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Workflow Fixes to Improve ASC Business Management

Tuesday, April 16, 2019   (0 Comments)
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April 16, 2019, ASCA News Digest  

Via Gastroenterology & Endoscopy News, Shaw, Gina 


When Coding Compliance Management, a health care consultancy specializing in ambulatory surgery centers, conducts assessments of ASC business offices, the assessors frequently find many of the same mistakes at different ASCs, according to the company’s president, Cristina Bentin.

During a webinar titled “A Successful High Performance Revenue Cycle,” sponsored by the Ambulatory Surgery Center Association, Ms. Bentin discussed six key areas in which they often find gaps and errors and made suggestions for ASCs to improve workflow efficiency and optimize reimbursement.

Staff benchmarks. In many cases, ASCs have “no benchmarks for staff, and they don’t know what they’re trying to achieve,” Ms. Bentin said. “You need to establish benchmarks—the minimum that each staff member is expected to be doing, for every position in your business offices. You also need a written orientation for the various revenue cycle processes, and schedules for evaluating staff according to the benchmarks you set.”

Interoffice communication—or lack of it. Some of the ASCs that Ms. Bentin and her team visit rely almost solely on email communications. “These can easily be misinterpreted, leading to either a waste of time or World War III,” she said. She recommended establishing weekly and/or monthly face-to-face meetings, as well as periodic meetings for significant changes, such as revisions to a major contract. “And don’t segregate your departments to the extent that one doesn’t know what the other is doing. We’ve seen different departments in the business office, or the business versus the clinical side, completely clueless as to the others’ processes, which may result in duplication of work or disparity of decisions for the same accounts.”

Precertification of patients. One of the biggest problems here is missing or incorrect demographics, such as a transposed or omitted Social Security number or incorrect birth dates. Ms. Bentin said if someone makes an error in demographics, “whoever makes the error corrects the error. If someone in collections or denials is correcting the errors when they’ve been made up front, then the person who’s making them will never learn. Send errors that are made up front back up for correction.”

Overreliance on online insurance verification. Although you can check online with a particular carrier to see whether your patient is insured, you are unlikely to be able to verify the coverage for a specific procedure under that patient’s plan.
Segregation of duties. Unless your facility is very small, checks and balances should be maintained between the roles in your business office. “The coder and biller should never also post payments or perform write-offs or deposit the incoming checks,” said Ms. Bentin. “Your mail clerk, your payment poster, your front desk collections and your staff performing deposits should be different people, as should the people doing materials management ordering and receiving or approval limitations.”

One red flag: staff making deposits after clocking out for the day. “That’s a huge risk for the staff member and the facility,” said Ms. Bentin. “Anything could happen between the time they clock out and when they make the deposit.” In one example she related, a staff member said that “if she didn’t have time to deposit the check on her way home, she would wait until morning and deposit the monies collected at the front desk on the way in.” Ms. Bentin stressed that this should never be done.

Delays in coding and billing. All claims should be filed, coded and ready to bill to the insurance carrier no more than 72 hours after the procedure. “Timely and accurate billing is critical to reducing days in accounts receivable,” Ms. Bentin said. “Monitor this periodically by pulling random accounts to see when the operative note became available to code, when it was coded, and how long after the time it was coded it was billed. Once an op note is coded, it needs to be billed that day or the next day.

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