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.
