At the 19th Annual Ambulatory Surgery Center Conference in Chicago on October 27, two ASC executives shared best practices for business operations. Carolyn Whitsel, senior director of business operations for United Surgical Partners International, and Margaret Chappell, RN, senior vice president of operations for Ambulatory Surgery Centers of America, discussed ideal business practices in the ASCs. The discussion was moderated by Holly Carnell, JD, lawyer with McGuireWoods in Chicago.
Q: What are some of your top priorities in business management?
Carolyn Whitsel: We want to make sure we get scheduling from physicians, verify procedures well ahead so we can calculate deductibles we want to collect up front.
Margaret Chapppell: Providing excellent service to physicians, staff and patients. The business office is the first encounter patients have with the surgery center, so you have to nail it on the first visit.
Q: What are the expectations for business office employees?
CW: First off, when they're hired, we lay down what the job expectations are and our policies and procedures state we collect this upfront. My team goes out and teaches it, they run reports to ensure it's being done. If not, they contact business office manager. On a side note, as far as counseling, if we have an employee who is not doing what is expected, then we sit with them to plan what we expect them to improve upon and a timeframe. Then we meet at end of that timeframe. If those expectations still aren't met, then we'll [set another timeframe] and begin a write-up program.
MC: It's communication, setting the standard and letting the employee know what the standard is ahead of time. We have benchmarks and [those are] clearly communicated to every employee. When I'm in the center, I usually look at 60 to 80 records every month in the system. Sometimes it involves calling the patient to ensure what's in the system was said to the patient. In the end, the administrator is accountable, but everyone in the office [is part of] a team effort. If you let [employees] know what they need to accomplish, they will. But [we do not offer] financial incentives.
Q: What are the top compliance issues that keep you up at night?
CW: Medicare compliance is a big one. There is something called Medicare secondary payor questionnaire. It states that any provider to a Medicare patient needs to have that form filled out to make sure Medicare is the primary payor. That's something we've always had our centers do, but now with RAC audits, they're starting to hit surgical hospitals. If they're looking for it at hospital level, they'll start looking for it at ASC level. Segregation of duties is a compliance piece for us. You don't want your payment poster to be your collector if the office staff is large enough. Typically, we do an audit every quarter of all of our centers.
MC: Absolutely. We also do coding audits quarterly, internal and external. We outsource our coding. You just have to continuously watch what is going on in your center.
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Q: What are some of your top priorities in business management?
Carolyn Whitsel: We want to make sure we get scheduling from physicians, verify procedures well ahead so we can calculate deductibles we want to collect up front.
Margaret Chapppell: Providing excellent service to physicians, staff and patients. The business office is the first encounter patients have with the surgery center, so you have to nail it on the first visit.
Q: What are the expectations for business office employees?
CW: First off, when they're hired, we lay down what the job expectations are and our policies and procedures state we collect this upfront. My team goes out and teaches it, they run reports to ensure it's being done. If not, they contact business office manager. On a side note, as far as counseling, if we have an employee who is not doing what is expected, then we sit with them to plan what we expect them to improve upon and a timeframe. Then we meet at end of that timeframe. If those expectations still aren't met, then we'll [set another timeframe] and begin a write-up program.
MC: It's communication, setting the standard and letting the employee know what the standard is ahead of time. We have benchmarks and [those are] clearly communicated to every employee. When I'm in the center, I usually look at 60 to 80 records every month in the system. Sometimes it involves calling the patient to ensure what's in the system was said to the patient. In the end, the administrator is accountable, but everyone in the office [is part of] a team effort. If you let [employees] know what they need to accomplish, they will. But [we do not offer] financial incentives.
Q: What are the top compliance issues that keep you up at night?
CW: Medicare compliance is a big one. There is something called Medicare secondary payor questionnaire. It states that any provider to a Medicare patient needs to have that form filled out to make sure Medicare is the primary payor. That's something we've always had our centers do, but now with RAC audits, they're starting to hit surgical hospitals. If they're looking for it at hospital level, they'll start looking for it at ASC level. Segregation of duties is a compliance piece for us. You don't want your payment poster to be your collector if the office staff is large enough. Typically, we do an audit every quarter of all of our centers.
MC: Absolutely. We also do coding audits quarterly, internal and external. We outsource our coding. You just have to continuously watch what is going on in your center.
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