6 Tips on Managing Business Office Staff in an Ambulatory Surgery Center

A productive business office is essential to get claims paid on time, which in turn impacts profitability. Adriaan Epps, director of contracting services for abeo, discusses six ways to maximize productivity in your business office.

1. Hire certified coders.
Mr. Epps says it's crucial for surgery centers to hire certified coders to handle coding issues. According to the AAPC 2012 Salary Survey, 54 percent of healthcare employers require certification today, compared to 47 percent in 2008. Mr. Epps says certified coders are essential to getting your claims paid on time, because a problem with coding will result in a denial that may involve a lengthy appeals process.

"Organizations I used to manage didn't have the proper staff," he says. "The doctors were just hiring friends or family members, and that was problematic. Just because they trust them, doesn't mean they're qualified to do the job." According to the AAPC survey, the level of credentialing can also give you an idea of average years of experience. According to the survey, CPCs had an average of 12 years of experience, while CPMAs and CPC-Hs had 14, and Certified Professional Coder—Instructors had 19.

2. Prioritize medical record staff with healthcare experience. Mr. Epps says it's important to have the proper personnel to manage medical records and transcription. "I frequently see that these staff members either don't have healthcare experience, or there's no training in place," he says. "They need to have some insights into ASC services and healthcare."

Ask about healthcare experience during the interview process; if your staff members are managing medical records, they should have familiarity with your EMR system — or you should have an in-house or external program to get them trained.

3. Conduct regular audits.
Make sure you're conducting regular audits to ensure quality in your business office, Mr. Epps says. "Audit medical records to make sure the coders are effectively coding things in the record and that the record is filled out properly," he says.

Once a month, for example, you can go through the records and mark down any problem areas. You should also track the collection of co-insurance and co-payments up front; are your staff members sticking to your policy of always asking for payment before surgery, or are they letting the patient off the hook because they feel uncomfortable?

4. Disseminate information through an EMR. How is information in your physician practices and surgery center disseminated to the team? Mr. Epps says at this point, you should be thinking about or implementing an electronic medical record.

"Physician schedules and other items should be disseminated to the back office personnel through a system like an EMR," he says. "If you're doing it with paper, you probably shouldn't be anymore." He says an EMR also makes it easier to conduct audits, because all the information is stored in the electronic system.

5. Meet regularly to discuss progress and patient feedback. Make sure your business office team is meeting on a monthly basis at minimum. At the meeting, you can discuss progress towards your collection goals and A/R turnover. You can also discuss feedback from physicians and patients — for example, are physicians saying it's difficult to schedule cases at the ASC because the scheduler is late getting back to them? Have patients complained about the service?

"You need to look at what you can do to improve the process in regard to patient feedback surveys and physician surveys," Mr. Epps says. "Otherwise, the patient could go to their primary care physician and say they want to go somewhere else. They could say, 'The staff member was more interested in playing [computer games] than in talking to me about my insurance benefits.'"

6. Target inefficiencies. Talk to the head of your business office to determine how many hours are devoted to each task. "How many hours are allocated for this activity instead of that?" Mr. Epps says. For example, maybe you have someone calling patients on the phone, but they take an excessive amount of time to get the conversation to a productive place.

Perhaps that person could be better utilized in a different position, to make sure you aren't spending fruitless hours calling patients who still aren't paying. He says if you recognize inefficiencies, you should put an improvement plan into action immediately. Meet with your staff to discuss the problem and ask for suggestions for improvement. Often, the low-level staff members will have a better idea of time-wasters in your facility than the management.

Related Articles on Coding, Billing and Collections:
6 Steps to Prepare for ICD-10's Detailed Code Set
6 Tips to Overcome Payor Concerns With Spine Surgery in ASCs
How Often Do Physician Offices Accept Medicare and Medicaid?

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