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Is Your Business Office the Best It Can Be?
Judith English
Publish Date: October 10, 2007   |  Tags:   Staffing

Whether there are two or 20 people in your business office, they perform many small and not-so-small activities that are critical to the success of your surgery center: scheduling, verifying insurance, coding, billing, posting payments, collecting, credentialing ... The list goes on and on.

To help you know how well your front office is performing, we've collected the tasks, goals and performance criterion of every non-clinical function that occurs in a surgical facility. The size of your facility and the volume of patients will determine how many of these 13 staff members you need. Some centers require a separate staff member for each of the positions listed while others 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 excellent patient care.

Being the best
The evaluation process should be ongoing and not seen as a monthly "must-do" chore. If approached positively, staff and administration can often develop a stronger bond of communication. Your staff will appreciate knowing what is expected of them and develop pride at performing their duties well.




Business Office Manager

? Supervises and coordinates duties
? Ensures HR and OIG compliance
? Acts as administrator's assistant
? Acts as physician office liaison
? Performs multiple business office tasks

? Auditing business office performances daily, weekly, monthly

? Patient satisfaction questionnaire
? Administrator review


? Schedules procedures and pre-op visits
? Determines if procedures are ASC-approved
? Responsible for time, anesthesia, special equipment
? Enters demographics/insurance information

? All scheduling completed
? All patients entered in computer
? Scheduling form given to insurance verification specialist

? Verify accuracy of tomorrow's schedule
? Determine if cases scheduled for future dates have been entered
? Scan schedule for any possible non-ASC-approved procedures

Insurance Verification Specialist

? Verifies patient's insurance eligibility/benefits
? Records patient information in computer
? Obtains required pre-authorizations

? Minimum one week ahead in verification - preferably two weeks

? Review report showing scheduled patients who haven't had insurance verification performed
? Only exceptions should be Medicare, new add-ons, self-pays

Patient Financial Counselor

? Contacts patients regarding financial responsibility
? Notes agreements in computer
? If necessary, arranges payment plans
? Alerts front desk of patient responsibility

? Minimum one week ahead in financial counseling - preferably two weeks

? At least weekly, review all financial counseling notes for next two days' surgery schedules




Coding Specialist

? From operative notes, codes (CPT and ICD-9) all facility services
? Communicates with physicians' offices when required
? Understands/conforms to compliance regulations

? Coding completed within 48 hours of receipt of operative note

? Audit date of coding against date of surgery on 50 percent of patients for each week

Billing Specialist

? Enters claim information from coder
? Balances daily report with schedule
? Submits electronic and paper claims promptly
? Sends timely patient statements

? Claims submitted within 24 to 48 hours of date of surgery
? Patient claims sent within 24 hours of change of guarantor

? Compare claims' batch date to date of surgery daily
? Verify that electronic claims have been submitted and reconciled

Posting Specialist

? Posts payments to accounts
? Compares insurance payments to contracts
? Transfers balance to secondary insurance/patient
? Balances daily entries against deposit
? Logs denials and initiates appeals

? Payments posted within 24 hours of deposit
? Denials and appeals initiated within 24 hours of posting

? Compare posting batches to deposits daily

Collections Specialist

? Follows up on all appeals and denials
? First contact 15 days, thereafter every 30 days ? enforces state prompt payment laws
? Answers patient/insurance inquiries
? Reviews credit balances/ensures appropriate and timely refunds

? Days in A/R fewer than 55
? A/R over 120 days less than 10 percent of total A/R

? Check for trends/problems on A/R summary report
? Review collector's collection notes - ensure all accounts being worked
? Review credit balance report to determine status


? Facility telephone operator
? Distributes mail
? Orders business office supplies
? Cleans/stocks patient refreshment area
? Greets patients, reviews demographics, copies insurance cards
? Prepares upcoming surgical charts
? Collects patient payments

? Phone calls and mail are being distributed accurately and on time
? Charts are assembled and ready for next day by day's end
? Daily payment log balances

? Review patient comments on satisfaction questionnaires
? Determine if patients are admitted in timely manner
? Verify next day's charts completed
? Verify all mail has gone out

Clinical Records Specialist

? Maintains facility's clinical records
? Provides physicians' copies
? Provides charts for QI assessment
? Ensures clinical charts are retained in a fireproof locked cabinet or area

? Clinical records to be completed within 30 days of DOS, or as required by medical staff by-laws

? Verify all patient charts are stored in clinical records area and secured appropriately
? Audit at least 5 percent of clinical charts for accuracy and timeliness

Accounts Payable Representative

? Combines/copies packing slips, purchase orders, invoices, statements
? Obtains appropriate vendor credits
? Issues checks in timely manner
? Researches refund requests

? All bills paid on time
? All refunds researched/paid within 30 days of request
? All paid bills and attachments filed at time of check issue

? Compare date of invoice receipt with date of payment
? Check on vendor discounts received
? Run report on credit balances

Medical Transcriptionist

? Transcribes dictated operative notes
? Copies to clinical records and physician offices
? Makes applicable physician corrections to reports
? Maintains delinquent dictation log

? 24-hour turnaround from time of dictation to completion
? Copies to chart and offices within 48 hours
? Notifies physicians of delinquent dictation

? Check delinquent dictation log
? Note date of DOS, date of dictation and date transcribed

Credentialing Specialist

? Gives approved applicants credentialing packet
? Performs primary source verification
? After credentialing process, obtains governing body OK; notifies practitioner of privilege status
? Notifies practitioners of reapplications and renewals

? Packet sent to applicant within 24 hours of approval
? Primary source verification completed within 30 days
? Tickler system initiated for reapplications

? Ongoing reports on status of applications to administrator
? Completed credentialing charts prepared for board approval