Special Report:
Defining and Measuring Business Office Staff Performance In Your ASC

First impressions are important, and a member of your business office staff is usually the patient's first contact with your ambulatory surgery center. This initial contact can significantly affect the patient's perspective of his entire surgical experience. Business personnel who conduct themselves as professional and knowledgeable caregivers can assist you in promoting the positive image your ASC wants to portray.

Your ASC's surgical volume and whether your revenue cycle management is in-house or outsourced will determine how many business office staff members you need. Large volume centers will need a staff member for each of the positions listed below while smaller centers may have their staff share some positions and responsibilities.

Whether separate or shared, each of the tasks listed below are necessary parts of the whole in providing a positive patient outcome.

 

POSITIONS/TASKS

Business Office Coordinator

  • Supervises and coordinates duties of business office personnel
  • Human resources and compliance
  • Acts as provider's office liaison
  • Assistant to administrator
  • Understands and can perform all business staff duties as necessary

Scheduler

  • Schedules procedures/preoperative visits
  • Determines if scheduled procedure is Medicare-approved for the ASC
  • Schedules accurate requirements for time, anesthesia, special equipment
  • Enters demographics/insurance information received from provider's office
  • Determines that all scheduling is complete and all patient information entered in computer
  • Provides information necessary to insurance verification specialist

Insurance Verification Specialist

  • Obtains and enters any additional demographic or insurance information from provider's office
  • Verifies patient's insurance eligibility/ benefits
  • Records patient insurance information and verification in computer
  • Obtains required pre-authorizations

Patient Financial Counselor

  • Contacts patients regarding financial responsibility
  • Provides notes on payment arrangements in computer
  • If necessary, arranges payment plans
  • Alerts front desk of patient responsibility

Medical Coding Specialist (Certified)

  • Obtains operative reports (codes only from operative notes)
  • Codes all facility services, implants, supplies using CPTs, ICD-10, HCPCS
  • Obtains implant invoices/code    
  • Obtains pathology reports
  • Communicates with providers' offices, when required
  • Understands/conforms to compliance regulations
  • If applicable, places appropriate notes in patient account
  • Balance to schedule

Billing Specialist / Charge Poster

  • Enter charges provided by coder
  • Post contractual adjustment manually or electronically
  • Upload to clearinghouse    
  • Make corrections, when necessary    
  • Check clearinghouse report for payor acceptance
  • Correct and resend non-accepted claims
  • Print and send paper claims, where applicable
  • Place appropriate notes in patient account
  • Balances daily report with schedule

Payment Poster

  • Posts payments to accounts
  • Compares insurance payments to contracts
  • Transfers balance to guarantor (secondary insurance or patient)
  • Balances daily entries against deposit
  • Logs denials and initiates appeals for underpayments or denials
  • Gives to collector for follow-up    
  • Place appropriate notes in patient account
  • Denials to code review

Third-Party Payer Collections Specialist

  • Works accounts receivable (A/R); first contact 14-21 days, thereafter every 21-30 days
  • Enforces state prompt payment laws
  • Follows up on all appeals and denials
  • Reviews credit balances/ensures appropriate and timely refund requests to center

Patient Collections Specialist

  • Preparation and timely mailing of patient statements
  • Courtesy phone call to patient for non-payment
  • Completes collection agency list and sends to center administrator for approval
  • Gives approved list to payment poster for appropriate adjustments to patient accounts
  • Sets up payment plans, if center allows
  • Place appropriate notes in patient account
  • Answers patient billing inquiries

Receptionist

  • Answers telephone (three rings or less)
  • Opens/sorts/distributes mail
  • Orders business office supplies
  • Keeps office supply area orderly
  • Cleans/stocks patient refreshment area
  • Greets patients, reviews demographics, copies insurance cards
  • Prepares upcoming patient charts
  • Collects patient payments
  • Balances daily payment log
  • Responsible for petty cash
  • Scanning/copying
  • Assists in stuffing patient statements

Goals



 

  • Regular audits of business office performances (daily, weekly, monthly or as needed)

 



 

  • All scheduling completed
  • All patient information entered in computer
  • Scheduling form given to insurance verification specialist











 

  • Verification is minimum of one week in advance of scheduled procedure date – goal is two weeks








 

  • Patient financial counseling is completed a minimum of one week ahead of scheduled date — goal is two weeks





 

  • Coding is complete within 24-48 hours of receipt of operative note














 

  • Claims submitted within 24 hours of receipt from coder













 

  • Payments posted within 24 hours of receipt
  • Denials and appeals initiated within 24 hours of payment posting










 

  • Days in A/R 45 or fewer
  • A/R over 120 days less than 10% of total A/R







 

  • Patient statements mailed within 24 hours of change of guarantor and every 30 days thereafter













 

  • Phone calls and mail are distributed accurately and timely
  • Charts are assembled and ready for next day prior to leaving
  • Daily payment log balances

 

PERFORMANCE MEASUREMENTS



 

  • Overall positive business office comments from patient satisfaction questionnaire
  • Review by administrator

 


 

  • Accuracy of next day's schedule
  • Cases scheduled for future dates have been entered in computer
  • Determine if any non-ASC approved procedures have been scheduled

 

 

 






 

  • Review report of scheduled patients who have not had insurance verification performed (only exceptions: Medicare, late add-ons, self-pays)







 

  • Daily review of financial counseling notes for next two day's surgery schedules






 

  • Audit 50% of patients each week to compare date of procedure against coding date
  • Annual auditing of coding accuracy by external auditor











 

  • Daily comparison of date of surgery to date of claims sent reports
  • Verify electronic claims have been submitted, received and reconciled











 

  • Daily balancing of posting batches to bank deposits












 

  • Check for trends on A/R summary report
  • Review collector's notes to ensure all accounts are worked on a timely basis
  • Review credit balance report to determine status



 

  • Review collector's notes for comparison between date of change of guarantor and date of patient statement
  • Review patient balances reports to determine if regular patient statements are sent









 

  • Review patient comments about receptionist on patient satisfaction questionnaire
  • Assess wait time between patient's arrival time and admission to clinical area
  • Verify next day's charts completed
  • Verify all mail sent out
  • Balance petty cash on regular basis

 

The tasks listed are the basic required responsibilities for each job title and are not meant to be a comprehensive job description. Employees in any of the positions listed above are responsible for coverage of other positions when needed (e.g., answering phone, lunch breaks, sick leave, vacations) as well as performing their own clerical work such as filing, scanning and copying).

Additional Positions

Depending on the size of the facility, other business office staff personnel (if responsibilities are not outsourced) may include:

  • Compliance officer
  • Business office personnel education specialist
  • Revenue cycle internal auditor
  • Clinical records specialist
  • Accounts payable representative
  • Medical transcription
  • Credentialing specialist
  • Clerical assistant

Checks and Balances

In addition to providing your business office staff with detailed job descriptions, you will also need to provide expected goals and develop ongoing checks and balances to determine if they are meeting those goals. Monthly monitoring/auditing is an important and necessary process to obtain the best revenue cycle outcome. If approached positively and with open communication of expectations, your staff will appreciate knowing what is expected of them and develop pride at performing their duties well.