Transforming your business office into a "well-oiled machine" requires a series of ongoing tasks consisting of checks and balances and education.
This auditing process should be ongoing rather than viewed as a monthly "must-do" chore. If approached positively, your staff and administration can develop a stronger bond of communication and staff will appreciate knowing what is expected of them and develop pride in performing their duties well.
Follow these three steps to conduct an effective audit of your business office performance.
Step 1: Establish performance objectives
The following are some suggestions for possible areas you may wish to evaluate/measure:
• Registration (demographic entry), which should be performed as soon as the case is scheduled.
• Insurance verification, which should be completed at least one week (preferably two) prior to the date of the procedure.
• Patient financial calls, which should be completed at least three days before the procedure but preferably 7-14 days.
• Coding and claim submission, which should be completed within 48 hours of receiving the operative report.
• Medical records, which should be completed within 30 days of the date of service or as required by your medical staff's by-laws.
• Refunds, which should be processed within 30 days of overpayment or as dictated by state or payer regulations.
• Accounts receivable over 120 days, which should equal no more than 10% of your total accounts receivable.
• Total days in accounts receivable, which should be fewer than 50.
Step 2: Staff education
After identifying areas of focus and their objectives, explain your goals to staff. Advise them that you will be auditing these processes on a continuing basis. Educate them on what role each will play in the overall patient care experience and how these performance checks and balances will improve the functioning efficiency of the business office.
Step 3. Determine auditing schedule
Auditing should be an essential component of daily business office tasks. To help ensure you do not miss a critical area for review, develop and follow an audit schedule.
Below are suggestions for areas you can concentrate on daily, weekly and monthly. These may need to be adjusted until you determine what works best for your center. These also may vary depending on whether your revenue cycle management is performed on-site or outsourced. Most audits centered on coding, billing and collections should be conducted regardless of whether your in-house staff members or outsourcing partner perform these tasks. Your off-site billing company should be considered an integral part of your business office staff with the same impact on the patient-care experience as those staff members present in the center.
Daily audits. Consider the following:
• Verify that all coded charges were entered.
• Check that all claims were submitted and accepted by the clearinghouse or, if applicable, were mailed for the current posting date.
• Review all denials to look for trends. Investigate as needed.
• Review bank deposit before it is taken to the bank. After deposit is made, verify that the bank receipt and deposit ticket match.
• Verify the patient schedule for the current day and the next day are accurate (e.g., all cancelled cases deleted, add-ons added).
• Scan the schedule for possible non-ASC approved procedures.
• Verify that all charts (paper or digital) are complete for the next day's patients.
• Verify that all patient insurances for the next day were verified and documented in the computer.
• Verify that all patients owing money for the next day were contacted and payment arrangements were made.
• If applicable, verify that all patient charts are stored in the medical records room and secured appropriately.
• Verify that all mail was sent.
• Verify that a computer backup is performed daily.
Weekly audits. Consider the following:
• Print an accounts receivable summary report and check for any problems with insurance carriers. Contact billing company, if applicable.
• Print weekly collection reminder notes to ensure all accounts are being worked appropriately, if applicable.
• Verify the status of all operative and pathology reports. Follow up on delinquent reports, enlisting the administrator's help if needed.
Monthly audits. Consider the following:
• Audit 10-15 write-offs for accuracy.
• Audit 10-15 accounts for accurate and timely coding and billing.
• Audit 10-15 accounts over 90 days of age for appropriate collection activity.
• Audit 10-15 cash receipts against the deposit log and the computer to ensure accurate posting.
• Audit 10-15 credit balance accounts to ensure refunds are issued accurately and in a timely manner.
• Audit 10-15 charts (paper or digital) for preparation accuracy. Check that co-pay/deductible information is in the chart/computer.
• Review the current insurance contract listing and add or delete as needed.
This list may seem daunting at first. However, if approached effectively and enthusiastically, these tasks can quickly become a part of the day's routine. Monthly audits take a little more time but must be completed during the same time period as month-end closing.
The reward for this diligence comes when a patient satisfaction questionnaire mentions a positive comment on the business office staff. Be sure to share this praise with staff members.
Caryl Serbin, RN, BSN, LHRM, is president and founder of Serbin Medical Billing, an ASC revenue cycle management company. Serbin Medical Billing's primary objectives are to provide the best coding, billing and accounts receivable management services available to ambulatory surgery centers (hospital joint-venture, corporate-owned or independent) and anesthesia providers. Ms. Serbin has been a leader in the ASC industry for 30 years. She was the founder of the first ASC-specific billing company.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.