How Many Billers?

Question: In your July/August issue, a reader asked a question about billing staff benchmarks. I need to figure out if my own practice is over- or understaffed. We are an anesthesiology practice with 10 physicians and 35 CRNAs; we do no pain management. We have seven full-time administrative staff. How many do we need?

Answer: The question in the earlier issue referred to how many staff you need to manage 100,000 claims, from beginning to end. Here is 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.

Industrywide, 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. According to data from the Medical Group Management Association (MGMA), anesthesiology practices have a median of .45 support staff per physician. You have closer to 1.25. However, you also have a lot of CRNAs relative to the practices in their survey (keeping in mind that MGMA has a low response rate in anesthesiology).

My less data-driven sense is that you have things about right for all you are handling in-house. That is especially true because coding and billing in anesthesiology is notoriously difficult.

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
• Percent 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
• 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
• 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.