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 [...]