Practice Management Alert

Separating billing duties by carrier and by provider both offer rewards

Efficiency isn't the only benefit of properly divided billing office duties - physician productivity monitoring, carrier contract negotiations and biller cross-training are also possibilities.

The way you assign duties in your billing office will depend on many factors, including practice size, number of specialties, and the number and experience level of billing staff. But some tactics prove effective regardless of practice size or specialty. First, here's a list of possible ways to divide your billing duties:

1. By doctor: Each biller is in charge of the billing for one or several providers.

2. By alphabet: Each biller does the billing for a different segment of your patient volume, according to patient last name. For example, one biller is in charge of patients A-M, and a second biller takes care of patients N-Z.

3. By carrier: Each biller handles the billing for one or multiple carriers that your practice deals with routinely.

And the Experts Say ...

Consider your current billing office arrangement - the challenges and advantages - and then take stock of what two experienced billing consultants have to say.

No ABCs, please: "I've tried doing the 'you handle patients from A-M, and someone else handles N-Z' routine," says Maggie Mac, CMM, CPC, CMSCS, consulting manager with Pershing, Yoakley & Associates in Clearwater, Fla. But this method "really doesn't work that well," she says.
 
The goal of using this arrangement can be to familiarize all billers with all insurers so that when someone takes vacation time, other employees can fill in, Mac says. Small billing offices with only a few billers may find this arrangement works well. For larger billing offices, however, this division of duties doesn't allow maximum productivity or efficiency when dealing with carriers.

By carrier is best: The best method is to assign different insurance plans to key employees (or managers) on your billing team, Mac says. Billers may have two or three plans each, and some may have several more, depending on your patient insurance population, she says.

After assigning carriers, hire or assign additional staff to assist these billers, Mac says. The assistants should be available to take messages, answer simple questions for patients, call carriers to check claim status, assist with claims transmittal, and contact patients for outstanding balances, she says. Assistant staff will slowly learn the ropes and eventually become competent backup in case a biller takes vacation - and some assistants may even develop into managers, she says.

Big benefits: Division by insurance plan allows billers to "really wrap their arms around specific carriers" and become experts, Mac says. Focused work with only a few carriers means that each biller can understand carrier-specific billing problems and find quicker solutions. In addition, billers can forge working relationships with carrier representatives.

Bonus: When the time comes to renew a carrier contract, the biller who works closely with that payer will be able to participate in the negotiations and offer input on problems the carrier must fix, Mac adds.

Some Offices Need More Divisions 

Dividing the reimbursement tasks of payment posting, appeals and collections by payer is definitely the best-proven method for office efficiency, agrees Catherine Brink, CMM, CPC, president of HealthCare Resource Management Inc. in Spring Lake, N.J. But if your practice has more than one specialty and your billing office includes coding duties, dividing the coding and charge entry duties by carrier is probably a mistake, she says.

Divide coding by doctor: Sorting coding and charge entry duties by carrier makes no sense and is nearly impossible for such practices, Brink says. So dividing your coding and charge entry by doctor is better because you ensure steady workflow for each employee. Plus, if you have a different coder/biller assigned to each provider, the billing manager will be able to closely monitor provider productivity and provider-based billing problems, she adds.

Multispecialty benefit: Division by doctor is even more important in a multispecialty practice because it allows coding and charge entry staff to focus on certain specialties, Brink says. Just as billers on the reimbursement side are more productive when they focus on certain carriers, coder/billers on the charge entry side are more efficient when they can learn all the coding intricacies of a certain specialty or physician - rather than having to be proficient in several.

Bottom line: Small billing offices with just a few billers will do best to cross-train and be competent in dealing with all carriers and billing issues, Brink says. And large multispecialty practices may do best to consider dividing coding and charge entry duties by provider, and then dividing payment posting, appeals and collections by carrier, she adds.