Practice Management Alert

Given all these variables, only your office can develop a fair and accurate assessment guide that works for you, but here are a few pointers that help no matter what specialty and practice you bill for.

Your job evaluation for collectors should include an assessment of how the A/R is managed and collected, a review of the aging sheet, and an examination of charges versus payments, says Kim McDonald-Buckley, a physician coding and reimbursement expert at Practice Performance Inc. in Dallas. Your job description for collectors should already have detailed what's expected of A/Rs, aging sheets and charges versus payments.

1. Assess the A/R. Experts differ on how much A/R reports should factor into job performance evaluations, but one thing's for sure: They at least partially reflect your collector's performance. A/R reports can tell you whether your collector is cleaning up billing messes, identifying errors in data entry and coding, posting correctly, and following up on requests in a timely fashion, says Andrea D. Parker of the Physician's Hearing Aid Center in Arlington, Texas. Consider comparing your collector's A/Rs to national averages for your specialty and payer mix.

2. Review the aging sheets. Take a hard look at your collector's aging sheets. If your collector's aging sheet stays the same or has never gone down since the job began, or if it increases, then the collector is not following up on charges, McDonald-Buckley says. You want to make sure the collector is working old claims, she adds. Verify that your collector writes off or sends to outside collections claims that remain unpaid. "There's no point in keeping uncollectible dollars on the books," McDonald-Buckley says. That requires time and energy.

Reviewing aging sheets may tell you, at the other extreme, that your collector is writing off charges just to get them off the aging sheets, Darling adds.

3. Examine how charges compare to payments. An evaluation of charges and payments will reveal problems that other data may not.

Make sure your collector's receivables match up to your charges billed out, Darling says. Also, verify that any adjustments made for contractual payers are in accordance with your payer contracts and not just written off.

Assess whether your collectors use their time profitably. If your collector makes phone calls and leaves messages that no one answers, she may touch many claims, but that doesn't mean she'll get them paid. To obtain the information that gets charges paid, a collector must spend adequate time on each charge, McDonald-Buckley says, so basing job performance on the number of accounts worked alone is "unfair." If you evaluated employees for certain carriers in Texas based on how many accounts they touched, "they'd never succeed."

The assessment plan works only if you tailor your job performance assessments to your specialty, payer mix and location, McDonald-Buckley states.

Collection rates are not the same over different specialties. Surgical practices, such as orthopedic practices, have collections rates that vary from those practices that are nonsurgical, such as family practices. Even practices within the same specialty can have different collections rate based on payer mix (for example, number of contractual payers) and location, she says.

If, as another measure of job performance, you compare your collector's A/R report to national averages or reports from other practices, you should adjust for practice differences. Use these practice reports Darling offers as guides, not standards. These examples are based on a skilled collector who diligently works, with one small break (30 minutes) with few interruptions and works accounts back to back.

Oncology: With an average of 25 lines per claim and $20k per account, your collector can probably work 15-30 accounts per day, more or less, depending on how often the collector must do other tasks, such as answer the phone, Darling says. However, if the accounts aren't kept clean, your collector is looking at 4-8 hours per account.

Ob-Gyn: With an average of 1-5 lines per claim and $150-$300 per account, your collector can probably work about 30 accounts, if she's doing nothing but making phone calls on those accounts all day. If your practice performs surgeries, the average price per claim can jump to $3k-6k, but your lines per claim doesn't really change. You have to take into account research time for surgical practices. If you have a collector who only does appeals and research for surgical ob-gyn practices, expect her to complete only 8-11 appeals per day.