Spot and Stop These 7 ASC Business Office Pitfalls

Posted on 1 Sep, 2017 |comments_icon 0|By Elizabeth
[addtoany]
1-3

Is your ASC’s business office set up for optimal profitability and compliance? Chances are that it’s not, says Cristina Bentin, CPPM, CPCO, CCS-P, CMA, President of Coding Compliance Management in Baton Rouge, LA. As a consultant, Bentin helps ASC managers spot and correct problems.

She highlighted the biggest pitfalls she sees for attendees at the 2017 Ambulatory Surgery Center Association (ASCA) annual conference and outlined tips for improving billing and collections processes.

 

Pitfall #1: Business office staffing isn’t a priority

Don’t let ASC staffing be an afterthought. You don’t want someone who has only posted cash at a physician office to be posting carrier payments at the ASC without any training, for example.

Make sure that you hire qualified, experienced staff, develop clear job descriptions, train them well, and monitor their performance with productivity benchmarks, Bentin says.

Pitfall #2: The patient registration desk does not set up the billing office for success

The lack of staff training contributes to this problem. Often, the least experienced employees end up checking in patients at the registration desk. These unseasoned employees make mistakes because they lack training and don’t have any policies and procedures to refer to. As a result, the business office lacks the information it needs to file clean claims.

Here are the problems Bentin sees most:

  • Insurance verification and pre-certification is not performed consistently.
  • Patient information is missing or entered into the system incorrectly. To prevent this problem, have the patient review the face sheet, Bentin suggests.
  • There is no copy of the insurance card. Don’t rely on the old chestnut front desk insurance question and ask “Has anything changed?” Bentin urges. Scan, swipe, or copy the card and keep it on file.

Pitfall #3: Financial functions aren’t appropriately segregated.

A lack of “checks and balances” leads to mistakes and can even set the stage for employee embezzlement.

Make sure your ASC establishes checks and balances among:

  • Coder/biller, payment poster, and collections.
  • Mail clerk, payment poster, front desk collections, and staff doing deposits.
  • Materials management ordering and receiving.

Pitfall #4: Slow claims processing. Bentin recently consulted with an ASC that was taking an average 7-14 days to submit claims, and that’s a problem.

To solve the problem, begin by looking at when the documentation was transcribed. If transcription happened 12 days after the procedure, for example, you need to work with surgeons as well to speed up claims processing. You should also maintain a transmission log to help you determine whether claims stall in the business office after transcription.

Your ASC should file all claims no later than three days after the date of service (DOS).

Pitfall #5. No one in the ASC’s business office is working denials.

If you aren’t routinely looking for denial patterns and sharing them with staff to fix (here’s where good, frequent communication comes in again), your ASC is losing revenue.

Make sure that someone is reading denial codes on the explanations of benefits (EOBs) and remittance advice (RA). Below are the most common reasons for ASC denials according to Gina Hobert, MBA, CHC, CPC-I, CPCMA, CEMC, CRC, Senior Manager at Baker Newman Noyes:

  • Unbundling
  • Mutually exclusive procedures
  • Duplicate services or frequency of services
  • Lack of medical necessity
  • Age or gender missing from documentation
  • Claim has triggered a National Correct Coding (NCCI) edit or a Medically Unlikely Edit (MUE).
  • Local Coverage Determination (LCD) or National Coverage Determination (NCD)
  • Use of deleted codes
  • Improper use of modifiers

Pitfall #6: Management of collections and A/R is subpar.

A well-managed business office should follow-up on unpaid claims within previously determined timelines and work accounts receivables daily. Owners and managers should see A/R reports and business office staff should be able to adjust or write off A/R only if the amount falls within a predetermined limit.

Pitfall #7: Insurance contracts are a mess.

How many staff in your ASC’s business office can actually locate current versions of insurance contracts? Make sure a paper copy is accessible to everyone or available to everyone on a server. Make someone accountable for checking for updates and whether terms should be renegotiated or revised.

When you renegotiate your ASC’s insurance contracts, make sure you involve coders and billers as well as ASC management. Why? It’s often coders and billers who are most familiar with sneaky payer tactics that are costing your ASC money day in and day out.

Are your ASC profits panning out?

Feather your financial nest and secure the ROI you deserve with How to Lead Your ASC to Excellence and Profitability: A Guide to Making the Right Decisions for Your Ambulatory Surgical Center.

Author

Elizabeth


More from this author

View More

Leave a Reply

Your email address will not be published. Required fields are marked *

Newsletter Signup

Top