Wiki Workload expectations-how much is too much?

[AR2728]

I am a CPC and the billing supervisor for physicians offices owned by a Hospital in a rural area. I'm curious is finding out if our workload with our current staffing is comparable to other offices and would love some feedback.

We have 3 full time billers, 2 full time coders (including myself), and our cashier assists in billing/coding probably on average 2 full days a week.

We bill for a large family practice as well as multiple specialties, we handle their daily patient visits as well as the professionl hospital services/surgeries. The easiest way for me to break this down is by claims a month. Total claims for month of September this past year was 6,911.

I'd love to hear from others out there, my staff is interested to know where they stand and if there should be a push for additional assistance.

 

[KathyJohnson]

For the billers that's 3000 bills a month or 150 a day not counting the additional part time help. For the coders it's about 200 a day. That seems like a lot to me if you take into consideration illnesses, vacations etc. How current do you stay and what is the opinion of the staff?

 

[mitchellde]

The way I break this down is.. take an average of 20 working days in a month, and that gives you 346 claims per day, or 173 per coder, and 115 per biller. with the additional part time help I see no problem with the numbers. The average coder should be able to code at least 200 physician claims per day. Now the real question is what is the back end like. How many rejections must be reworked each day? How many claims do not go out with the correct codes? To me this is the bigger problem, I have audited offices where the coders devote 6+ hours a day to reworking the back end. Things they did not code properly the first time. If you code it correctly the first time this should significantly decrease the back end work. So the real question is, in addition to new claims how much time needs to be devoted to old claims, there is where the answer lies.

 

[aaytes]

Good question. For the 173 claims per day for the coders, is that just diagnosis coding or procedure code(s) and diagnosis codes? I'd be interested in hearing from others that have goals/benchmarks that have to be met daily or weekly with tips on how to have the most productive billing office possible. We want the claims to be correct going out the door the first time too.

Anne Aytes, CPC

 

[AR2728]

Thanks for replying. I wanted to try to answer some of the questions you presented. Posting/Coding of claims is required to stay very up to date. Physician productivity is taken into account at the end of every month based on RVU work totals/ We make every attempt to be no more than a day behind in coding/posting of charges with the exception of procedures requiring pathology, usually these are 3-5 days behind. Our family physicians and OBGYN clinic utilize an EMR, they have around 2500 claims monthly-these require review of codes versus coding from documentation alone. Our other clinics, although they utilize a superbill, procedure and diagnosis coding is extracted from the visit note.
As far as corrections on the back end, the majority of corrections are due to incorrect insurance or patient demographic information-information captured on the front end. On average 20% of total claims are rejected requiring corrections.
In addition to the claims currently being handled. We are adding pain managment as an outreach clinic, services provided once a month. Our Rheumatology and Pulmonology outreach clinics have also expanded, each adding an additional day a month with Pulmonology increasing productivty by having a Nurse Practitioner see patients as well.
I am thrilled to see our rural area grow as it has, providing much needed care close to home. The addition of specialties provides a continued growth in our field and job security for which I am extremely greatful. However, I want to continue to be realistic in our goals and prefer to increase staffing prior to an employee breakdown due to work overload. As I said, being in such a rural area we have no idea what expectations are in other areas so I truly appreciate the feedback!