How Medical Billers Deal with Difficult Coworkers

July 23, 2013

A biller walks a tight rope when it comes to inter-office relationships. Here’s why.

Dealing with difficult people is a fact of life for medical billers. Irate patients and frustrating insurance customer service agents are simply par for the course; anyone who’s been in billing long enough has learned to anticipate and prepare for these difficult encounters.

But what about when it’s a coworker dishing up the difficulty? A biller walks a precariously tight rope when it comes to inter-office relationships. While most people genuinely want to get along with their coworkers, there are some serious pitfalls that can isolate billers from the rest of the team. 

All billers know that the success of a clean claim going out depends heavily on the information put into the system before the patient is ever seen. Schedulers and receptionists are typically the people responsible for gathering this much-needed information. When they fail to accurately gather and input the necessary data, the biller’s success is handicapped immediately. The biller either has to stop her job to obtain the correct/missing information before being able to proceed with her assigned work or she has to report the problem to the proper personnel and wait for the problem to be resolved. Occasional mix-ups are going to happen and shouldn’t bring the house down, so to speak, but when mix-ups become a part of the daily routine with no real efforts made by those coworkers to correct the situation, a biller’s frustration mounts.

EHRs were supposed to be our saving grace. What has happened, at least in my corner of the world, is that it added one more thing to my “babysitting” list. The babysitting list is the list of things I have to continually check behind other people to make sure they’ve done so that I can do my billing job. In most systems, if the doctor or nurse does not complete their note, the biller cannot see what was done and therefore does not know what to bill. Unless of course the billing department crystal ball is working that day.

When the biller cannot send a batch of claims without having to fix numerous repetitive mistakes made by the same coworker(s), resentment can easily take root. Especially when the biller has to listen to the giddy chit chat of that coworker while she is on the phone having to repeat her story to the seventh person at ABC Insurance company trying to find out why their pre-certification request from three weeks ago has still not been answered.

Seeing other staff members treat collections with an errant flippancy can get extremely unsettling to a biller who is putting 110 percent effort into making sure the office is getting paid correctly because she knows that if claims don’t get paid, nobody gets paid. Numerous times I have seen that balances were not collected when the patient was at the office, despite notes on the superbill, notes in the computer that automatically popped up when you click on the patient, and a note being typed into the appointment that says, “patient needs to pay past due balance today.”

Excuses I’ve received from reception employees have included: “Well the patient didn’t have their checkbook”… “Mr. Jones said his wife pays the bills so send the bill to her” … “I didn’t see that big neon pink sticky note you had on their chart” … “I was too busy making their next appointment to read the pop-up notes.” My number one tip for collecting at the front desk is to never ever say, “Do you want to pay your balance today?” I had one coworker who refused to stop saying this. It was brought up in meeting after meeting, yet she continued using the forbidden phrase. Ultimately, it was her downfall because her attitude about that one area spread to other areas and her performance overall suffered to the point of dismissal.

What is extremely frustrating to me as a biller is not that mistakes are made but that many people do not take ownership of or show any initiative to learn from their mistakes. A growing attitude I’ve experienced in recent years from front office staff is “it’s the biller’s job to worry about that.” So billers have a choice: They either keep fixing the mistakes or they take the problem to the powers that be. Then billers run the risk of being labeled “difficult to work with.”

The first deal with these types of difficult coworkers is to be honest, to stick to the provable facts. Don’t resort to name calling or vague generalizations. Don’t wait until you’re exploding with anger to discuss the issue. Document the facts as instances occur. Find a way to keep track of what mistakes are made and how often. I’ve developed simple spreadsheets as well as used various system reports to help me track problem areas. For example, there was an issue where patients’ benefits were not being checked prior to the appointment. To track that, I simply looked at the schedule at the end of each day and counted how many patients should have had benefits checked but did not. I created an Excel spreadsheet with columns for the date, number of patients with insurance, and number of patients whose benefits were not checked. The last column contained a formula that calculated the percentage error rate. Once I had tracked it for a month, I took the report to my manager and we discussed it. After another couple of months when improvements were not made, I discussed my findings with the physician. Once I had done everything in my power to make positive changes, I left the outcome in the hands of the manager and the physician. I then went home with a clear conscience and got a good night’s sleep.