Billing Benchmarks

Question: How many billing staff do I need?

Answer: Here is what Physicians Practice recommends for billing staffing, by claims volume:

• Billing full-time employees (FTEs) per 100,000 claims: 10.45. (Claims are the basic work unit of a billing staff member, just like work RVUs are for a provider.)
• Payment posting/cash management FTEs per 100,000 claims: 1.9
• Credit resolution FTEs per 100,000 claims: 0.4
• Insurance denial and follow-up FTEs per 100,000 claims: 3.1
• Patient follow-up and inquiry FTEs per 100,000 claims: 1.8

One biller per 10,000 claims may seem a bit low, but if the claims are clean, then no billing staff intervention is needed at all. Therefore, the ratio is not just a reflection of how good the biller is, but how good the process is.

A biller is defined as anyone who touches the process from the time a charge becomes a claim until the claim is fully paid.