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Carol Ciluffo Archives - Pinnacle III

Dec 06
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Onboarding a New Department Manager

Onboarding a New Department Manager

By ASC Management, Leadership, Revenue Cycle Management No Comments

For those in ASC leadership, building the right management team is essential to success. This primary objective should not be taken lightly. Once you build an effective team culture with dynamic and engaged individuals, you can expect to make meaningful progress towards organizational goals. Thus, the process for finding and hiring management team members should be a selective one, based on your organizational needs. But what happens once you have selected and hired new management team members? How do you effectively integrate new department managers into your company and cultivate dynamic, engaged team members?

One key to the success of a new manager is a solid onboarding program. Anecdotal evidence shows, properly onboarding an employee can lead to higher job satisfaction, decreased occupational stress, enhanced company commitment, and improved employee retention.

A thoughtful onboarding program eases a new or existing employee’s transition into a new role, ensuring the individual has the tools needed to succeed. Without it, you will likely be performing another employment search soon.

Joining an existing team may be difficult for the new manager and existing team members who have already formed working relationships. So, how do you create an onboarding process that works for all members of your team?

Onboarding takes many shapes and forms, including, but not limited to, meetings, printed materials, one-on-one training, webinars, and corporate retreats. It’s not just training and education – there is also a social aspect to onboarding.

An example of how you may choose to approach employee onboarding for new department managers is outlined below. The process is outlined from a global perspective. As you read, consider how you might incorporate specific actions for your company.

Let’s get the onboarding process started! Day 1:

  • Make the new manager feel welcomed. Ensure their office, computer, phone, etc. are set up and ready for use.
  • Walk through the office and make personal introductions to colleagues.
  • Hand the new manager off to HR for completion of all the necessary employment forms and benefits enrollment.
  • Schedule meetings with other managers and key personnel. Share informative insights on the organizational culture and important team initiatives.
  • Set the tone, framework, and timing for learning. Be open to the process and willing to change timelines based on individual needs.

It is important to be patient during the initial onboarding process. Listen to the feedback and questions from the new manager. Not everyone is comfortable forging ahead or immediately creating relationships in a new company. Many might be hesitant to ask questions. Even new managers with industry experience have much to learn about this unfamiliar environment. It is our job to make sure they are given ample opportunity to absorb all the information and have the tools needed to succeed.

Onboarding checklist guide

It can be helpful to maintain a detailed onboarding checklist to guide you through the manager’s initial employment period. Some of the items you may want to include on your first 90-day checklist follow.

  • Set a 90-day expectation of objectives and performance.
  • Discuss the onboarding checklist in detail – and I mean detail!
  • Be available to mentor and coach daily. Make yourself available to discuss ideas and perceptions with the new manager and how to proceed.
  • Establish regular reporting with the new manager, perhaps weekly. Determine the reporting format and due dates. These reports may provide you with insight about the progress or struggles of the new manager as you move through the onboarding process.
  • Share a company organization chart and make introductions, demonstrating the bench strength and support of the company infrastructure.
  • Schedule regular one-on-one sessions to review the progress of onboarding and performance objectives. Identify tasks/initiatives which need further review and education. Identify initiatives from the orientation checklist which need to be added.
  • Schedule or incorporate the manager into existing management meetings and encourage collaboration from everyone present.
  • Observe, listen, and support. These activities will likely provide additional insight into the manager’s performance and how they are integrating into the company.
  • Complete a 90-day evaluation and thoroughly review the orientation checklist. Ensure any area that has not been adequately covered is addressed.

Following up

Once the new employee has successfully completed the initial employment period, don’t make the mistake of cutting the cord. Continue to offer relevant opportunities for education and development.

Figuratively speaking, it is common for companies to let the manager jump into the pool before they know if there is water in it. This tactic typically does not allow the new manager to get up to speed more quickly. Rather, it will likely delay the successful results you were hoping for from the beginning. Alternatively, giving your new manager adequate training and introduction to the company’s philosophy before overloading them with responsibilities sets them up for the best possibility of success.

Hiring is challenging enough, but once you have done your due diligence and recruited the person you want to your team, your job is not complete. An effective onboarding process requires putting in the time to foster training, provide support, and cultivate positive relationships. You want this to be a long-term win-win for the employee, the company, the clients, and you.

Carol Ciluffo, VP of Revenue Cycle Management

May 02
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Revenue Cycle Management Processes: Establishing a Status Quo and Incorporating Input from New Employees

Revenue Cycle Management Processes: Establishing a Status Quo and Incorporating Input from New Employees

By ASC Management, Revenue Cycle Management No Comments

It’s Monday morning and one of your billing office employees walks in with a bizarre patient statement. To make matters even worse, your employee’s work on the statement does not reflect your office’s revenue cycle management processes. Where did this statement come from? How long have your employees employed this process? Where did the communication go wrong?

