PHYSICIANS PRACTICE PEARLS: Toward Better Billing

February 1, 2006

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I frequently get calls from practices looking for help with billing. I’ve come to believe that many practices miss the forest for the trees on this subject.

Here is a list of some of the biggest areas for error in billing. Practices that don't get these things right are hurting themselves:

Get time-intensive patient collection activities out of the billing office - and into the front office. It's a waste of resources to call a patient 10 times after he's left your practice, particularly when he was standing in front of you in the office and you failed to ask him to pay you then!

Unfortunately, these phone calls are also usually unsuccessful. It is far better to get patient collections done at check-out - or even check-in - when the patient is still in the office, feeling good about your service. Cross-train your front office staff to collect at the time of service; collecting copays and so forth is not a job for the billing office. At the very least, make sure your statements are accurate and legible - so patients are more likely to pay if you do send an invoice - and maintain a good relationship with your collection agency. Don't be afraid to send them work before the accounts get too old.

Here are some more tips:

  • Do it right the first time. I see lots of offices staffed to the gills to handle denials. Don't staff to cover mistakes. Why do you need more staff to follow up on insurance denials when you coded the claim incorrectly in the first place? Or sent it to the wrong payer? Or the wrong address? It's far better to properly train staff on the front end of the process than to re-do the work later on. Focus on getting it right the first time around, instead of just fixing it.

  • Don't blindly trust your payers. Payers make mistakes, too. Have systems in place to watch for pended or open claims, underpayments, and inappropriate edits. Place a lot of emphasis on payment posting, so that payers' mistakes can be caught early.

  • Use technology. Even though most payers now have Web sites set up to handle insurance verification and even claims status, I still see office staff sitting on hold for hours waiting to get through on the phone. Help your staff by making sure you have Internet access and passwords for the sites they need to use, and bookmark the relevant sites.

  • See the whole cycle. I've met some fantastic billers who, all on their own, still can't turn around a poor-performing practice. Good collections is not just up to your billers. Positive performance requires accurate documentation and coding, timely and accurate claims submission, and collecting accurate information from patients, referring physicians, and the hospital. Learn to see the entire staff - and the physicians - as part of the billing team.

Get these fundamentals right and leave the fancy footwork for later.

Elizabeth Woodcock, MBA, CPC, is a professional speaker and consultant specializing in practice management. Elizabeth is a Fellow in the American College of Medical Practice Executives and a Certified Professional Coder. She may be reached at elizabeth@elizabethwoodcock.com or via editor@physicianspractice.com. For more information about Elizabeth, see www.elizabethwoodcock.com.

This article originally appeared in the February 2006 issue of Physicians Practice.