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FEATURE


There are many different front-end processes that need successful execu- tion to reduce the likelihood of prob- lems or unnecessary work for the back end, and some might be more unusual than others, Goehle says. “An unusual situation—but one that ASCs need to be prepared for—is what happens with young patients when they come in with someone who does not have custodial control and the ability to sign for the patient,” he says. “That is a legal issue. There is also the issue of someone signing the insurance docu- mentation but the insurance is in the name of someone else; does the person signing documentation have the author- ity to do that on behalf of the subscriber? It is not uncommon in the charts to see the wrong person signing documents for either the patient, who is a minor, or for the subscriber, who is maybe a relative. “ASCs should have a process up- front for gathering information con- cerning these issues even before the patient comes in,” Goehle continues. “The front office person making the preop phone calls should gather this information and it should be confirmed upfront on the day of surgery.” Another issue Goehle says he has


observed in some centers concerns up- front collections of copays and deduct- ibles. “ASCs will often follow a policy that has them work to identify what pa- tients will owe and then informing pa- tients to bring that amount with them on the day of surgery or the procedure will be canceled. But even when pa- tients arrive without the means to cover their copays and deductibles, the cases are not canceled and these copays and deductibles are not collected. This is becoming a significant financial prob- lem as copays and deductibles increase as there are increases in the number of people opting for high-deductible insurance plans to save on premiums.” If your ASC is in this situation,


Goehle says it would be wise to revisit your upfront collections policy and


with them, so we want our front office to ask for a copy of the proxy prior to the day of surgery. This way the patient knows to bring it with them, and then we want to have the receptionist request the copy when the patient arrives. “If we can capture that information on the front end, it reduces the amount of work for the nurse who is required to ask who would serve as the patient’s proxy,” Goehle continues. “He or she can just look at the patient’s chart to see if it is in there.”


Anyone in the front office needs to have excellent customer service capabilities in communicating with the outside world.”


—John Goehle, CASC Ambulatory Healthcare Strategies


make sure its procedure is conveyed, understood and followed by front of- fice staff members. “You need to make sure your front-end people are educated in that policy and procedure, and once you establish your rules, hopefully they become enforced and everyone knows there are no exceptions,” he says. “There should be continuous reassessment


to determine if the


policy and procedure is properly fol- lowed and is successful in achieving its objectives.” The collection of health care proxies is a process that might also challenge ASCs, Goehle says. “A health care proxy is essentially when the patient says ‘If I am not mentally here, this per- son can act in my stead.’ Patients do not usually carry that information around


Don’t Overlook Routine Responsibilities Other processes involving the capturing of patient information may seem more routine, but failure to follow them on the front end can still lead to significant issues down the road, Goehle notes. “One of the administration issues I am seeing quite often is the rejection of claims because of poor patient in- formation captured in the system,” he says. “Your front office staff needs to obtain a copy of patients’ insurance cards every single time they come in, even for those patients who were in the ASC just two weeks prior . . . to make sure you know what the current infor- mation is and nothing has changed. “The staff also needs to always


make sure the demographic informa- tion is correct, especially the telephone numbers,” Goehle continues. “They need to determine the telephone num- ber of the person the nurse will contact the day after the surgery for follow-up and the telephone number of the pa- tient if there is a question in regard to insurance information.” Front-end responsibilities do not just include capturing information. They also include providing critical in- formation, Jacobs notes. “Front office staff members need to remind patients to bring in the list of medications they are on, for example, and they need to remind patients to have a driver to bring them home following


ASC FOCUS JULY 2013 21


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