Optometry Coding & Billing Alert

Published on Sun Dec 26, 2004 PDF

Seek a qualified, detail-oriented, small-practice staff that's willing to learn

If you're part of a small eye practice, you know that each individual in the office wears many different hats. Finding the right person to fill each position is critical to your practice's success. Our experts share seven time-tested tips for intelligent hiring and efficient office organization.

Hire a Qualified Staff

"If you have a qualified staff, it saves you money in the long run because you don't have a lot of fires to put out later," says Rachel M. Mitchell, CPC-H, director of coding and billing services with Applied Medical Services Inc. in Durham, N.C.

1. Conduct a thorough screening of applicants for billing positions during the interview, Mitchell says. Gauge their experience through keystroke tests and analysis of old insurance remittances. For example, Mitchell suggests having them point out contractual adjustments and explain what denial codes mean. You should also use the interview to get a feel for how well you think the candidate adjusts to changing regulations and insurance policies.

"It's all about getting the information in the computer correctly," Mitchell says. That is why qualified personnel are key. A certified, experienced coder who is detail-oriented will substantially decrease the number of denials your office has to deal with, Mitchell says.

Juggling act: Finding a "very versatile, bright and hard-working individual" to serve as billing manager, transcriptionist, and fill-in receptionist has been a great help to Carol Oviatt, MS, MPH, accounting manager at a practice in Syracuse, N.Y. Having each staff member deal with multiple responsibilities is a notable challenge for small practices, she says. You need to hire people able to handle the minor details without sweating the small stuff.

2. Create clear job descriptions for each person in the office, says Terri Fischer, CPC, CMC, manager of the Health Care Group at Larson, Allen, Weishair & Co. LLP in St. Louis, Mo. This task ensures that you have a list of what each individual is responsible for, and if that person leaves or goes on vacation, you'll know what jobs need to be covered, Fischer says.
 
"Staff can leave on a moment's notice, and unless there is someone else there to pick up the pieces, it can be a real disaster," Oviatt says. She also keeps written documentation about how each billing task is performed so someone else can take over if the situation arises.

Joan Eason, director of insurance processing at Optometry Eye Care Center in Rocky Mount, N.C., advises small-practice owners, or someone guaranteed to stay with the practice, to learn the billing process so the knowledge always stays with the practice.

You may also want to keep a tracking sheet of the denials and update their status until resolved. Include dates of service and the name of the contact person at the insurance company so anyone in the office can know the status of the appeal at a glance.

Upside: Fischer stresses that clear job descriptions also eliminate assumptions about who's doing what. If jobs are clearly apportioned, they get done.

Stop the Snowball Effect

Small practices do get audited, Mitchell says. And when a small practice faces a big fine, it can be enough to put you out of business. Think small things don't matter? Mitchell has seen auditors shake charts to remove loose paper. The auditors refused to consider anything documented on those loose sheets. Organization counts, and we've got tips to help you get organized.

3. Have a qualified quality-assurance person audit your charts as often as possible, at least two to three times a year, Mitchell says. If no one in your office is properly trained, this is an instance when hiring outside help could be well worth the money. The "auditor" should look for coding discrepancies such as whether the documentation supports the level of evaluation and management codes.

4. Have one qualified person deal exclusively with accounts receivable, Fischer says. This "absolutely should be a priority" for small practices, she says. With one person to deal with these issues, you capture the money that would have been lost from accounts that are often ignored or that age beyond collection.

5. Deal with denials within 24-48 hours, Fischer says. Remember, your job isn't done once you send in the claim. You may ignore denials because they don't interfere with your daily cash flow, but you're missing the chance to collect for the services you rendered if you don't follow up.

6. Categorize your denials to find where the bulk of them are, Fischer says. You may be surprised to find that small details are causing problems, she says.

Mitchell agrees and recounts the time she discovered a denial due to someone writing the wrong date for a patient's birthday in the chart. You may end up with stacks of denials if you don't catch these small problems.

Fischer has also found trends among providers. If you have more than one provider in your office, you may see that one consistently reports the wrong diagnosis code while another upcodes for E/M. Once you see where the problems are, you can educate the individuals according to their own needs.

7. Consistently update lists of common billing problems, Oviatt says. Her office keeps lists of rebilled claims for specific carriers and specific procedures that certain carriers won't pay.

Helpful: If this all seems overwhelming, consider hiring a consultant for a one-time training. Hang on to the tools they teach you, and you'll be able to deal with problems as they arise.