5 Steps to a Better-Run Surgery Center Revenue Cycle

Michael Orseno, revenue cycle director for Regent Surgical Health, shares five strategies to improve your ASC's business office processes.

1. Arrange for payment from patients up front. Mr. Orseno recommends arranging for payment prior to the procedure, which doesn't necessarily mean collecting the payment up-front. "The patient should be called prior to the appointment, and their benefits should be reviewed with them," Mr. Orseno says.

Prior to calling the patient, Mr. Orseno says the front desk coordinator should determine how much the patient owes the facility, so the center can present a clear, understandable financial responsibility with an explanation according to the patient's insurance. "The staff member might say, 'In our experience, this procedure will be X amount of dollars, and you have this much remaining on your deductible. You have an 80/20 policy, so you're going to owe $2,700'," he says.

The patient would then submit his or her credit card information and sign a credit card authorization form upon arrival at the center. Once the claim is adjudicated, the center would call the patient and say, "I just want to let you know that your claim has been adjudicated, and per your EOB, you owe $2,700. We'll be charging that to your credit card." This process keeps the patient informed about his or her payment and eliminates any 'surprises' about the amount owed.

2. Take advantage of technology. Surgery center leaders are frequently hesitant to adopt information technology because of costs, time constraints and employee push-back, but Mr. Orseno says technology can significantly improve business office functions if implemented correctly. He recommends the following technological upgrades to an ASC:

A quality desktop scanner. Mr. Orseno says a good desktop scanner will run your ASC around $500. He says his company has scanned around 18,000 documents with the new scanner and has never experienced a problem. "We're completely paperless," he says. "It saves us money in storage costs, and all my billers and collectors are much more efficient."

He says to make sure the scanner helps your business office, you need to have a plan as to how your files will be stored in a hierarchy. He says before Regent implemented the scanner, he talked to the business officer staff to ask how they wanted the charge tickets and EOBS stored. "Some of them wanted them stored by date received; some wanted by date of service," he says. "As long as you get staff buy-in and they know the hierarchy of the storage, you should be fine." He says the company also hired a part-time employee to scan all the old documents and get Regent "up to date" as the company implemented the new scanner.

Electronic payment and attachment posting. Mr. Orseno says many billing software programs allow the ASC to post payments and attachments electronically. He says this technology has helped improve efficiency and accuracy in the Regent business office. "Staff members are much quicker at posting payments and much more accurate," he says. "The file comes in electronically from the payor, so it just populates into the software and they can review it." He says the payment posting process now takes a few minutes instead of up to an hour. He says it's also much quicker to send attachments electronically rather than physically attaching claims on paper.

Dual monitors. Mr. Orseno recommends investing in two computer monitors per staff member. He says while the investment seems like a luxury, an extra computer monitor actually costs around $100, and the ASC can make up for that in efficiency in a week. He says an extra monitor allows staff members to pull up all the files they need without having to print anything out, which cuts down on paper costs and saves time.

3. Lay out expectations ahead of time — and then monitor performance. Make sure staff members understand the goals for their performance, Mr. Orseno says. For example, for your ASC collector, set a goal for the number of accounts they need to work every day. Mr. Orseno says a collector should be expected to work about 25-30 accounts — 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 says. "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 rebill a customer if they weren't billed correctly initially."

Once you've established your expectations, perform weekly and monthly audits of your staff, Mr. Orseno says. 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 says.

He 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.

4. Meet regularly with staff and be open to their suggestions.
Mr. Orseno says some of the best suggestions for business office improvement will come from staff members. For this reason, ASC leadership should meet regularly with business office staff and ask for suggestions for improvement. "The idea for dual monitors in our business office came from one of our billers and collectors," Mr. Orseno says.

He says his office holds bi-weekly meetings, where they discuss specific business office issues for their centers, as well as issues that affect the ASCs as a whole. "For instance, the new Medicare changes in billing — that's something we would bring up as a general announcement," he says.

5. Cross-train all business staff. All business office staff members should be trained to perform duties outside their main job description, Mr. Orseno says. "Make sure your person who's posting payments knows how to schedule, perform follow-up and work the front desk," he says. 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," Mr. Orseno says.

Learn more about Regent Surgical Health.

Related Articles on Coding, Billing and Collections:
12 Steps to More Robust Reimbursement in a Surgery Center
Medicare Physicians Still Code Manually Despite Availability of EHR
5 Core Concepts for a Great Billing & Collections Business

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