Wiki RE:Billing--advice staying on top of things

Create Wiki
K

Kar116

Guest
Messages
69
Best answers
0
RE:Billing--advice staying on top of things

I am a new medical biller employed less than 5 months. I work with another biller and was wondering how each of you who are biller/coders handle claims in each office. Trying to get things organized such as getting out letter of appeals for timely filing, checking eligibility, follow up on claims, billing claims electronically, etc. I have been working on the 60-90 day aging list and posting eobs while the other biller has been working on older claims. She is also an MA and doesn't have 100% time to do billing since she has to deal with patient care. Any suggestions to get the ball rolling? Maybe one of us should handle the bills from A-M and another biller handling N-Z perhaps? We have been comparing our notes on Excel but seems like we are going in circles at times. Any suggestions out there? This is a small office which has doubled with patients in the past year. Thanks.
 
That's a great question. I work for a large billing service that handles the billing, coding, and practice management for over 20 practices. Our main staff (not including management) is 9 people. Our billing software, Healthpac, handles a lot of this kind of thing for us. It has a function where denied claims come in from the clearinghouse and are sent to a queue, which can be sorted by insurance type, denial type, age of claim, etc. I can typically work about 500 denials in a week with this program. Our clearinghouse, Realmed, also does a great job of pre-scrubbing claims to catch simple errors, including eligibility errors, that can clog up the denial queue. I think my first step would be to talk to the billing software and clearinghouse reps and see what kind of time-saving features they may have that you aren't currently using.

I'm not a billing manager but my personal philosophy is that there is nothing worse than a timely filing denial. Even if I think I don't have all the info, I get a claim filed because even a denied claim will reset the timely filing clock with many payers. I would also sort the denied claims by payer, as some payers have shorter timely filing limits than others.

Good luck!
 
We have almost the exact same set up as you do, in that there are two billers who handle everything and one of them is an MA a portion of the time.

Here we have split it up by insurances. For example, our biggest payer is Medicare and she handles everything regarding that.

I handle every other insurance.

She handles all of the aging reports, and I manage all of the denials and do the follow-up on all claims with issues. She sends claims on one day and I do them another day so they go out twice a week. She does all statements and I answer all billing questions on the phone and she does them in person.

On two days a week I call insurance companies, one day a week I do every corrected claim and other claim issue, two days a week I audit charts for current week and so on.

This ensures we both have time to get everything done and we are completely caught up plus some right now even though our practice has multiple locations.

I don't know if this will help, but we have a similar setup, so maybe it's worth a shot.
 
Yes, it does sound like we have some issues that need to reorganized. I love the sound of the software Healthpac. We currently use the IMS billing software which in my opinion not the most helpful tool. April, I like how you organize by insurance companies. We have tons of Medicaid claims in our office so keeping up with term dates is now finally being worked upon and straightened out. Just knowing how everyone keeps organized in their office is good to know! Thanks for all your posts!
 
Divide and conquer. I do clinic tickets, mail paper claims, patient debt letters, appeals, and handle various other aspects of helping patients with their bills. The other biller does the same things minus clinic tickets and she also does the benefits for one of our doctors exclusively. Our A/R is divided by insurance company. I think it makes it easier because you learn a companies habits and policies. Our billing manager handles everything else and directs how to handle sticky situations.

Honestly, this job is a lot of work. You have to get a lot done in 8 hours daily. My normal routine is to do my tickets first. It normally takes about an hour-2 hours. Then I check my clinic tickets. If I have appeals to do I get those knocked out, and then mail out paper claims. Once that gets done I work my A/R. Most days the last 3-4 hours are spent on the A/R.
 
Kar116 said:
I am a new medical biller employed less than 5 months. I work with another biller and was wondering how each of you who are biller/coders handle claims in each office. Trying to get things organized such as getting out letter of appeals for timely filing, checking eligibility, follow up on claims, billing claims electronically, etc. I have been working on the 60-90 day aging list and posting eobs while the other biller has been working on older claims. She is also an MA and doesn't have 100% time to do billing since she has to deal with patient care. Any suggestions to get the ball rolling? Maybe one of us should handle the bills from A-M and another biller handling N-Z perhaps? We have been comparing our notes on Excel but seems like we are going in circles at times. Any suggestions out there? This is a small office which has doubled with patients in the past year. Thanks.
Click to expand...

Alpha splits help, but when you're really far behind, it's more efficient to work by payer (1/2 take commercial, 1/2 take government, or split up your major payers).

1st - Get your aging accounts under control. You're increasing your workload, by having to file timely filing appeals, and probably losing money in the process.
Does your practice's billing system provide a claim queue, for outstanding stuff? If so, can it be sorted different ways?
- The system I used to work on, had the option of looking at only overdue charges, or overdue and new, etc., plus, you could sort it by account, payer, charge amount, or amount due. If you have this capability, take advantage of it. First, sort by account. Accounts where entire claims are still outstanding, often have a problem with either the claim not being received, or the patient's benefits. Then, sort the accounts by the amount due, and you'll start seeing patterns of charges that are frequently denying, and you can find a solution that's applicable to all of them.

Whenever I had appeals or corrections I had to send often, I'd made a template, that I could fill in with the account & claim info, every time I needed it.
I also tried to work similar things, at the same time. If I had to call a payer, I'd make sure to have a few accounts that needed to be called on, so I could knock out several at a time.
Work pending claims, before denials. You have around 30-45 days (depending on the payer), before an appeal deadline hits, so they're not a priority over claims that have yet to process.
Use payer websites whenever possible, to check claim status and file appeals/corrections.

It sounds like your office could use another person on billing - it's a big job, and it's more cost-efficient to have enough people, to do it all. You've definitely got your hands full!
 
Organizing job duties....

Since you mentioned working in a super small practice where the MA helps out the front office which is you, I would stick with alpha split. Then split your day up with commercial payers in morning federal in afternoon or by hours. Morning – Commercial, Late Morning-Early Afternoon – Federal, Late Afternoon – Everything else. If you had more employees, 4 or more-having at least 2 people on each, yes, payer split is best.

Reason for this? Turn around Employees, PTO, Sick Leave, etc. If one of you leave employment or are out for sick leave then the other will not be up to date on changes of the commercial or federal payers and you will have to work slower to learn all the new changes. If you split to alpha you can jump in and cover the other position to a temp comes to train or a new employee without missing a beat.
 
You must log in or register to reply here.
Top