I've spoken often about identifying the answer to the question: "Whose job is it, anyway?"
When it comes to getting you paid for your services, having clear and concise responsibility lists are the first step in this process. Is your front-office staff pointing fingers at the billing company or department? Is the billing company or department saying, "We asked for that information months ago?" If the answers are "yes," then, it's time to sit down with a representative of each, and make a list.
Once you have a meeting date set — this can also be a conference call if logistically it is impossible to have a face-to-face — have your two representatives do some homework prior to the meeting. Give them enough time to really work on this, as it is important to have buy-in from both sides and feel like they are a part of the solution. Perhaps a week would be ample time to devise a thorough list.
On this list, you will want them to list their daily tasks; even if it seems minimal. Everything should be written down. This is an excellent exercise to see exactly what the front-office staff are doing. The billing representative will make a similar list. Then, have the billing department make a list of what they think is front-office responsibility, and the front office staff will make a list of what they feel is the billing department's responsibility.
What will come of this during the meeting is you will find three things:
1. A list of tasks not being done by either group;
2. A list of tasks that are being overlapped and duplicate work is being performed; and
3. A list of tasks that either group thinks belongs to the other group
It's a very interesting exercise and the results will probably shock everyone.
For the first item, really review this area. Are there specific tasks that you have requested to be performed, or are policies that have been ignored or not given the proper attention that you feel are still imperative to the operations of your business?
For item number two, the three of you should talk it out and figure out who should really be performing those tasks. You do not want two (or more) resources performing the same or very similar tasks. Have them help decide which group is more appropriate for the task and move along.
For item number three, this is where the finger pointing will start. This is also where everyone needs to remain objective and focus on the end result, which is ultimately getting you paid for your services. If appeal letters are the issue, look at what is involved. Perhaps the task can be a joint effort. The front office can gather the information and send it to the billing department. The billing department writes a compelling letter on your behalf and send claims again. If the topic is obtaining retro-authorization, or even first-run authorization, this should fall squarely on your front-office staff. This is something that needs to be obtained prior to the patient's arrival at your office. The billing department is in place to send claims and follow up on denials.
Have your two representatives really talk out the logistics and keep in mind that anything before a claim is generated should be front office, and anything after the patient was seen should be the billing department. Of course there are always caveats to this, but that could be a great place to start.