"It takes two to make things go right," says Nila Dowell, revenue cycle manager at In2itive Business Solutions who spoke at Becker's ASC Review 22nd Annual Meeting — The Business and Operations of ASCs.
In2itive Business Solutions is revenue management and healthcare consulting firm that serves ASCs and hospitals. Although it's based in Overland Park, Kan., the company has done business with a variety of clients from across the country.
While speaking at the Becker's conference, Ms. Dowell highlighted the importance of integrating both sections of an ASC — the front office and the billing team. While the front office primarily works on scheduling and data input, the billing team handles everything from coding and revenue cycle management to billing and follow up.
"The billing team and the front end office are partners, and their relationship should reflect that," Ms. Dowell says. Her presentation focused on what the front end office can do to make the entire process go smoothly.
In2itive researched where problems are occurring in the front end. Over the span of three months, In2itive analyzed 405 cases per month. Approximately 30 percent of errors were caught before the billing left the office. The most common areas in which mistakes were made revolved around patient information: a patient's date of birth, name spelling, claims information and ID number.
To eliminate such errors and the risk of denials, Ms. Dowell suggested a variety of tactics for the front end office:
- Determine whether the patient has the benefits for the scheduled service
- Make sure the insurance in your system matches the patient's insurance
- Inform patients of what types of insurance your center doesn't accept
- Ensure the insurance authorization and verification are completed correctly
- Explain to patients what their financial responsibilities are
- Double check contracts to guarantee that they're current
But it's not only up to the front end office to ensure minimal denials. The billing office also has its fair share of responsibilities. "It takes a strong billing office to identify missteps," said Ms. Dowell. "They should always inform the front office."
For example, the back office should supply the front end with a list of needs and information. Ms. Dowell suggested providing a cheat sheet with insurance prefixes and CPT codes to simplify the experience for the front office.
Unfortunately, providers may still make unpreventable errors. "Once the damage is done, there's no simple fix," said Ms. Dowell. "Someone will always miss the mark, but there's almost always something to be done after the fact."
In Ms. Dowell's experience, sometimes mistakes are a simple case of using different terminology. When a terminology-related mistake is made, the billing team can work with physicians on terminology use.
Overall, both parts of the office must recognize errors and work to communicate. Educate the entire staff about why mistakes are being made. For a successful and denials-free ASC, the front end office and the back end office must work together. "We need to assist the other offices as much as possible. We all need to work as allies," said Ms. Dowell. "It takes two for teamwork."