RATE GREAT? How would you rate your business office?

Behind every successful surgical facility is a strong business office. Is yours up to par in the areas of scheduling, coding, billing and other business operations? Let's see how many of these 17 boxes can you check off.

Staffing situations
❑ If you can't compete with larger facilities in hiring qualified, experienced coders and billers, consider supplementing lower salaries or hourly rates with strong benefits packages or other perks.

❑ Test candidates for coding positions with actual op reports before making an offer. This will provide insight into a coder's experience with your case mix and how long it takes her to handle the task.

❑ Your case volume depends on your scheduler's relationships with physicians' practices. Monitor that relationship by regularly speaking with surgeons and their schedulers to determine whether any obstacles exist. If the schedulers communicate via e-mail, review those messages for clarity.

❑ Schedule weekly or monthly meetings with business office staff to discuss challenges, share information and solve problems. Discuss managed care contract updates, payor challenges, coding and billing issues, collection goals and denial trends. Understanding your business staff's work goes a long way toward improving its results.

Physician outreach
❑ Physicians do cases where it's easy to schedule them, so develop a user-friendly process. Many facilities have implemented hard copy or electronic scheduling request forms, rather than requiring phone calls to make arrangements.

❑ Deficient documentation adversely affects your reimbursement. Address coding and billing concerns and their financial impact at your medical executive committee meetings. Your business staff can tell you which of your surgeons provide ambiguous op notes.

❑ Keep your surgeons updated when Medicare approves new procedures for reimbursement, so they can bring them to your ORs. Make sure they're also aware which procedures offer little or no reimbursement to your facility.

Patient management
❑ Don't depend on the physician's staff to verify a patient's insurance coverage or pre-certification of a procedure. Verify it in-house.

❑ Make a policy of re-verifying a patient's insurance coverage when there's a significant lapse between the initial verification or pre-certification and the scheduled date of surgery. A patient who's ruled eligible for a procedure in June might not be covered for one in July. Deductibles met in December will be fully collectible in January.

❑ Notify patients of their estimated financial responsibility in advance, and ask for payment on, if not before, the date of service (see "Collect Every Dime Your Patients Owe" on page 16). While many facilities arrange payment plans with patients who can't afford the full amount, only offer this as a last resort. First, detail your traditional methods of payment: "We accept all major credit cards, checks, cash, and financing through XYZ Credit Services."

❑ Developing online pre-registration and pre-surgical instruction forms for computer-savvy patients can minimize the amount of time they spend filling out forms and reduce the possibility of anxious errors on the morning of surgery, which can prevent delays in the reimbursement process.

Reimbursement
❑ When negotiating managed care contracts, include your coding, denials and materials management experts in the discussion. They can provide insights into the implants, supplies and procedures that may require strategic approaches for capturing reimbursement.

❑ Always calculate supply and implant costs, not just clinical performance requirements, before introducing new procedures to your case mix. Services added without an aggressive comparison of case costs against actual reimbursements can spell disaster. Begin negotiating contracts for new procedures as early as possible. The process can be time-consuming.

❑ Don't rely solely on vendor-supplied reimbursement information or coding directives when deciding whether to add new procedures. Work with your coders to verify the information through a reliable source and research the appropriate coding and billing details according to carrier directives.

Follow-up
❑ Adopt a standardized method of measuring coding quality. Periodic audits can provide a baseline indicator of accuracy by identifying root causes of error, as well as the strengths and weaknesses of the coders, billers and physicians' documentation, to decrease variance and increase reliability.

❑ You'll want all op reports coded within 24 hours to 48 hours of the procedure. Timely billing demands that all claims be filed no later than 3 business days after the procedure.

❑ Involve the business office team in your monthly goals. A common benchmark for accounts receivable is fewer than 50 days. Prominently display daily collections, days in accounts receivable and monthly case volume expectations. There's nothing like friendly competition to encourage staffers to achieve collection goals.