ASC Administrator Becky Ziegler-Otis Offers Several Best Practices for Improved Billing and Coding
Billing and coding is a critical area of ASC operations that must run smoothly and efficiently in order for a facility to become successful. While many ASCs keep these operations in-house, others consider and turn to outsourcing for them.
The Ambulatory Surgical Center of Stevens Point (Wis.) is one such ASC that outsources its billing and coding. Becky Ziegler-Otis, administrator of the ASC, says one of the most important steps when considering outsourcing your billing and coding practices is to "take a clean look at your business operations." Once this is done, it is important to consider where your center can improve and if it is possible for you to handle these changes internally. Here are some areas to examine when evaluating your current in-house operations.
1. Abilities of the staff. When deciding whether or not to set-up billing and coding in-house, it is important to consider the abilities of the current staff. "The skill sets for billing and coding in an office setting are different than those required at an ASC," says Ms. Ziegler-Otis. Her center had previously relied on a physician's office to handle its billing and coding, but this arrangement was not ideal as there are nuances when it comes to modifiers and coding for an ASC that are not seen in an office setting. In addition, contracts with payors are unique to the surgery center.
2. Other staffing concerns. If it is decided that your center will need to hire new staff in order to improve the efficiency of the department, there are a few other areas to consider including the following:
- how many full-time equivalents are needed;
- is there a qualified pool of potential staff in the area or will it be difficult to recruit new staff; and
- how easy will it be to keep staff trained?
Ms. Ziegler-Otis cites two important considerations for this final area. First, it is important to have more than one person trained in billing and coding in order to prevent any backlog when the primary biller or coder is on vacation or out sick. Second, technology and standards are rapidly changing, so it is important to evaluate if an ASC can keep up with this information.
3. Available resources. "Non-clinical space in a surgery center is limited," says Ms. Ziegler-Otis, and this can be a critical issue when it comes to setting up in-house billing and coding. In addition to allotting office space, resources are essential to having expertise in-house — manuals, dictionaries, code books, etc. — also take up extra room. With the addition of more staff and equipment, you may need and use more IT and office resources.
The relative size of the ASC can also dictate many of the capabilities of its staff. Larger surgery centers have access to more staff and equipment, making it easier for them to handle an in-house billing and coding department. However, the task may be much more difficult for smaller centers. "When you're all alone, you don't have the resources to handle it all," says Ms. Ziegler-Otis. "It is impossible to take care of maintaining quality and improvements as well as billing and coding."
4. Research billing options. Even if your billing and coding operations are going well, it may still be worthwhile to explore what an outside option could bring to your center. You may find that it's not a good fit at the moment but then you would at least have a better idea of an alternative for the future. Or you may discover that your operations could see some strong improvement with major or even minor changes.
If you decide to explore whether outsourcing may be a good fit for your ASC, Ms. Ziegler-Otis says one of the most important steps is to do your homework when it comes to the availability of billing and coding service providers. She suggests researching potential providers on the Internet to determine which ones focus on ASCs.
"Just like the concept of centers of practice for expertise in specific specialties (such as, centers of excellence for orthopedic care or cardiac care), you can say the same for billing," says Ms. Ziegler-Otis. "If their focus is on ASCs, you can be more assured they will remain current on regulation and changes and billing nuances as this is their main focus and it is not diverted by focusing on a variety of areas such as hospital and clinic so they have to be everything for everyone."
She also notes that only a handful of software vendors that provide ASC software, which can be a hurdle for billing companies who do not specialize in ASCs to jump over. "In our use of the billing company, we were using a software they were already comfortable with and using so that the transition/training time was faster," she says.
5. Internal reporting capability. Ms. Ziegler-Otis suggest that administrators should take a look at what you are providing to your board members for internal reporting related to billing operations. Another thing to look at is if you are able to meet the best practice benchmarks as it relates to billing. "With handling many other facets, it is difficult to put the time into the capture of specific reporting information that is of value to the board in an efficient and effective manner," she says.
Billing companies provide a monthly report that encompasses the various facets of the billing process that can be used for board reporting, according to Ms. Ziegler-Otis. "In addition, many of the elements captured can be benchmarked with other facilities, which enhances the usefulness of the information being reported," she says.
Six benefits of outsourcing
There are several potential benefits that can come from an ASC outsourcing its billing and coding operations. Here are six that Ms. Ziegler-Otis has seen at her facility.
1. Reductions of days in accounts receivable. It may be difficult for smaller centers to keep track of A/R on top of the numerous other responsibilities of the staff. In addition, a billing company may be able to take quicker action than the center itself. Before outsourcing, Ms. Ziegler-Otis' center had reached an all-time high of 100 days in A/R. With the assistance of the outsourced billing and coding company, follow-up begins no later than two weeks after the procedure. Since choosing to outsource, the ASC has reduced the time in A/R and set a monthly benchmark of 40 days. In Jan. 2009, it was able to beat this mark with an average of 38 days in A/R.
2. Expertise in working with patients. Billing companies can assist surgery centers in receiving payments from their patients. Rather than accepting the payments that patients are able to provide, billing companies have the expertise to help patients set up payment plans, which means potentially more revenue for the center.
3. Collections. In addition to setting up payment plans, billing companies can be helpful in guiding payments to collection agencies, when necessary, as many centers do not have the experience in this area.
At Ms. Ziegler-Otis' center, the billing company was able to set up a system before turning patients over to collection agencies. After sending three follow-up letters, Ms. Ziegler-Otis could send a letter under her name and call patients directly. Ms. Ziegler-Otis notes that this personal step is important, as her center is in a small community. As a result of this combined approach to collections, the center was able to reduce the number of patients sent to collection by 50 percent.
4. Software issues. According to Ms. Ziegler-Otis, a billing company can help your surgery center with any clearinghouse issues it may encounter.
"We transitioned to a new software and clearinghouse as we transitioned to the billing company — all at the same time," she says. "As a result, claims were not processing as needed. However, having the dedicated expertise of the billing company on this issue allowed this to be resolved."
Ms. Ziegler-Otis notes that if her center had to have worked on these issues on top of handling other facility operations, clearing up problems would have taken much longer. "Because the company was already familiar with the ASC software that we were transitioning to, they were very helpful in assisting us with understanding how the billing area functioned, how to access information, and so on," she says.
5. Relationship with payors. One advantage of using a billing company is that a billing company is able to "speak to payors in their own language," according to Ms. Ziegler-Otis. This knowledge can help when assuring the payments receive correlate with what was agreed to in the contracts.
"They work closely with your individual contracts to assure you are paid what you supposed to be paid," she says. "Though one could say this happens with an internal billing department, in reality, as you continue to grow, usually the last area to add resources is the non-clinical areas, and as a result, you expect existing staff to do more and more."
6. Reduced workload. Finally, Ms. Ziegler-Otis says, "Administrators wear so many hats; it can be nice to get rid of one."
"Anytime as an administrator you can move out of the day-to-day time routine items, you can focus your time on areas which maintain and enhance the overall center's operations," she says. "There is always something new on the regulation or compliance front to pay attention to (such as new CMS regulations). There are also opportunities that are presented by the owners for you to explore or work through. Many of these items are strategic in nature and require time and effort for development. Freeing one of daily tasks allows more time for both the future planning of projects/activities as well as execution and implementation of planned activities."
Ms. Ziegler-Otis notes that when you outsource your billing to an outside company, it is important to remember that you are the client and treated as a customer to make sure you are delighted with the services. "This is a different perspective than if you have staff doing this task internally," she says. "You expect the activities to get done with the staff and time you allocate. With a billing company, they expend the resources needed to assure you are delighted with the service."
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