When I review billing of an ambulatory surgery center, here’s what I mainly look for and it usually gives me enough clues to what I need to know.
1) Are there unbilled charges from more than a month ago?
2) How many denials show up in the EOBs received from Medicare and BlueCross for the previous week? I tend to review ALL the EOBs.
3) What’s the comparison of new patients to existing patients over the past year? What types of insurances do they represent?
4) How does the Accounts Receivable Master look? How many high-dollar claims (e.g. above $1,000) are untouched – over 90 days, 120 days and so on?
5) When were the contracts last updated?
There are several other things that I could look for and I do but at the outset am looking for a feel of how a center is doing. Answering these five questions usually provides me with a direction to probe more. I supplement these with interviews with staff. Another important activity that I do is to simply sit by the front desk and observe patient flow and work flow through the day – sometimes for several minutes at a stretch.
Taking the above steps, we turned around a gastroenterology center at one of the major hospitals in New York.