Practice Management Alert

Explosive growth can be a great thing, but if your billing department doesn't find a way to keep up with your growing practice, your collections will suffer.

Here's how one practice's billing team responded to a growth spurt, and managed to cut its A/R rates in the process. Farrell Pediatrics in South Riding, Va. went from being a single-physician practice to an eight-doctor operation in less than four years, reports practice administrator Manny Oliverez. Billing had a tough time keeping up with the growth, and they fell behind, he tells Medical Office Billing & Collections Alert. So they made some changes, and turned themselves around. Ayear and eight months ago, the practice's 120+ days A/R was 22 percent  now it's at 3.3 percent, and their 91-120 days A/R is now down to 1.6 percent.

The secret to Farrell's success: organization and accountability. The billing department now runs like a well-oiled machine, with each of five people taking on a specialized role.

One piece of Farrell's puzzle is a full-time billing manager, who oversees the department and also handles patient collections. She sends a collections letter to patients after 90 days, and if they still haven't paid at 120 days, they're handed over to a collections agency (for claims under $200) or an attorney for suit (if the claim is $200 or higher). "That's just like clockwork," Oliverez notes, "and then they're asked to leave [the practice] if they don't pay."

Next is a full-time employee who dedicates her time to following up with insurance companies for claims more than 30 days out. It's important to find just the right person to take on this challenge, because often billers must be aggressive with insurance companies to get paid.

To stay organized and up-to-date, this employee has set up a day timer on her computer. "If someone tells her [a claim] will be processed and paid by next Tuesday, she gets a pop-up note next Tuesday," which reminds her to check up on the claim. If it hasn't been paid yet, she follows up with the company yet again.

Tip: When you talk with an insurance company claim representative, write down his or her name and phone number. That way, when you call back to follow up, you can say, 'You told me this would be done by today. Where is it?,'" he says. Or you can talk to a supervisor and mention the person you originally spoke with by name. "When you know names, that really helps,"says Oliverez.

Farrell also has hired a part-timer who devotes 10 hours a week to following up on claims less than 30 days out. She calls to make sure that every claim was received. "Even with electronic billing, they lose claims," Oliverez marvels. "When we first started this she said that one out of five electronic claims had a problem." And when you catch these problems immediately, you can solve them quickly, which of course results in faster payment than if you went a month or so before realizing there might be something wrong with the claim.

Tip: Make sure your claims are clean before you send them out.

A second part-time team member devotes 20 hours each week to charge posting. The key to making this piece of the puzzle fit is ensuring that the billing department receives correct and complete information from the front desk, Oliverez points out. And the only way to make that happen is through regular communication and training between the two groups, he urges.

Farrell holds weekly training meetings with the front desk staff. "We have them collect all the information, so we work with them very closely and give them a lot of feedback in these training meetings."

 Finally, a third part-timer dedicates 10 hours each week to EOB posting. "Accurate coding is necessary because when we look [claims] up in the system, we need to know exactly why something was denied," Oliverez explains.

While everyone in the billing office at Farrell has clear-cut responsibilities, they work as a team in all they do, Oliverez cheers. "We set goals and post our progress so we can see where we are and where we need to be," Oliverez says. "We have a big board for this on the wall." And when staff achieves a goal, celebration is in order. For example, this powerhouse billing department recently hit a "major goal," so they were treated to a "special luncheon in their honor with flowers, gifts and bonuses." The result of this kind of appreciation: "They came up to me and set a new tougher goal for A/R than I would have set," Oliverez enthuses.