Practice Management Alert

To assess a potential collection employee's knowledge, iLIANT Management Directions in Winston-Salem, N.C., a provider of outsourced services for physician practices that handles billing and collections for about 500 doctors, tests the applicant. In addition to helping the company identify applicants with a billing and collections background, the test also indicates how much additional training a potential employee might need, says Chris Uthe, director of centralized billing services for iLIANT.

Physicians often hire staff members for the wrong reasons, such as liking the potential employee. "In most interviews, a person is going to tell you what you want to hear," he says. "In many cases, you have a physician involved in the hiring who really doesn't know the questions to ask. The test at least provides some degree of objectivity on what a person knows and how they might handle the accounts receivable."

The test includes true-false, multiple-choice, and fill-in-the-blank questions on topics such as insurance terminology, kinds of insurance contracts, payment systems, claim denials, and claim information requirements. It also includes an essay question in which applicants must give a practice's collection problem scenario. The test is based on a weighted average of the questions with the essay counting the most.

There are a variety of personal characteristics a collector needs, Uthe says:

1. Aggressiveness and persistence. Collectors need to be aggressive to encourage payers and patients to pay, but there are limits to it, Uthe cautions. "You don't want someone who is going to be rude. You need a person who is going to be willing to understand and work with different situations but realize that the bottom line is to get a commitment to get the money in." For example, if an insurance company or a patient stalls or delays to evade payment, the collector needs to know how to get around those tactics. "If someone tells the collector he or she can't have payment now, the employee has to know to ask when the practice can have it and what it is going to take to get it," he says. "The persistence comes in handling objections."

2. Self-motivation. Collection staff cannot view their pursuit of payment for the practice as something personal, Uthe says. "If patients are yelling at them, saying they didn't get the right service, or they don't owe the bill, the collector needs to see this as an objection, not a personal attack, and find a way around it."

To foster motivation, make billing and collection staff feel part of the practice's team, says Patricia Vogel, MPH, president of iLIANT. The greatest asset any practice has is its accounts receivable. Physicians trust the collections team to collect that money. Allow your staff to see the integral part they play in the financial success of the operation.

3. Organized, methodical approach. Follow-up can mean the difference between collecting payment and losing it. For example, if a collector persuades a patient to make a payment on an overdue account by a specific date, but fails to follow up with the patient when the payment doesn't arrive on the due date, it's likely no payment will ever be received. The patient will view the lack of follow-up to mean the practice wasn't serious about collecting the money in the first place. "If collectors are not very well organized, they're only going to collect whatever is the least amount, and they'll only collect from the easiest person who's going to send in money," Uthe says. "They have to be able to track things on an automated process or some sort of tickler system."

And, collectors must be consistent in the methods they use. "For example, if you have an older person who gets to the heartstrings of the collector, and if that employee doesn't stick to asking the same questions and trying to get payment as they do from everyone, that collector is going to get caught in an emotional situation." he says. "Chances are that's not going to lead to as much collection."

4. Goal orientation. Although successful collectors strive to meet goals, many practices fail to give them defined, achievable benchmarks. At iLIANT, the collectors have monthly production goals that are broken down into daily goals. According to Uthe, the guidelines are based on:

For example, if your practice normally collects 70 percent on its charges and has $1 million in charges, you should expect to get $700,000. Divide that amount by the number of business days in the month to determine how many dollars you need to collect each day. By specifying that each collection call should net a certain number of dollars, you can calculate the number of calls required to achieve that daily dollar goal.

Instead of ordering an employee to make 400 calls in a month, ask if the individual can make five calls in an hour. That amount times eight hours a day times five days a week is 200 calls per week. If the collector keeps that pace, he or she would double the original instruction. If the daily goal is not achieved, the staff member will have to make up the calls at another time. As the billing or practice manager, you must also determine why the goal was not met. Uthe says, "You need to find out whether it's something permanent that needs to be addressed or something temporary."

5. Flexibility. Collectors have to be flexible to work with patients and payer to get payment, Uthe says. "If they are merely saying I have to get everything or nothing, chances are they will get nothing. They have to understand that the medical practice would rather have some payment consistently than nothing." $ $ $