1) Get A/R days below 50
Determine your days in A/R by adding charges for the last three months and dividing by business days in that time period. Divide this number by the current balance in your A/R. Analyze trends by payer. Delegate oldest, highest balances to collectors. And follow up on appeals.

2) Rid A/R of 80 percent of the accounts more than 120 days old
Audit A/R for errors. Adjust off any contractuals that haven't been adjusted at time of posting. Write off balances below $10. Offer a one-time, 25-percent discount to patient balance accounts if paid in full in 30 days. Divide the over-120 insurance accounts into categories (managed care, Medicare, Workers' Comp, commercial, Medicaid). Assign a collector to work each category for three days (oldest, highest balances first) and then to move on to the next category. Repeat this cycle. Finally, if you have a lot of patient balances, suggest part-time evening shifts or regular collectors working a couple of hours of overtime to call overdue patient accounts and run patient statements.

3) Use a certified coder
If your coder isn't certified, incentivize her to work toward that goal. Encourage your coder to attend seminars and courses to further her education. Keep your CPT and ICD-9 books current.

Purchase and use coding helps (CCI coding edits and encoder, for example). Work with surgeons and their offices to make sure that operative notes support all codes. Research new or questionable codes with such online services as listservs.

4) Set reachable goals for staff
Once you've determine what areas you need to revitalize (see Nos. 1 through 3), set a realistic time frame for accomplishing these changes. Divide the task into monthly or weekly increments. Post these goals on a bulletin board using colorful graphs so everyone may follow the progress. Consider incentives.

5) Start a denial log
Track types of errors (form, coding or clearinghouse, for example). Assign correction of these errors to appropriate staff. Compare monthly to make sure the types and numbers of errors are decreasing.

6) Make an insurance contract matrix for staff members
One way to do this is to copy all the rate sheets from your active contracts and put them in a notebook. Another way is to make a spreadsheet with all of the rates for each company (procedure rates, discount for secondary procedures and implant coverage, for examples). Be sure to keep your spreadsheet up to date.

7) Negotiate carve-outs
Although you may not consider negotiating better rates on high-ticket procedures and implants with managed care companies a part of billing and collecting, it certainly goes hand-in-hand. Do case costing on your top 10 procedures, direct and indirect (be sure to list costs for frequently used implants).

Negotiate with provider relation representatives, giving them the costs and requesting carve-outs where needed. List the advantages your center provides their company, such as patient convenience, lower cost to insurance company, etc. Offer a tour of your facility to the provider.

8) Audit coding, billing and collections monthly
Check billing reports against scheduling reports to confirm that you've charged and billed all surgeries. Check posting reports against deposits. Post and balance deposits within 24 hours of receiving monies; attach a bank proof to deposits.

Review a sampling of no-pay EOBs to determine trends. List no-pay EOBs on the denial log. Check collection notes reports to determine that accounts are being worked in a timely manner. Review electronic claim submission receipts for appropriate dates and successful transmission.

9) Evaluate billing software for efficacy
Review the many surgical software packages on the market to see if they could make your office operate more efficiently. Outdated software often slows down claims submission and encourages errors.

10) Benchmark your surgical center against national standards
Measure your A/R, collections activity and case costing against other centers nationwide using standards from such national organizations as FASA, AAASC and MGMA.

Don't you feel better?
I'm not suggesting you tackle all 10 of these resolutions. But don't fool yourself into believing that you don't need to adopt any of them. No matter how well you're doing now, you can always do a bit better.