Addressing front desk issues helps ASCs optimize revenue cycle

“How do I keep patients happy, while making sure they pay their bills, on time and in full?”

That’s the critical revenue cycle question today for ambulatory surgery centers (ASCs). While survey after survey shows patients overwhelmingly prefer the care they receive in ASCs and other outpatient facilities, more than one-quarter of bad debt, as a percentage of net patient revenue, originates in an outpatient setting, according to an Advisory Board study.

Outpatient surgery bills also are some of the most expensive write-offs for providers, the study shows: On a per case basis, the average bad debt associated with outpatient surgery was approximately triple that of imaging, emergency room visits and other non-inpatient, hospital-based care.

Combined with an increase in patient financial responsibility, a key goal of the Affordable Care Act, these write-offs could increase if outpatient providers don’t mitigate the risks. According to The Henry J. Kaiser Family Foundation, deductibles for employer-based plans increased by an average of 255 percent today as compared to ten years ago. And there’s little indication of this cost-shift letting up. In the coming years, patients may be responsible for paying as much as 40 percent of the overall cost of healthcare procedures—roughly twice what it is today.

With more payments coming directly from patients, front desk operationsplay an increasingly important role in optimizing a surgery center’s revenue cycle. By focusing resources on these important steps, however, facilities can limit their financial risk and make their patients happy.


Successful outpatient surgery centers share one thing in common: a relentless focus on effective staff and facility utilization. Efficiency and accuracy in scheduling cases limit downtime and unnecessary labor costs. So to ensure success in this critical function, your front desk staff must be trained to handle multiple tasks, including capturing all relevant patient information to avoid payer based issues or denials; they need to understand the individual provider’s scheduling rules in order to avoid cancellations; they need to be able to effectively communicate with patients to advise them regarding their financial responsibility and documentation requirements; and they must capture all calls, call backs, voice mails and online inquiries. Prospective patients should be contacted and scheduled as soon as possible.

In addition, front desk staff should have at least six weeks of each physician’s availability on hand at all times. These details will allow them to fillout the long-term schedule and book any empty near-term slots. The operations team should understand the various policies associated with Medicare, self-pay, workers’ compensation, motor vehicle accidents and other typical payers.

Patient accounts

In 2013, J.P. Morgan published an analysis of the current forces affecting healthcare’s new revenue cycle, finding that “the current systems infrastructure in most provider organizations is not designed to provide the necessary level of detailed, accurate and timely payment processing service to patients. Hospitals and clinics often have manual processes for verifying eligibility, requesting payment, collecting and posting payments and managing exceptions.”

“Clearly, providers are in a position to lower many healthcare consumers’ barriers to paying,” the J.P. Morgan study concluded at the time. “One approach would be to adopt new approaches to make payment more convenient and less confusing. A second approach would involve helping consumers distribute their healthcare costs over time.”

Three years after the J.P. Morgan study initially was published, these recommendations still largely hold true. Front desk staff should be trained to collect co-pays, co-insurance and deductibles up front, and credit card payment information should be gathered for completing future transactions—a step patients say will make them more likely to meet their financial obligations at the doctor’s office.

“A McKinsey Quarterly survey of retail healthcare consumers showed that 52 percent of consumers would pay from $200 to $500 or more by credit or debit card when they visit a physician, if an estimate was provided at the point of care,” according to the J.P. Morgan study. “When asked why they would opt not to pay a medical bill, the survey respondents indicated that a lack of options for payment plans, poor timing of bills and difficulties coping with confusing statements or policies were major barriers to paying.”

A patient’s benefits should also be verified and gathered during every visit, including copies of front and back of insurance and photo ID cards. And if not paying in full, patients should be made aware of a payment plan’s full guidelines and their obligations under it. Finally, patients should be provided details on how to use online portals—HIPAA-secured communication tools that allow patients to proactively provide and maintain demographic and insurance information, view payment history and pay their bills.

Physician relations

“Today, physicians are spending approximately 20 percent of their time on administrative tasks,” according to a 2014 survey by The Physicians Foundation. “Doctors spending more time on administration had lower career satisfaction, even after controlling for income and other factors,” the study concluded.

Therefore, it is critical that every step should be taken to minimize administrative responsibilities, many of which result from the patient responsibility process. Helping physicians minimize their administrative responsibilities not only makes them happier, but it also can increase patient satisfaction and optimize the revenue recycle: Less unnecessary paperwork means more time to spend with patients. Communication between the physicians and their front desk staff plays a critical role in minimizing these tasks. Specifically, front desk staff should keep current with carrier-related policy changes, conduct research on reimbursement changes, and communicate any updates to physicians, so they can determine if a given procedure should be approved for an outpatient setting and payable by a given contract.

Working together, the clinical and front office staff can limit the number of denials and unreimbursed procedures—and scheduling, patient accounts and physician relations are just the beginning. Coding, managed care contracting, claims and payment posting and other important components of the ASC revenue cycle also should be analyzed to determine if staffing changes or additional front desk training is necessary. Understanding the risks in all of these key areas, and how they can be minimized, can help outpatient facilities successfully address their front desk challenges and minimize their financial exposure.

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