Practice Management Alert

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 [...]