Because of these additional requirements in pursuing your ASC's compensation, it requires more man-hours to bill and collect. Additional staffing is needed for IT software and clearinghouse challenges and employees with this experience usually command higher salaries. As always, additional staffing requires more office space and computers. These increases, along with the increasingly lower reimbursement rates, are negatively affecting your ASC profit margins.
In order for your ASC to afford these additional specialized employees, it's important your business office staff understands their role in the reimbursement cycle. Usually only billers and collectors are considered as reimbursement staff. However, to generate appropriate payments rapidly and accurately, all business office staff needs to be actively involved as well. Even with everyone doing their part perfectly, getting reimbursed correctly and in a timely manner is becoming more and more difficult.
Depending on your ASC's caseload, some positions may be able to be shared. Regardless of the number of employees, it's important to emphasize to each staff member their role in the reimbursement process. The following outlines only the "reimbursement cycle" tasks for each position and does not necessarily list all responsibilities entailed in that job description:
- Scheduler/registration clerk is responsible for obtaining accurate and up-to-date patient demographics and insurance information and ensuring rapid and correct input of data into system.
- Insurance verifier is responsible for full verification of insurance eligibility and coverage; obtain pre-authorization codes where applicable
- Patient financial counselor is responsible for contacting patient and explaining their financial responsibility, offering payment options when applicable
- Receptionist/up-front collector is responsible for collecting agreed-upon payment amount from patient at time of financial counseling, as well as checking insurance card to verify information in computer system
- Coder is responsible for the timely and accurate coding of all services provided by the facility
- Medical records clerk is responsible for providing coder with operative notes, pathology reports and other related reports for optimal coding
- Biller is responsible for the timely and accurate billing of all facility services to third party payers and patients
- Payment poster is responsible for the timely and accurate posting of all payments to patient accounts; deposits; credit balances/refunds
- Insurance collector is responsible for requesting reviews / appeals of incorrect payments or zero payments, follow-up on all overdue balances from third party payers, submission of secondary insurance claims
- Patient/self-pay collector is responsible for generating accurate patient statements and ensuring that these are sent in a timely manner
- IT personnel is responsible for ensuring reliable connectivity, as well as providing regular software and hardware maintenance and updates
- Business office coordinator is responsible for planning ahead and providing advance notification to patient about the ASC's financial practices (brochure, Web site, flyer), as well as oversight of reimbursement cycle effectiveness
Because of the increased complexity of getting paid, the multiplicity of tasks associated with each of the positions listed above and the necessity for cross-training for other positions in the business office, your employees need to be first-rate multi-taskers with healthcare reimbursement experience.
To learn "5 Steps to Finding the Right ASC Reimbursement Cycle Employees," click here.
Learn more about Serbin Surgery Center Billing at www.ascbilling.com.