ASCs frequently don't pay sufficient attention to billing operations, which can result in overwhelmed staff, uncollected money and significant losses, according to Caryl Serbin, president of Serbin Surgery Center Billing. "ASCs are often understaffed or billing personnel are inexperienced and not properly oriented," she says. Ms. Serbin makes seven recommendations to improve ASC billing operations.
1. Don't decrease billing staff when revenue falls. "When revenue drops, the first place ASCs look to cut staff is often in the business office," Ms. Serbin says. "However, it should really be last place to cut." Struggling ASCs need to make sure they bill and collect for all services performed. "In this slower economy, with line-of-credit loans almost non-existent and ASCs operating with less money in the bank, cash flow is critical," she says.
2. Hire certified and experienced coders and billers. Certified and experienced coders are a good investment as they usually increase revenue by optimizing coding. This can make up for more than the difference in their salary. It's important to employ billers and collectors with on-the-job experience. "Although billing courses and certification are important, a self-taught biller with experience is probably better than someone who only took a course," she says. "In order to remain on top of your accounts receivable, you need to have the best and the brightest."
3. Pay them well. "Generally, ASCs often find it difficult to hire experienced coders and billers because their business office salary budgets are unrealistic," Ms. Serbin says. "Talented billing personnel tend to migrate to the hospital setting, not necessarily because they pay more, but because they offer better benefits," she says. It is more difficult for a small employer like an ASC to have a good benefits package, but competitive benefits are imperative if you want to attract higher-level employees.
4. Set up job criteria and goals. ASCs frequently don't provide job descriptions for billing personnel, leaving staff inefficient and unfocused. Make sure that each employee has a job description that is specific to the tasks you expect them to perform. That is, if they are going to be doing both charge-posting and collections, modify their job template to reflect this. Goal setting is also important. "If you clarify what goals are expected to be met for each task, this will better define how much time needs to be spent for each," Ms. Serbin says.
5. Orient new billing staff. "We frequently find many ASCs have a history of hiring less-than-qualified personnel, throwing them into the job and not giving them sufficient direction," Ms. Serbin says. New personnel need extensive orientation followed by continued oversight and guidance.
6. Hire enough staff. When Ms. Serbin begins working with an ASC, "I'm surprised at the number of hands performing the whole revenue cycle," she says. "The ASC might have 2-3 employees to do the same work that we'd have 6-8 people working on." She prefers not to set a definite ratio of billing people per volume of cases. The number depends on many factors, including the percentage of cases with more time-consuming payers such as worker's compensation.
Ms. Serbin says a good way to determine whether staffing is sufficient is to calculate the total business office man-hours per case that it takes to efficiently maintain your accounts receivable at a healthy level. To monitor accounts receivable, she recommends establishing center-specific benchmarks that include a combination of total A/R, A/R by payor, aging of A/R, days in A/R and the patient portion of A/R.
7. Hire extra staff when necessary. "If you have 30 extra patients, you call in a temporary nurse to help with the cases, but ASCs don't hire extra billing staff to handle the extra caseload," Ms. Serbin says. But in fact, hiring extra staff is just as crucial on the billing side. When billing staff get behind because of a surge in patients, it's hard for them to catch up. She says it might be helpful to hire temporary clerical staff to perform the routine tasks such as filing and sending statements so that more experienced personnel can concentrate on the billing and collections.
Learn more about Serbin Surgery Center Billing.
Read more practical guidance from Caryl Serbin:
- ASC Coding Guidance: Modifier -73 and -74 — Know the Difference
- 8 Quick Tips for Picking the Best Insurance Plans for Your ASC
- 12 Best Practices for Analyzing Business Terminology in Payor Contracts