Perhaps your organization is in growth mode and new staff began implementing experiences and practices from their previous employers. Their understanding of the best way to proceed may not align with your company’s established revenue cycle management processes. Additional education or retraining is necessary.

Perhaps it’s time to re-evaluate your processes to assess if they still meet your business needs. If you’re not auditing your current protocols, how do you really know they are effective?

Consider the following practices to ensure successful communication is being delivered to your billing office employees. These suggestions will also ensure your processes remain relevant and effective.

  • Create, implement, and adhere to a robust onboarding process. This helps managers and trainers provide each new employee with the same foundation. A key onboarding element is spending time in other departments to gain an understanding of how each department contributes to the process. If you don’t have a well-defined new employee onboarding process, you need one. The orientation period is the most important opportunity to position new employees for success.
  • Hold educational boot camps when issues arise. It may be much easier to hold short 15-minute topic-specific meetings to address identified issues, than a 30 minute or an hour-long meeting designed to cover multiple topics. This tactic will allow you to be very detailed in reviewing and educating your team about the specific processes or issues in question. Addressing one topic per meeting leads to a greater chance your team will adopt your revenue cycle management processes. Addressing multiple topics in the same meeting may cause the team to become overwhelmed and lose direction, not knowing what to tackle first.
  • Review your policy and procedure manual. Engage your team members in revamping or creating revenue cycle management processes. Allow them to review existing policies to determine if they are still relevant. Retraining and education naturally occur through this type of employee engagement — a win-win for your team.
  • Allow employees to cross-train or shadow in different departments. Confusion often occurs when multiple departments are part of a process. Allowing employees to cross-train or shadow in departments other than their own will help them understand the process in its entirety. Once they have a clear understanding of the entire process, they are better equipped to problem-solve in areas they can control to help their colleagues. Time spent cross-training or shadowing also allows employees to establish relationships and team build with one another.
  • Audit, and then audit some more. Audits don’t have to be cumbersome. A high-level review can reveal where you need to focus your attention. The issues you discover may apply to only one employee and may not be departmental problems.

Bottom line: don’t bury your head in the sand and hope for the best. When adding new team members, training, education, and communication are your best shots for success to ensure their understanding and continuous use of current, relevant revenue cycle management processes. Allowing new team members to suggest alternate ways of proceeding is a bonus for the organization. Their fresh perspective may lead to improvement of established or outdated processes.

Carol Ciluffo, VP of Revenue Cycle Management

Feb 15
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Addressing Patient Requests for Charity Care or Financial Hardship at Your ASC

Addressing Patient Requests for Charity Care or Financial Hardship at Your ASC

By ASC Management, Payor Contracting, Revenue Cycle Management No Comments

As insurance plans continue to shift more of the financial burden of health care to patient, providers receive more requests for charity care or financial assistance. Health care services have become unaffordable for many, forcing some patients to avoid necessary treatment if they do not receive substantial financial discounts.

Does your ASC have a process in place to address the rise in patient co-pays and deductibles, and the growing need for charity care?

One option for dealing with patient payments is to waive co-pays or deductibles to avoid the process altogether. Such a tactic, however, could lead you straight into legal issues related to the False Claims Act, Anti-Kickback Statutes, and non-compliance with managed care agreements. Additionally, there are state specific laws addressing waiver of co-payments and deductibles. The best response is to develop sound financial hardship and charity care policies to help you legally and consistently navigate these waters.

What is the difference between charity care and financial hardship?

There are no formal definitions for charity care or financial hardship. Health care entities use a variety of terms including, but not limited to, uncompensated care, charity assistance, and bad debt. In Pinnacle III’s managed facilities, we have established distinct definitions to minimize confusion and enhance communication.

Charity care is free care. The patient simply has little to no means to pay for needed medical services. The benchmark for receiving charity care is typically set using family income between 100% and 400% of the Federal Poverty Level (FPL). A chart with percentages of the poverty guidelines listing yearly and monthly levels can be found online.[1] The U.S. Department of Health and Human Services releases U.S. Federal Poverty Guidelines which are updated every year using Census Bureau data. The current data can be found online.[2] If you choose to use this method, make sure you update your policy annually when the new guidelines are released.

Work with your Board of Directors to determine what poverty level you will use to grant a charity care service. You may want to consider a sliding scale as listed below; however, charity care is typically “free.”

An example of a sliding scale is:

Below 250% of FPL: 100% charity care
Between 251%-300% FPL: 75% discounted care
Between 301%-400% FPL: 60% discounted care

If you choose to implement a sliding scale, keep your procedure costs in mind. Set your lowest discounted rate at or slightly above Medicare reimbursement which should allow you to break even on the services being provided.

