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In Medical Billing and Collections, You Never Answer to One Person


Thoughts on the difficulty of juggling physicians' requirements, patients' demands, co-workers' needs, and still getting your job done as a medical biller.

In every medical office there is a hierarchy of importance among the staff. Typically, it would be a downward flow from the doctor to the office manager to the rest of the staff, unless of course you are in a larger office where there are department supervisors between the office manager and the rest of the staff. The chain of command is laid out in black and white, alleviating any problems of who answers to who and who can get things done. Unfortunately that works only in a perfect world where "things look good on paper." The reality is very different from the biller/collector’s standpoint.

I’ve been in medical billing and collections for 20 years and this one thing has rung true: A biller never answers to just one person. The biller must find a way to manage the doctor’s requirements, coding guidelines, insurance policy rules, patients’ demands, needs of co-workers and still get the claims out correctly and money in promptly. If you’ve ever wondered where the buck stops ….it stops at the biller’s desk.

Most doctors and managers are bottom line type of people in that if they ask why collections are down, they want short bullet point answers. But the answers to why collections are down are not always that easy. As any biller knows, there are so many variables that account for what is collected. They may not care that the 20 insurance plans with which they signed contracts, each with a different set of hoops that you (the biller) must make sure the office has jumped through before sending the claim.

Patients are the same way. They want a short concise answer as to why their insurance didn’t pay and what you are going to do about it; they don’t want to hear about the hidden intricate loopholes their insurance policy has which doesn’t allow their skin cancer to be removed on the fourth Friday of the month after a full moon. Patients get an abbreviated description, if any, of their benefits from their employer. The intricate details are left to the biller to explain when the patient ends up owing more than their copay. Patients don’t want to hear that their surgery is is not covered by their policy because "their cousin’s mother-in-law in California had practically the same surgery in 1992 and her insurance paid for it." And I might add, the biller gets the bad end of the deal because they do shoot the messenger.

Coworkers should be there to commiserate with, right? Unfortunately not. The biller is most often caught in the middle between patients who complain that "nobody told me when I checked out that I had to pay this" and the receptionist who swears she did. The biller also gets the evil eye from the nurses for being the one to remind them they must fill out the requisition forms a certain way in order for the insurance to pay for the labs they ordered. Billers also must bear the brunt of coworkers' frustrations when their answer to the doctor’s "why are collections down" inquiry happens to include some staff shortcomings or mistakes.

In short, the life of a biller is not always a bed of roses. Most days, it’s like being in a three-ring circus as you try to juggle everyone making demands on your time and your performance. I can’t think of another job except maybe an IRS agent, in which the first prerequisite is having skin like an armadillo. The successful biller is one who has learned the art of juggling demands placed on them by all of their "bosses" while still keeping their sanity.

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