Administrators and business office managers who can clearly outline the processes to observe when completing key business office tasks and who are able to ensure that designated personnel comply with those processes are more likely to find their centers are stable and profitable.
To ensure your center falls into this category, here are best practices for seven essential business office functions.
1. Scheduling
ASC scheduling is nothing short of an art form. The more successful facility schedulers achieve the following:
- build relationships with schedulers in every physician’s office that frequents your center;
- create a user-friendly, efficient scheduling process that allows the physician’s scheduler to check that particular task quickly off his/her assignment list;
- know physician practice patterns and adjust the schedule accordingly;
- effectively juggle the various needs of the cases being performed with the facility’s available resources; and
- remain in tune with, and aware of, specific coverage restrictions relating to the facility’s managed care contracts.
2. Verification
Many ASCs skip the insurance verification step when they become very busy. Unfortunately, doing so does not bode well for the ASC’s financial stability. After all, there is no point in increasing your volume if you are unable to fully capture the reimbursement related to that volume. The verification process should include the following:
- ensuring an authorization process is in place;
- assessing available procedure-specific benefits;
- determining the patient’s financial responsibility;
- conveying financial responsibility clearly and concisely; and
- clearly outlining payment expectations to the patient prior to the scheduled date of service.
Make “no surprises” become the mantra of staff performing verification tasks.
3. Registration
Even with preparation, patients typically experience a measure of anxiety and/or discomfort upon arriving for their procedure. Ensuring the registration process is patient-friendly is imperative.
Pre-registering patients minimizes the time the patient spends filling out forms and provides them with an opportunity to ask last minute questions. This approach creates a subtle shift in focus — the patient receives a strong message that you are intent on serving them rather than having them meet your documentation and information collection needs.
Their initial ASC encounter becomes one where a communication stream is created. Make patients feel like they are being treated as a person rather than a conveyor belt object: “Fill this out. Sign here, now here. How do you intend to pay? NEXT!”
It is also essential to ensure the information that has been obtained is accurate. Avoid the transposition of identification numbers, the use of nicknames rather than legal names and outdated addresses, for example. This will help to ensure unnecessary delays in the reimbursement process are bypassed.
4. Coding and billing
If scheduling is an art form, coding is an exact science. It is an extremely difficult job to master and, given the continued gap between the rates hospital outpatient departments receive compared to the rates received for the same procedures performed in ASCs, it is crucial to capture every dollar your facility is entitled to based upon the work performed. Your certified coder(s) should perform the following tasks:
- create a safety net to capture all cases;
- code directly from the operative report, not a super-bill;
- bill only what is documented using the narrative dictated by the physician to substantiate the charges;
- ensure the diagnosis is specific using the operative report/procedure note narrative to underscore subtleties between diagnoses;
- apply the correct modifiers in an accurate coding sequence;
- identify excision sizes via pathology reports;
- capture implants used during the course of the case; and
- ensure sent claims are accepted by the clearinghouse and the third-party payor.
Provide your coders with continuing education opportunities and regular feedback on their performance gleaned from external coding audits. They will appreciate the chance to improve, fine-tune their skills and appropriately increase your bottom-line income.
5. Accounts receivable follow-up
Following up with third-party payors on outstanding accounts receivable (A/R) should occur within 21-28 days after the initial claim has been generated and on a routine basis thereafter until payment in full is secured. The most effective follow-up personnel:
- create relationships with the payors;
- consistently work the facility’s aged A/R report;
- respond to correspondence daily;
- identify denial trends and assist with putting processes in place to avoid rejection of claims and deal with issues that are attributable to specific third-party payors; and
- obtain answers to these questions:
- What is the name of the payor representative you are speaking with? How can you reach them directly if you need to follow-up again?
- When was the claim received? What is the status of payment?
- When was the check cut? What was the payment amount? What is the check number and date sent?
6. Payment posting
Payment posting goes beyond dropping the third-party payor funds onto the patient account, applying the contractual write-off noted on the payor’s explanation of benefits and then transferring the remaining balance to the patient’s responsibility. Facilities who manage their payment processes well ensure:
- payor specific contracts are loaded into their patient accounting systems and queued to post contractuals at the time of billing;
- payments are posted by line-item, thus creating automatic identification of discrepancies between anticipated payments (those outlined in the facility’s contract with the payor) and actual payments received;
- applicable balances are promptly transferred to patients and secondary payors;
- patient statements are generated within 7–10 days of the balance becoming the patient’s responsibility;
- a reliable, effective communication loop is established with coding, billing and A/R follow-up personnel; and
- refunds are processed daily in deference to the OIG’s fraud and abuse guidelines.
7. Patient collections
Patient collection duties require patience and persistence. Notable success comes to those who:
- create patient relationships;
- clearly define payment policies;
- refer back to information collected during patient registration;
- employ strong customer service skills; and
- consistently and systematically refer accounts to an outside collection agency if the patient does not respond with payment upon receipt of no more than two or three statements.
-- Ms. Woodruff is vice president of corporate finance and compliance for PINNACLE III, a company specializing in the operational development, management and turnarounds of ASCs. PINNACLE CBO, a third-party billing service specializing in ASC and physician billing, is a subsidiary of PINNACLE III. Contact Ms. Woodruff at kwoodruff@pinnacleiii.com. Learn more about PINNACLE III.