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Practice Management Alert

Find a Billing Manager Who Fits the Bill

Published on Thu Aug 01, 2002

In a time of declining reimbursements and increasingly restrictive Medicare regulations, practices need first-rate billing managers more than ever.

Qualities to Look For

When searching for a biller, be on the lookout for the following qualifications:

  • Experience or training. While experience is always a plus, don't rule out someone less experienced who is knowledgeable and continues to educate herself. Just make sure that her knowledge is up to speed in your specialty area. Ask for credentials, type of education she has completed and what her goals are for the practice.
  • Coding and billing knowledge. Though coding is ultimately the physician's responsibility, a good billing person should be able to spot coding errors and advise corrective action. Ask the candidate if he has coding credentials such as a CPC (certified professional coder). The candidate should also thoroughly understand claims processing and other billing issues.
  • Compliance readiness. "Make sure your candidate understands the provisions of a practice compliance plan and HIPAA as they relate to billing. Familiarity with the requirements for ECS (electronic claims submission) and basic confidentiality guidelines is also important. Ensure they have resources to keep updated as rules are finalized (e.g., Web sites, newsletters, etc.)," says Janet McLaughlin, MBA, CHBC, with PMC-Consultants to Health Professionals in San Francisco, Calif.
  • References. If job references are not available, ask candidates to provide references from teachers, associations or course instructors.

    Questions to Ask

    Ask the candidates the following questions to discover what their work style is:

  • What type of reports do you typically generate and analyze? How frequently? Monthly, quarterly, annually? "Ask what information each of these reports provides and how it is useful to job performance, and to the practice," McLaughlin advises.

  • How will you follow up on claims?
  • What type of appeal system do you use?
  • How would you monitor capitation utilization in relation to capitation revenue?
  • What type of billing software are you familiar with? "Ask him or her to tell you which programs are preferred and why," McLaughlin says. Billing is increasingly computerized, so the person in charge must be computer-savvy.
  • Are your coding books up-to-date?
  • What is your typical collection procedure (i.e., do you provide soft collections and alert staff to take action on accounts requiring extra attention)?
  • What is your personnel management style? "Provide scenarios related to personnel management and ask for responses," McLaughlin suggests. For example: A) A good employee is developing attendance problems (late for or absent from work). What should you do? B) You have received complaints that there is an uneven distribution of work in the billing department. How would you approach this, and how would you evaluate if this is accurate?

    "Maintaining a full staff of competent employees is critical to the successful management of accounts receivable," McLaughlin says.

  • Do you belong to any professional organizations such as the Professional Association of Health Care Office Management (www.pahcom.com)? Or, do you have a certification as a medical reimbursement specialist awarded by the American Medical Billing Association (www.ambanet.net)?
  • Finally, ask job candidates to take a test such as the free one available online at http://www.karenzupko.com/ Resources/tools/Forms.htm. Consider asking them to produce customized spreadsheets and analyze recent accounts receivable statements. Ask them how they would handle curious billing scenarios.

    McLaughlin offers a sample scenario to test a billing candidate's acumen: Outstanding accounts due from ABC Insurance company has increased significantly over the past several months without a corresponding increase in charges to that company. An internal review has determined that the claims have been submitted properly, but payment processing has slowed. How would you approach this problem? Or, as another example, your physicians are concerned that insurance companies are not reimbursing according to their contracted rates. How would you determine if this is true? When presenting your findings to the doctors, what format would be most useful?

    What Makes an Effective Billing Manager?

    McLaughlin says he has seen ineffective billing managers "who focus on the daily routines of submitting charges, posting payments and depositing checks, but let delinquent accounts get out of control."

    In contrast, effective billing managers think globally. Instead of burying themselves in coding, for example, they study accounts receivable reports and explanation-of-benefit statements (EOBs) for patterns that may translate into tens of thousands of dollars in jeopardized revenue. Note: For tips on how to analyze your EOBs, see article two.

    Your billing manager must also be able to manage four key relationships:

    Subordinates: Can she listen to them? Communicate clearly? Train them? Evaluate their performance? Avoid favoritism? Motivate? Some billing managers attempt to motivate through directives and criticism. The best ones, however, motivate through positive reinforcement: Ice-cream socials for a good month of collections, wall charts to show whether accounts receivable is falling or rising.

    Physicians: The billing manager is responsible for informing doctors about collection status, but should not overwhelm them with stacks of printouts. Data should be summarized in a consistent format, each month, for the doctors to review. The manager should also be capable of verbally interpreting the data, including explanations for variations. For example, if the amount outstanding from a particular payer has risen significantly, the billing manager should be able to explain reasons for the increase and what steps she has taken to correct the problem.

    Insurers: Billing managers should usually work within the realm of the insurer's rules instead of demanding that they be changed. If the billing manager must confront an insurer about a problem, she should gather the facts and present them in a positive manner. Often, payers are willing to adjust their processes if you have factual data to support the issues you raise, says Cathy Berto, PAHCOM president, assistant administrator for a multispecialty group in Melbourne, Fla.

    Patients: When it comes to collecting from patients, a billing manager should be compassionate yet firm. Most patients cannot control their medical bills if they are sick. Good billing managers make it clear that health is the most important factor. They will help the patient set up payment plans and work with them to pay off their balance. Also, if a Medicare patient calls for clarification on a claim, the billing manager should happily provide the answers to the best of his knowledge.

    Where Do You Find Good Candidates?

    There are several techniques for recruiting a strong billing manager. They include:

  • Networking. Contact the Web sites of state and local chapters of the MGMA and PAHCOM. Click on the career center listing.
  • Asking other practices. Other doctors and administrators in town may be able to point out possible prospects.
  • Staying away from hospital billers. "Unless the biller has worked in a hospital-owned doctor's practice, she may be unfamiliar with physician coding. In addition, hospital culture is much more bureaucratic in comparison to a physician's office," Berto says.
  • Promoting from within. Recruiting a billing manager from the inside has advantages. "It builds staff morale because everyone can see there is opportunity for advancement," Berto says. "Unlike an outsider, an insider already knows the office politics and practice's philosophy."
  • Providing on-the-job-training. "This is important so you do not set the person up for failure and select a candidate who has already displayed the ability to fill a supervisory role," Berto says. "Continuing education is a must for any billing manager, whether the person is promoted from within or hired for the position from the outside." $ $ $

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