Billing Wake-Up Call By Rachel M. Mitchell, CPC-H What will it take to convince physicians and practice administrators that efficient medical billing requires a staff with experience? Throughout my years of being a professional coding and billing consultant/manager, it has been my experience that the billing departments in medical practices are viewed as inessential. Even practice administrators sometimes fail to recognize the need for experienced billing personnel. Dealing with insurance companies, especially federally funded entities, is not a process that can be taught overnight. A clinic’s success depends upon the level of education and tools available to their account representatives. It is amazing how many practices I have walked into and found the staff was billing claims repeatedly because they didn’t understand how to handle the denials that they received. I have seen provider manuals sitting on shelves collecting dust and unbilled claims lying under stacks of paper. More importantly, I have had practice administrators pay for my advice and not use it. Physicians and administrators will wait until their accounts receivable is almost unmanageable before they will call for help. When a billing or consulting agency is finally called major problems already exist, and because accounts have not been handled properly, finances are already thin. A consulting company is then asked to work a miracle that is both time consuming and expensive. If physicians wish to avoid this situation and reduce overhead, the first step should be hiring a qualified staff or billing agency. In most cases, the first open position should be filled with a coder to assist in the accuracy of claims billed. Undercoding for levels of service is where most of revenue is lost. Many accounts receivable problems disappear with a qualified staff, whether the staff is an outside service or simply a competent employee on location. In my experience, clinics will often hire family friends or the person willing to do the job for the smallest salary. They assume that a good personality and a small amount of computer experience is enough to be a competent billing clerk. This is not the case. Though these are positive attributes to look for in any employee, a qualified billing clerk should also be able to read insurance remittances and rectify claim denials. When hiring an employee that will have a large influence on your accounts receivable, it is important to distinguish between a staffing problem and a staffing opportunity. Hiring the proper clerk is not as easy as reading resumes and picking the candidate that looks the best on paper. Account representative is a hands-on position and requires a similar approach to the hiring process. Numerous tests can be given to interviewees to help determine whether a prospect has the necessary knowledge and skills to perform the duties that you require. My suggestion is to test candidates on reading insurance remittances. Use old vouchers and test the interviewees on identifying payments and contractual write-offs. Choose some of the more difficult remittances to use for testing to determine if their abilities match the experience listed on their resume. In addition to insufficient revenue, an inadequate staff can lead to improper billing which can cause greater problems, such as an audit by the federal government. Single physician practices need to avoid thinking that they are exempt from investigation. I have first hand experience in seeing a small practice in a rural area fail due to fines from an audit. Employing a competent billing staff to increase both the accuracy and efficiency of your claims remittance, is a small price to pay to avoid the cost of losing your practice. To conclude I have some simple advice for practices: Find out what your current billing staff is doing to ensure that the cash flow is adequate in your office. Ask them about denials or trends on codes that are not being paid. Find out the steps that they are taking to correct these problems. Then, hire an outside firm to perform a documentation audit to make certain that the levels of service and procedures that you are billing are correct. Consulting professionals will play close attention to your accounts receivable and review insurance remittances and denials to correct future blunders. Once you are confident that your practice is heading on the correct path, consult regularly with your account representatives to make sure that your billing procedures are still aiming in the right direction. Ms. Mitchell is the Billing and Coding Manager for Applied Medical Systems, Inc., an accounts receivable management company in Durham, North Carolina. Ms. Mitchell has over 10 years experience in medical billing, coding and consulting. For any questions regarding the above editorial you may reach Ms.Mitchell at (919) 477-5152 or at [email protected] This article is reprinted with permission from the March 2002 issue of M.D. News magazine.