Practice Management Alert

To operate your billing department effectively and efficiently, you need to recognize that billing and collections require good management, says Elizabeth W. Woodcock, MBA, FACMPE, the director of knowledge management for Physician Practice Inc., a practice-management solutions company based in Glen Burnie, Md. Applying management techniques to your billing and collections process can help your practice avoid common problems that result in reduced revenue. Among the techniques that can improve your billing efficiency and help you get paid are the following:
 
1. Establish expectations. Expectations need to be set with your patients, your payers, and your staff, Woodcock says. For example, a common problem practices face is getting patients to pay their bills, deductibles or copays. Although nearly every practice has a financial policy covering when payment is due and how it can be paid, patients often don't know about it. "If we have a financial policy in our heads but we don't ever communicate it to patients, why would our patients follow it?" she says. "You have to have a financial policy that is given to all patients when they register as new patients. It should state what you're going to do about time-of-service payments, how you handle collection later, whether you have any rebilling fees, and anything else you want to establish up front."
 
Expectations also need to be set for your billing and collections staff. This can be done by adopting policies and procedures regarding how your practice will handle past-due accounts, including addressing questions such as when patients should be called about their past-due accounts and when to send an account to a collection agency. "If a practice makes patient calls and tells them to call back in 14 days or their accounts will be sent to a collection agency, and then doesn't do anything and doesn't look at that account for a year, how can it ever send the account to a collection agency?" she asks. Failing to define follow-up protocols means that work may never be done and renders the financial policy meaningless.

Practices should also strive to set expectations with payers, Woodcock says. "Practices think that if an insurance company sends them a contract, there's nothing they can do about it, and they have to accept everything the company says. Maybe you cannot change the fee schedule, but what you can do, for example, is if the insurance company has a 45-day timely-filing provision, you can say you want that to be 60 days," she says. "You should try to define the expectations, or at least make an equal playing field. Look at what your billing office protocols are and go back to the insurance company and say you need 15 more days to file that claim."
 
2. Establish accountability among your billing staff. Practices should organize their billing offices so staff members know their responsibilities and can be held accountable. Woodcock recommends organizing a billing department by payer. "I like the payer basis because every payer is different, and there are different rules and regulations for each," she says. "If you have someone who really understands Medicare, for example, that person knows what the contract says. That person should submit the claim, look at the claim reports, review the remittance edits, and work the rejections." By having the Medicare person submit the claim, review the reports, and work rejections, the practice ensures that the staff member who is familiar with the original claim follows up. That person would have the knowledge to compare what was submitted with the report, find out what occurred and make the appropriate changes.
 
To promote accountability, business office staff are assigned by payer at Family Medicine Associates, an eight-physician practice in Carrollton, Texas, says Diane Colton, CMOM, BS, practice manager. One person is responsible for all the activity on one insurance plan, but a person may be responsible for multiple plans, she explains. To balance out the workload, the practice re-evaluates the accounts receivable distribution each quarter. "We do that so someone is not dealing with 18 percent of A/R while someone else is dealing with just 6 percent," Colton says. "Obviously, if someone has a big piece, it's going to be harder to stay on top of it from an accountability standpoint."
  
3. Avoid batching work. Organizing work in batches may delay work and create bottlenecks, Woodcock says. "People don't realize how much time they spend organizing the work versus doing it. For example, we gather the charge tickets on a desk or gather referral forms to be typed into the system, but we're not doing the work," she says. "We need to go ahead and process the work."

For example, a practice has some problems with claims with a particular insurance company. Every time the problems occur, they are recorded in a log in the hope that someone will eventually discuss them with the payer. "That doesn't solve the problem. Taking all your little questions and piling them up for a day when you might call means you may never get to it," she says. "And, if you get to it, you inundate someone with too many questions and problems that they can't solve. If you focused on the problems, instead of writing in the log, the problems might get addressed." To focus on the problems, the practice needs to look at the processes in which they occur and decide how to improve them.
 
By examining the process, Family Medicine Associates found a problem it had with claims taking up to 12 days from the date of service to get billed, Colton says. The practice has a certified coder with a clinical background review all the practice's superbills to make sure diagnoses are linked to the codes and to check for coding errors. When the reviewer discovers a problem, the bill is sent back to the physician. The problem was that the doctors could not always quickly conduct their reviews, delaying the billing process.
 
"We wrote up a protocol for what to do and how to do it, and now we try to keep the work moving day by day. For example, everyone knows that we're working on Monday's data entry on Friday. And then it's done and out the door," she adds. "There may be some stragglers that doctors have to review, but now the work is moving every day instead of sitting." Claims now take four days from the date of service to get billed.
 
In some cases, Family Medicine Associates is batching its work. The superbills are gathered for a day and given to the coding reviewer. The next day, the reviewer checks for coding problems and proper documentation, divides the bills by payment type, and gives the work to the data entry staff who enter the charges and close each batch. Because the entry is done in smaller batches than before, the chances of a check being mistakenly posted as a charge and vice versa are reduced, Colton says. The goal is to process a day's claims in one day. Electronic billing is done daily, the edit report from the previous day is also reviewed, and corrections are made.
 
"It used to be that we'd have days with a large charge entry, and then there were other days when there was very little. We knew the doctors saw patients every day, so the question was, where were the superbills? Now, we have smaller pieces going to data entry every day and getting out the door," she says.

4. Acknowledge the billing staff members and make them a part of the practice team. Practices often make the mistake of ignoring their billing office staff, which makes the billing and collections job tougher. "Working in the billing office is not a fun job," she says.  "When you're in the billing office, when do you talk to patients? When they are upset about a bill. When do you talk to the physicians? When you have to confront them about needing to code services better. You need to make the billing office part of the practice team, not an isolated problem place." For example, putting photographs of the billing staff in the reception area can help patients better identify with the people who handle the bills. It can also make the billing department feel as if it is part of the practice, rather than stuck in the "back office." Thank-you notes from the physician to the staff member who worked hard to solve a problem claim can also make the biller feel like a part of the team.
 
Inconsistent messages discourage teamwork. "For example, physicians tell the billing office it's doing a great job on collections and to keep up the good work," Woodcock says. "Then, a patient who owes $1,000 tells the financial counselor at checkout that the doctor said not to worry about the bill. That's an inconsistent message. The billing staff on one hand has the physicians saying they're proud of the work on collections, but then on the other hand they make it hard for the staff to collect."
 
Communication is the key to teamwork at her practice, Colton says, and it is fostered using a variety of tools and techniques. For example, the business office and front-desk staff meet often so each unit can discuss what it needs from the other to make patient registration and billing easier. The practice's computer system includes pop-up memos so if the business office finds that a patient's insurance card is no longer valid, it can create a memo that reminds the front desk to ask the patient about current coverage. When the front desk makes an appointment for that patient on the computer system, the reminder appears. The business office's billing computer system also includes a chart feature that lets the biller make notes about a claim or problems so follow up is easier. The practice's senior physician visits the business office often, making a point to acknowledge work well done. The doctor also routinely writes notes to staff members inquiring about the status of claims and problems. "We know that nobody can do their job without the others," Colton says. "If one person doesn't do his or her part, it can kink up the whole system."