Biller Benchmarks

Question: How many billers do I need?

Answer: The Medical Group Management Association says that multispecialty practices spend a median of 2.7 percent of net medical revenue on staff related to patient accounting, general accounting, and managed-care administration. Not exactly what you needed to know, but it’s a start.

The association also lists a median number of 0.61 staff per FTE provider in these categories.

Here is yet another way to analyze your billing needs:

The standard of comparison for billing departments is number of claims per biller. Count the number of claims you process annually. Be sure to include electronic as well as paper claims, and any secondary billing.

Next, count your billers. How many full-time equivalents (FTEs) do you have doing all components of billing? Include everything in the central billing office except charge entry, credentialing, compliance, training, and registration.

Finally, divide the number of claims by the number of FTE billing staff to get the number of claims processed per biller.

Industry-wide, the median number of claims processed annually by a biller is 6,700; some can work more. Just be sure that the demand for speed does not lead to reduced accuracy.

You certainly can also do a more intense analysis of your billers.

First, measure:

• Time from service provided to charge entered;

• Time from charge entered to claim submitted;

• Time from claim submitted to claim paid by insurance company;

• Percentage of claims denied on the first submission;

• Time from the receipt of those denials to action taken (such as appeal, resubmission, or write-off);

• Time from insurance payment to sending patient statement; and

• Time from first patient statement to patient payment.

Next, evaluate each employee:

• Ask them what they do - then ask them to walk you through it. You may be surprised by what your staff is spending their time doing.

• Track noncontractual write-offs by employee - look for timely filing deadline write-offs, registration errors, and other internally generated causes for write-offs.

Also, measure the number of:

• Accounts your billers work per day, including patient accounts;

• Appeals they write per month;

• Denials they work per day; and

• Payments they post per day.

Finally, audit a minimum of 20 accounts per staff member worked during the past six months. Again, look for timeliness, accuracy, and results. Pull these files randomly so that the employees can’t work them before your review.

Some uneven distribution of work is valid, as some payers, like workers’ compensation, take longer to work than others. Therefore, an employee may legitimately have as much work to do with half the accounts as a colleague.