprise” bills. Also, it is critical to evaluate your percentage of zero-pay claims, which are those claims that fail to gener- ate any payment. If your percentage begins to rise, figure out why as you
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cannot afford to take on cases that do not pay.
OR utilization rate is important for gastroenterology for volume and reimbursement reasons. If your utili- zation is not where you want it to be, determine where you can gain effi- ciencies, such as training your front desk staff, nurses or surgeons.
NS: I would suggest a daily check of OR utilization rate and number of procedures performed. You want to determine if your number of pro- cedures declined compared to his- torical averages due to protocol changes necessitated by COVID-19 that require allocating more time to completing processes. What impact are changes having on your cen- ter and what options exist to over- come them? Can you add hours to your days of operations? Add a day to your typical week? Monitor met- rics such as cancellation rates, daily billed cases and daily billed charges and compare them to historical aver- ages as well. You also want to understand your pipeline for upcoming visits. You need to know what revenue is going to come in and what your expenses will be as centers continue to operate in this “new normal.” With this infor- mation, you can better project future revenue, which will help you make the educated decisions about where to adjust operations to best ensure short- and long-term success.
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