Some ASC’s establish a “Charity Care Day” for a set number of patients who have cleared the Center’s approval process. On this day the providers, staff, and even some vendors donate their time and/or resources for the charity care surgical cases. This practice demonstrates significant commitment to the Center’s community. Share with the local newspapers or launch a public relations effort to alert your community to your initiative to help those in need.

While charity care is “free,” financial hardship is a request for discounted care. Some of the other terms used to describe financial hardship are economic burden, economic hardship, financial burden, financial distress, and financial stress. Being under-insured, having no insurance, and increasing medical costs are situations that contribute to financial hardship. When reviewing a financial hardship request, it is essential to have patients substantiate their financial need. In some cases, patients with insurance who choose not to file their claim with the insurance company, may not be eligible for your financial hardship program. Ensure your board clearly defines your facility’s financial hardship parameters.

Creating a Policy

Both charity care and financial hardship requests should go through an application process. Assign a financial counselor, or someone in your facility who handles financial discussions with patients, to guide them through your process and move completed applications along for consideration and approval.

Consider the following when setting up your financial hardship and charity care policies:

  1. Create an application form for the current episode of care.
    1. Require a new application and proof of hardship for future care.
  2. Be precise about the documentation needed to support the request.
    1. Tax returns
    2. W-2s
    3. Bank statements
    4. Proof of unemployment
    5. Alimony, child support, etc.
    6. All sources of income
  3. Reject incomplete applications.
  4. Consider all financial resources available to the patient.
  5. Provide available options to patients upfront.
    1. Payment plans
    2. Low cost health care loans
  6. Establish timeline for review and approval.
  7. Determine notification process of approval or denial – letter or phone call?
  8. Maintain the confidentiality of the data received with the application. Ensure bank account details, social security numbers, etc. are redacted (or partially redacted) to prevent this information from falling into the wrong hands.
  9. Make the process known to your patients who apply and ensure staff consistently follow it.
    1. Educate your staff on policy guidelines, timeliness of the process, etc.
    2. Consistently apply the process to each individual patient to avoid claims of discrimination.

Once your policies are created, consult your attorney to ensure you have appropriately addressed any risks and you are following state laws.

Unforeseen circumstances arise at the worst times. Having sound policies to review financial hardship and charity care requests will help you compassionately work with your patients while protecting your ASC’s bottom line.

[1] US Department of Health & Human Services; Office of the Assistant Secretary for Planning and Evaluation, Resources, A chart with percentages (e.g. 125 percent) of the guidelines

[2] US Department of Health & Human Services; Office of the Assistant Secretary for Planning and Evaluation, Poverty Guidelines

Carol Ciluffo, VP of Revenue Cycle Management

Jan 11
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9 Strategies for Upfront ASC Patient Collections

9 Strategies for Upfront ASC Patient Collections

By ASC Management, Revenue Cycle Management No Comments

With the continued rise of co-payments, deductions, and co-insurance percentages, patient balances are quickly becoming the largest payer class for ambulatory surgery centers. This increased financial burden for patients places upfront ASC patient collections front and center for every facility. ASCs who adopt a proactive stance toward patient financial responsibility can significantly shorten their payment resolution cycle and increase profitability.

In an ideal situation – submission of a clean claim and prompt processing of same by the third-party payor – payment from the patient’s insurance company is received approximately 15-30 days following the date of service. Upon completion of a properly processed claim, the facility can then generate a statement notifying the patient of any residual financial responsibility.

In many cases, however, the actual “payment in full” status of an account extends well beyond a 45- to 90-day timeframe, particularly when the balance attributed to patient responsibility is significant.

To avoid becoming a long-term creditor, ASCs can positively impact patient balances by employing the following ASC patient collections strategies in the upcoming year.

  1. Consider hiring a Patient Financial Counselor to serve as your ASC’s primary source of patient estimates. With their solid understanding of how insurance works and ability to relay patient responsibility expectations in understandable terms, your ASC’s upfront patient collections and patient satisfaction will trend in a positive direction.
  2. Pre-verify patient insurance benefits specifically noting deductibles, co-pays, and co-insurance parameters, as well as the portions patients have already met in each of these areas.
  3. Collect co-pays and deductibles on the date of service, prior to patients undergoing scheduled procedures.
  4. Ask for payment in full.
  5. Don’t fall into the trap of extending payment plan terms that will not pay off patient balances owed in a reasonable amount of time (e.g., $10/month on a $500 bill); otherwise, your ASC can easily become your patients’ loan officer of choice.
  6. Establish hard and fast payment plan guidelines. Ensure staff consistently adhere to them when payment plans are required.
  7. Accept credit card payments and offer alternative payment services (i.e., low interest health care loan programs).
  8. Employ the use of a secure online payment portal.
  9. Accelerate your statement process. Gone are the days of monthly statements – it is simply too expensive to carry an interest free loan for your patients. Shorten your statement cycle to daily, weekly, or every 15 days. Ask for payment in full via the initial statement with one final notice generated 30 days later.

