Q: We have a midsize practice of five internists and three cardiologists. We perform many laboratory services in the office, including bone density and nuclear stress tests, Doppler studies, and echocardiograms. We employ five billers to handle the volume, with one biller devoted to laboratory services exclusively. Are we overstaffed? The billing supervisor says she does not know how we could manage with fewer billers, yet my partners are convinced we can let one go.
A: Productivity metrics for billing and collections is very important and is measurable. To fully answer your question, however, more detail about your practice is needed.
In general, the number of providers in your practice and the services provided are important factors. But even more imperative are the collections per visit (or claim), total annual collections, and the duties that your billers are expected to perform. For example, if they are posting demographics and charges from hospital testing reads, most benchmarks will not account for those functions.
To fully evaluate your staffing needs, begin by benchmarking outcome measurements against best practices.
For example, the benchmarks in your practice should have an accounts receivable outstanding measurement of less than 30 days, net collections should be 98%, and charge lag should be less than 3 days. Based on the comparison with some benchmarks, you can determine whether your billing staff is performing well or below standards.
Second, determine the duties your billers are performing. Are they posting charges, payments, and pre-certification, and doing follow-up work, or do other front-office staff members assume some of those duties? Be sure that the benchmarks used for comparison define the work function being compared.
Because a biller’s job is to collect every dollar owed to the practice, I’m not a big believer in measuring keystrokes, claims processed, time on the phone, etc. A biller will work to the measurement that you develop, which may or may not achieve practice goals. Measure claims processed internally against your billers, and check notes posted in the billing system to ensure accounts are being worked; do not use outside benchmarks for these functions.
For your practice, a fair benchmark would be collections of $1.3 million to $1.4 million per biller. In other words, with five billers, you would expect your practice to collect $6.5 million to $7 million annually.
Finally, measure the productivity against the outcomes to determine whether staff members are performing to their expected levels.