serbin, caryl transform-improve reimb-stevens point-becker ... · serbin surgery center billing,...
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Presented by
Caryl A. SerbinPresident and Founder
Serbin Surgery Center Billing, LLCand
Becky Ziegler-OtisAdministrator
Ambulatory Surgical Centerof Stevens Point
• Opened August 2006
• Multi-specialty
• Two operating rooms
• Medicare certified
• 100 cases/month average
• Clinic and ASC same site
• Orthopedics
• Ophthalmology
• Pain Management
• Urology
• Podiatry
• General Surgery
• Plastic Surgery
• Requested business officeevaluation* to determine if:
1) processes efficient
2) reimbursement optimized
3) meeting compliance guidelines
*evaluation of both clinical/business office were performed -this presentation reports only business office findings
1) Processes• Using practice software
Recommend acquiring ASC software
• No CMS list of ASC covered servicesor matrix of insurance contractsRecommend providing both toscheduler and insurance verifier
• No up-front collectionsRecommend notifying patient of financial responsibility before DOS
2) Reimbursement• Billing not up-to-date
Recommend hiring additional staff oroutsourcing
• Coding inaccuracies identifiedRecommend coding audit by certified coder – rebill where necessary
• Not following up on submitted claimsRecommend audit to determine timelyfiling, refunds, resubmission claims
3) Compliance• Receptionist making patient contact calls
Recommend moving these calls toback desk for HIPAA reasons
• No notification to payor of OONRecommend notifying payor at timeof verification and again at billing
• No advance notification of financialpolicy to patientRecommend providing written policyprior to DOS via phone or brochure
• Review fee schedule
• Contact insurance network torequest insurance contracts
• Changes in staffing tasks
• More separation betweenClinic and ASC
• Revise fee schedule
• Request copies of payor contracts
• Outsource coding and billing
• Appoint new administrator
• Discontinue leasing employees
• Adopt business office recommendations
• No billing backlog
• Days in A/R average 38-44
• Increase in revenue per case
• Meeting compliance guidelines
DAYS IN ACCOUNTS RECEIVABLE
0
20
40
60
80
100
120
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
2007
2008
Presented byBecky Ziegler-Otis
Administrator
• Practice software not meeting allASC needs
• Billing outsourced to clinic billingstaff resulting in:- overwhelming volume- increase in errors due to lack of
ASC billing knowledge
• Revenue stream reduced to trickle
• Days in A/R escalating
• Claim backlog growing
• Denial rate climbing
• Cost of staffing and supplies as a percentage of revenue continuingto increase
• Non-compliance concerns mounting
1. Have center evaluated forefficiency and compliance
AFTER EVALUATION DECISIONS
• Outsource coding and billing
• Incorporate suggestions received from evaluation
• Specializes in ASC billing
• Reputation within the industry
• Uses only certified coders
• Understands/follows current compliance regulations
• Has up-to-date programs for HIPAA, Red Flag and RAC audits
• Performs internal audits
• Fees based on productivity
• No off-shore outsourcing
• Appointed separate ASC administrator
• Changed to ASC software
• Revised fee schedule
• Acquired copies of payor contracts
• Initiated use of bank lockbox
• Created new insurance verification position
• Established process to collect co-pays
• Developed financial policies to handle self-pay patients, payment plans, financial hardship cases, etc.
• Made changes in business office task responsibilities
• Outsourcing company uses experienced billing staff whose only tasks are coding and billing
• Eliminates billing calls to center
• Reduction in front office staff results in:- less payroll and benefits- less computers and desks- more space
• Allows ASC staff to concentrate on other tasks
• No worries about billing staff coverage for vacations and employee turnover
• Decreased A/R dollars and days
• Regular revenue stream
• Reduced compliance concerns
• Daily interaction with billing company
• Allows ASC staff to concentrate on other tasks
• No worries about billing staff coverage for vacations and employee turnover
• Decreased A/R dollars and days
• Regular revenue stream
• Reduced compliance concerns
• Daily interaction with billing company
1. Reactionary- “just get us through it all”
2. Educational / Informative- learning curve- details important to ongoing
survival
3. Advice / Consultative- payer input- compliance input- collaborative team
• Teamwork
• Center focuses on clinical aspects
• Adding new physicians
• Increasing caseload
• Daily communication with billing company
• Billing company provides worry-free billing services
• Assists with business policies and procedures where applicable
