1. Be clear on employee expectations and monitor performance. Make sure staff members understand the goals for their performance, said Michael Orseno, revenue cycle director for Regent Surgical Health. For example, set a goal for your ASC collector of the number of accounts he needs to work every day. A collector should be expected to work about 25 to 30 accounts, he said, and the definition for "working" an account should be established ahead of time.
"Working an account is not just making a call to the payor and then hanging up when no one answers," he said. "Working an account is a completed action — they've got to receive and post a payment, get confirmation that the payment will be sent, or re-bill a customer if they weren't billed correctly initially."
Once you've established your expectations, perform weekly and monthly audits of your staff. For a collector, the supervisor should go through the accounts and make sure the collector is working them thoroughly. "If you monitor your collector, for example, you won't be surprised by huge spikes in A/R that occur because the collector isn't doing their job," he said.
Mr. Orseno also recommends setting collection goals for the whole team every month. He says a collection goal might be calculated by taking the average of the last three months' net revenue, minus two percent for bad debt. The team should receive a tangible award for meeting collection goals, such as a pizza party or gift cards.
2. Verify registration information with patients and make any corrections immediately. Staff at ASCs should verify patient information prior to surgery, including taking a few seconds to make sure the center has the right address to mail the claim to, said Catherine Meredith, vice president of finance for the Ambulatory Surgery Centers of America. "Taking care of all of this on the front end will ensure your claim is paid very quickly," she said. It's also important to collect the patient's payment responsibility — the co-pay, or co-insurance deductible — as soon as possible.
If patient needs a payment plan, have all the papers signed at admission, she said. ASCs should bill the patient immediately after surgery for the estimated amount they owe.
3. Bill patients immediately after surgery. Third party services can help ASCs obtain debit or credit card information so payments can be automatically deducted. Ms. Meredith said ASCs should aggressively monitor the payment plan. It's important to call and speak to the patient if payment is delinquent. "Passive aggressive behavior is not going to get you your money back," she said.
Even though ASCs want — and need — to be reimbursed, it's also important to empathize with patients struggling to make payments given this is still a difficult economic time for some. Ms. Meredith said ASCs should work with patients to come up with a payment solution fair for both parties.
4. Allow staff to focus on billing. A surgery center's revenue cycle team should not be constantly embarking on special projects, said Caryl Serbin, president of Surgery Consultants of America. Special projects are a sign that routine daily work is not getting done. It could mean a center doesn't have enough staff or the right staff. For example, if your ASC finds a need to have a "special project" for keeping up with payment posting or refunds when you have had no volume changes, then you need to find the cause.
Revenue cycle processes should verge on "boring" because they are so systematic, she said. Ms. Serbin also advises surgery centers to change aspects of the revenue cycle process one at a time. "Don't change 10 things at once," she said. "Change one, monitor it and go forward."
5. Cross-train all business staff. While revenue cycle personnel should be focused on billing tasks each day, all business office staff members should also be trained to perform duties outside their main job description, Mr. Orseno said. "Make sure your person who's posting payments knows how to schedule, perform follow-up and work the front desk," he said. Ideally, each staff member should spend some time every month performing another job function, to make sure they maintain their skills in other areas. "That way, if anyone is out or absent, you don't miss a beat," he said.
6. Immediately follow up on claims, denials, appeals. Surgery centers may fail to follow up on claims, denials and appeals if they lack the necessary staff to do so. Billing teams should keep track of claims to make sure the correct reimbursement is received in a timely fashion; if not, they should take steps to find out what went wrong, Ms. Serbin said. Staff members should feel comfortable using the payor website and making phone calls; sometimes the website is enough to follow up, but often a phone call can save time and help your ASC build a relationship with the payor representative.
Billing staff should also be alert to common payor responses, such as, "The claim is not on file" or "The claim is processing." Be persistent and make sure you understand the status of your claims by the time the phone call is over, she said. Most importantly, document your findings so you can refer to the payor's response later. For example, if the payor says the claim will be paid by a certain date, document the date and then check in to make sure the payor has followed through.
