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River Valley ASC: Mapping Out a Game Plan for Efficient In-House Billing

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Though the market for outsourced services is rapidly growing, many ambulatory surgery centers run in-house billing units. Rich Searles, a Partner with Merritt Healthcare, describes how the three pillars of efficient and effective billing have created a smoothly run in-house department at River Valley ASC in Norwich, Conn.

Opened in August 2013, River Valley ASC is a multispecialty center with 17 physicians actively performing cases there. The business office staff includes a business manager, two FTEs dedicated to billing and collections and an additional three FTEs that focus on scheduling and patient registration, with the capability to provide billing support.

Practice management system
The right practice management system is essential to accurate billing. "You need to know with 100 percent certainty that bills are being processed exactly the way you want," says Mr. Searles. "There is no room for system error when it comes to accurate and clean claims." The right practice management system for an ASC will offer:

•    Vendor supported training, both initial and ongoing
•    Ease of use
•    Ability to extract data for performance analysis purposes

At River Valley ASC, the center's PM system vendor came in and spent hours training the staff and helping them to grow comfortable with the system. Since the center's opening, trainers have returned once or twice a month to check on the staff and ensure that they are able to use all the system has to offer as efficiently as possible. "Take the time to really learn your system. Little features can save time and money," says Mr. Searles.

At River Valley ASC, Mr. Searles and his team hired the billing department from scratch. While billing experience is a definite plus in a potential hire, Mr. Searles found dedication to the job at hand to be the most valuable trait. "I would rather have hard worker with no experience than an apathetic biller with 20 years in the business."

Once an ASC has brought together a trusted team, they can be key in improving the billing and collections process. "Overlooking your staff's contributions is a big mistake," says Mr. Searles.

The framework for strong in-house billing begins with leadership and how the team shoulders responsibility.

•    Oversight: Administrators and business office managers are often in charge of determining how to execute daily processes. "Spend time in the trenches and truly understand your processes," says Mr. Searles. "I don't ask the staff to perform any task in the revenue cycle that I haven't taken the time to fully understand or perform myself."

•    Delegation: ASC leaders need to understand the inner workings of billing and collections, but also how to divvy that work up amongst staff members. Strengthen the billing department by cross training business office staff to ensure one person's absence will not mean billing and collections come to a grinding halt.

•    Checks and balances: Shared responsibility and accountability is important. "One employee performing all tasks with no oversight can lead to problems," he says. "Make sure that all monies are received, reconciled and approved by a manager daily."

•    Daily scorecard: At River Valley ASC, the billing staff takes 15 minutes at the end of the day to send management an account of what was done. "The following metrics are reported to management: number of claims billed, number of pending claims, total dollars received, number of claims paid, number of claims denied and number of A/R claims called upon," says Mr. Searles.

More Articles on Coding and Billing:
PPACA Update: What Do Exchanges Mean for ASCs?
Avoiding ASC Claims Denials in an Age of ICD-10: 8 Key Concepts
AMA: ICD-10 Impact Assessment Checklist

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