Failure to proactively manage patient balances can result in a higher percentage of accounts receivable attributable to individuals than third-party payors and more patient accounts than you can afford to contact. Ensure your patients are informed about their financial responsibility prior to their procedure and actively work with them to secure payment at the time of service. Upfront ASC patient collections can significantly impact your ASC’s cash flow, especially as you move into the new year.

Carol Ciluffo, VP of Revenue Cycle Management

Nov 21
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Patient Billing – Enhancing Patient Satisfaction & Your ASC’s Revenue Cycle Process

Patient Billing – Enhancing Patient Satisfaction & Your ASC’s Revenue Cycle Process

By ASC Management, Revenue Cycle Management No Comments

You may think service to your ASC patients ends upon completion of their surgical visit. The reality is, patient satisfaction extends far beyond their date of service. An effective patient billing and collections process can impact patient satisfaction both prior to and after their visit.

How can your surgery center create a positive revenue cycle experience and improve your patient billing process?

1. Proactively address financial concerns prior to each patient’s surgery by obtaining and providing thorough information on their behalf.

  • Contact patients prior to their date of service to verify registration information.
  • Perform insurance eligibility and verification to obtain prior authorization, if required.
  • Create a patient financial responsibility estimate for services to be performed.

2. Avoid potential billing misunderstandings by clearly relaying payment expectations upfront.

  • Discuss patients’ financial estimates with them prior to their scheduled appointment.
  • Secure payment from patients or explore payment plan options.
  • Clarify any remaining billing questions patients might have concerning the billing and collections process.
  • Record details regarding any prior arrangements made with patients in your ASC’s patient accounting system. This will assist with future collections efforts, if needed.

3. Improve upfront collections and/or adherence to agreed-upon terms for financing by reviewing patient estimates with them on the date of service.

  • Review financial responsibility estimates and payment options with patients again, answering any remaining questions they may have.
  • Secure signed financial agreements outlining payment plan details.
  • Collect payments that are due at time of service. Your patients are more likely to pay their bill when you review financial expectations and proactively involve them in the estimation and payment process.

4. Make it easy for your patients to remit payments.

  • Offer an online payment portal accepting ACH debits from bank accounts, a variety of credit cards, and payment plan options.
  • Provide patient friendly statements.

An efficient insurance verification process allows claims to move through the third-party payer system. The result? Timely reimbursement. Conversations with your patients regarding their anticipated financial responsibility ensure they are informed ahead of time. If you’re communicating well, they are able to understand and follow the ASC revenue cycle process.

The goal is a positive patient billing experience from referral all the way through to a zero balance on their account. Patient satisfaction, timely revenue collection, and recommendations of your facility to other patients seeking quality care and a smooth process is a win-win for all!

Carol Ciluffo, VP of Revenue Cycle Management

Sep 06
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Patient Registration Issues? Consider a Front Desk Audit

Patient Registration Issues? Consider a Front Desk Audit

By ASC Management, Revenue Cycle Management No Comments

Inaccurate patient registration can quickly derail a facility’s revenue cycle management efforts. Delayed reimbursement is costly. If your ambulatory surgery center is experiencing patient registration issues leading to lost or delayed reimbursements, consider conducting a front desk audit. Audit results often help identify training, communication, and process gaps that, once addressed, can get your center back on track.

When conducting your front desk audit, review how facility personnel collect the following items from patients:

  • Are scanned copies of patients’ insurance card(s) obtained and retained for future reference?
  • Does data entry in the patient registration sections of your patient accounting system match the scanned insurance card(s) on file? If not, what variances occurred?
  • Were the proper benefits eligibility and verification checks performed prior to the date of service?
    • Were eligibility and verification activities performed via a phone call or online?
    • If verified by phone, were the following elements – phone number, person spoken to, and reference number – recorded in patients’ accounts?
    • Were eligibility and verification details noted in patients’ accounts?
  • Were co-pay, deductible, and co-insurance details obtained and noted in patients’ accounts during the eligibility and verification process?
    • Were patients’ copays and deductibles collected on or before the date of service?
    • If not, were explanations recorded in patients’ accounts?
  • If required, were prior authorizations obtained before the date of service?
    • If not, was there information listed in patients’ accounts explaining why?

Recording audit results in a simple spreadsheet will provide you with an easy tool to assess your findings and identify trends.

Consider having staff members perform front desk audits on each other. Involving them in the assessment, education, and training aspects of patient registration auditing often yields lasting process improvements. Perhaps your ASC will realize the added benefit of a team inspired to collectively work towards an error free patient registration process.

Share this formula with them: Error free patient registration = clean claims = faster reimbursement = patient satisfaction = happy investors and staff. That’s a win-win for all involved!

Carol Ciluffo, VP of Revenue Cycle Management