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"Working an account is not just making a call to the payor and then hanging up when no one answers," he said. "Working an account is a completed action — they've got to receive and post a payment, get confirmation that the payment will be sent, or re-bill a customer if they weren't billed correctly initially."
Once you've established your expectations, perform weekly and monthly audits of your staff. For a collector, the supervisor should go through the accounts and make sure the collector is working them thoroughly. "If you monitor your collector, for example, you won't be surprised by huge spikes in A/R that occur because the collector isn't doing their job," he said.
Mr. Orseno also recommends setting collection goals for the whole team every month. He says a collection goal might be calculated by taking the average of the last three months' net revenue, minus two percent for bad debt. The team should receive a tangible award for meeting collection goals, such as a pizza party or gift cards.
2. Verify registration information with patients and make any corrections immediately. Staff at ASCs should verify patient information prior to surgery, including taking a few seconds to make sure the center has the right address to mail the claim to, said Catherine Meredith, vice president of finance for the Ambulatory Surgery Centers of America. "Taking care of all of this on the front end will ensure your claim is paid very quickly," she said. It's also important to collect the patient's payment responsibility — the co-pay, or co-insurance deductible — as soon as possible.
If patient needs a payment plan, have all the papers signed at admission, she said. ASCs should bill the patient immediately after surgery for the estimated amount they owe.
3. Bill patients immediately after surgery. Third party services can help ASCs obtain debit or credit card information so payments can be automatically deducted. Ms. Meredith said ASCs should aggressively monitor the payment plan. It's important to call and speak to the patient if payment is delinquent. "Passive aggressive behavior is not going to get you your money back," she said.
Even though ASCs want — and need — to be reimbursed, it's also important to empathize with patients struggling to make payments given this is still a difficult economic time for some. Ms. Meredith said ASCs should work with patients to come up with a payment solution fair for both parties.
4. Allow staff to focus on billing. A surgery center's revenue cycle team should not be constantly embarking on special projects, said Caryl Serbin, president of Surgery Consultants of America. Special projects are a sign that routine daily work is not getting done. It could mean a center doesn't have enough staff or the right staff. For example, if your ASC finds a need to have a "special project" for keeping up with payment posting or refunds when you have had no volume changes, then you need to find the cause.
Revenue cycle processes should verge on "boring" because they are so systematic, she said. Ms. Serbin also advises surgery centers to change aspects of the revenue cycle process one at a time. "Don't change 10 things at once," she said. "Change one, monitor it and go forward."
5. Cross-train all business staff. While revenue cycle personnel should be focused on billing tasks each day, all business office staff members should also be trained to perform duties outside their main job description, Mr. Orseno said. "Make sure your person who's posting payments knows how to schedule, perform follow-up and work the front desk," he said. Ideally, each staff member should spend some time every month performing another job function, to make sure they maintain their skills in other areas. "That way, if anyone is out or absent, you don't miss a beat," he said.
6. Immediately follow up on claims, denials, appeals. Surgery centers may fail to follow up on claims, denials and appeals if they lack the necessary staff to do so. Billing teams should keep track of claims to make sure the correct reimbursement is received in a timely fashion; if not, they should take steps to find out what went wrong, Ms. Serbin said. Staff members should feel comfortable using the payor website and making phone calls; sometimes the website is enough to follow up, but often a phone call can save time and help your ASC build a relationship with the payor representative.
Billing staff should also be alert to common payor responses, such as, "The claim is not on file" or "The claim is processing." Be persistent and make sure you understand the status of your claims by the time the phone call is over, she said. Most importantly, document your findings so you can refer to the payor's response later. For example, if the payor says the claim will be paid by a certain date, document the date and then check in to make sure the payor has followed through.
More Articles on Coding, Billing and Collections:
Dr. Marc Cohen: 4 Big Coverage Challenges for Spine Surgery
Report: Geographic Medicare Spending Gaps May Be Due to Waste, Overuse
Arizona Healthcare Bill Calls for Cash Price Availability