Before day of procedure
1. Educate your staff about pain management procedures. According to Ms. Mowles, one of the most important steps that a surgery center can take to ensure efficiency in pain management is to educate all ASC staff about pain management procedures.
“The staff should be educated about each procedure,” she says. “Let all of your staff watch each procedure so they can really understand what each one entails. Staff who understand the pain management procedures taking place will be better able to communicate with expertise and authority with insurance providers, patients and referral sources for scheduling, verifications, payments, and [this approach] will certainly reduce the number of questions your staff has during billing and collections.”
2. Provide consent forms that include all the new Medicare Conditions for Coverage information. Ms. Mowles suggests that facilities give patients a copy of a single consent form with all pertinent information in advance of their scheduled procedure day.
Providing this document to patients in advance gives them time to read the documents carefully and helps pain management providers ensure they are meeting Medicare’s new directives requiring that centers make patients aware in writing of physician ownership and of the opportunity to provide advance directives.
“Pain centers can put all this information ─ ownership disclosure, calls for advance directives, other items of patient consent such as billing procedures and the patient’s financial responsibilities ─ on one form,” says Ms. Mowles. “This makes it easy for the patient and for you.”
The ASC staff must also review the consent form with patients on the day of the procedure. “The consent needs to be reviewed again and initialed on the day of the actual procedure,” she says.
When patients are not seen at a facility before a procedure, Ms. Mowles recommends that centers send a copy of the consent form to the patient via e-mail, by regular mail or perhaps include a copy on the center’s Web site for patients to download.
“For patients not seen prior to procedure, as happens sometimes in a series of injections, you could give them a ‘sample’ copy of the consent along with their prep instructions via mail,” she says. “They then execute the consent on the day of their procedure.
“In either event, the patient has ample opportunity to read every last line of the consent, on their own time and at their own pace,” she says.
Provide the patient with sufficient time to read the consent, rather than simply handing a patient a form and having them sign on the spot. This can help reduce the questions that patients have about procedures and financial responsibilities, thus increasing the efficiency of the center.
3. Verify coverage well in advance of day of procedure. Ms. Mowles stresses that facilities verify patient coverage before the day of the procedure. “Verification of coverage prior to patient’s arrival is key and research on payor policy is imperative,” she says.
Ms. Mowles warns that centers should not rely on referral sources for insurance information. Instead, staff should call payors directly to confirm patient information and coverage in addition to preauthorizing procedures, when required.
Ms. Mowles also recommends that centers clearly define which specific members are responsible for verification. “The biggest problem I see at centers performing pain management procedures is that staff members are not sure which tasks are whose responsibility ─ from insurance verification to turning over procedure rooms,” she says. “Staff members need to be sure of what is there responsibility and what is someone else’s. Pain center leaders need to clearly define job responsibilities for each worker. If this isn’t done, duties will slip through the cracks.”
Ms. Mowles also says that staff time may need to be reallocated to ensure that verification of coverage occurs. “Administrators must be willing to allocate staff time towards verification,” she says. “It is the most important step that centers can take to ensure they’ll get paid.”
4. Educate patients about clinical information and financial responsibilities. Patient education is the key to patient satisfaction and getting paid, says Ms. Mowles. She recommends ASCs provide this information in writing and in person
“Pain management centers should put their financial policies in writing,” says Ms. Mowles. “A document of financial policies should include information about what is due at time of service and any discounts that are applicable.”
Ms. Mowles also recommends that ASCs call each patient prior to their first procedure. This pre-procedure phone call should include a discussion of clinical information for the procedure, instructions for the patient about the procedure and what to bring on the day of the procedure, as well as payment instructions and information about any money due by the patient, which can be determined through proper insurance verification. If a procedure is not covered by a patient’s insurer or Medicare, the phone call should clearly discuss this and the patient’s responsibility for payment.
Ms. Mowle’s advises that pain management centers should consider requiring all new patients to meet with the billing supervisor on their first visit to the center. “Having patients meet with a biller gives the patient an opportunity to gain an understanding of financial responsibilities – whether or not their deductible has been met, co-insurance costs, and co-payments for each visit – and puts a face to your billing office.”
When patients arrive on the day of their procedure, Ms. Mowles suggests handing patients an information card specific to their procedure while they wait. “It’s a great idea to write up an information card for each procedure that describes to the patient what exactly will occur during the procedure and each step of the process,” she says. “This will cut the procedure time because the patient will have fewer questions and won’t be as apprehensive about the procedure.”
Pre-procedure
5. Tailor staffing for each patient. Ms. Mowles says that staffing should be dictated by specific patient needs. Facilities should determine staffing needs before the procedure to make sure staffing is medically sufficient but also financially responsible. “You need to make sure you are not over- or understaffing for your procedures,” she says.
To determine staffing needs, pain management centers should examine patient acuity and type of sedation required, she says.
Ms. Mowles provides the following suggestions for staffing, though notes that requirements may vary by state:
- Sedation monitor: For a procedure where physician performing the case and is also providing sedation, there must be a trained observer to monitor sedation without any other interrupted duties. An RN is the standard.
- X-ray technician: A certified X-ray technician is often required by the state for pain procedures. If it is not required, there is typically some documentation and/or training requirements for physicians to be able operate the C-arm. However, Ms. Mowles suggests that having a CRT in the room, even if it is not required, can improve efficiency be reducing the amount of time needed for each procedure.
- Unlicensed personnel: An additional staff member, such as a medical assistant or surgical scrub technician, could serve as a circulator on more invasive procedures.
6. Ensure that the physician is only performing procedures that are preauthorized and discussed completely with the patient. ASCs need to ensure that physicians only perform procedures that have been preauthorized by a payor since those procedures are the only ones that the facility can be assured will receive payment.
Ms. Mowles suggests that before each procedure the pain management physician and staff take a “team time out.” This time out should occur before any sedation is administered, and the team should verify that they have the correct patient, which procedures have been authorized and that they have the correct procedure sites.
ASCs should also educate physicians on the importance of performing preauthorized procedures only. Facilities may also considering using a locked key on EMRs so that the patient cannot add or change the planned procedures, says Ms. Mowles.
Post-procedure
7. Provide detailed discharge instructions. Detailed discharge instructions will ease patient’s worries and reduce the amount of phone calls a facility receives.
“Discharge instructions should be very specific,” says Ms. Mowles. “They should include information such as ‘this is normal, this is not.’ They should also include the ‘do’s and don’ts’ after a procedure and specific instructions on what to do if a fever, sign of infection or other, specific, adverse reactions occur.”
Ms. Mowles suggests that centers call pain management patients after their procedure, within two business days. “A post-procedure phone call will enhance your satisfaction rate and save you from patient calls at their convenience,” she says. However, Ms. Mowles suggests that pain centers that are unable to call all patients can instruct patients who want a call to specifically request the call. Then, the center is only responsible for calling patients who request this service.
Ms. Mowles (amy@mowles.com) is president and CEO of Mowles Medical Practice Management, which is dedicated to assisting pain management and other specialists develop efficient, productive and profitable ASCs and practices. Learn more about Mowles Medical Practice Management.
