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FEATURE


try to make sure we set really clear expectations for people working in the office. Do they know what they are doing, what they are expected to do and the timeline in which they are expected to complete those tasks?” It also requires putting staff mem-


bers in the best position to succeed, she adds. “We realign job duties to play to each of our staff members’ strengths. If we learn that one of our people is a bull- dog who will fight to make sure insur- ance companies are paying what we need to be paid, we will task them with following up with our payers. The per- son who pays close attention to every detail? That could be the team member we want verifying that our claim infor- mation is correct. No one here is doing exactly what they were hired to do.”


Avoid Complacency Unfortunately, McDonald says, even the best efforts to optimize workflows will not eliminate billing challenges. “Insur-


ance companies are coming up with clever reasons to deny our claims. Estab- lish processes that allow you to effec- tively track denials, learn why they are occurring and what needs to happen to solve these problems. We see a lot of denials not being worked properly and eventually written off. ASCs cannot afford to let that happen.”


Optimization must be ongoing,


Overton-Geise says, as billing pro- cesses will need to undergo regular adjustments. “Leadership needs to keep up with changing payer guidelines and coverage. The payer newsletters you receive provide valuable information that could significantly change your workflows.” As an example, she cites a situation that occurred at the beginning of 2018. Early that year, a payer sent out a medical policy update notifying ASCs that it was going to start requir- ing authorizations on nearly every case. Those ASCs that did not read and act


upon the update got to March and found themselves inundated with denials. When your ASC makes changes to its


workflow, do not assume those changes will hold, McDonald says. “Trust that your employees will follow what you said but verify they are following the new pro- cesses. Too many administrators will roll out something new but fail to follow up to make sure what needs to happen is actu- ally what is being performed.” ASCs must be prepared to do what-


ever is necessary—no matter how diffi- cult—to maintain their solvency, Ebert says. “If we notice something is not working, whether it is with an employee, vendor partner or payer, we have to be able to recognize that quickly and act. We are always going to try to resolve issues, but if we are not getting the results that are in the best interest of our business, then we must be prepared to look at other options and be willing to make a change.”


14 ASC FOCUS APRIL 2019 | ascfocus.org


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