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The smarter way to faster billing and collections


To collect all you earn, your billing staff need clear roles, policies, goals, and the right tools.


Problems may emerge, though, when more doctors join the practice, and they hire two additional billers. Although the billing department has gotten bigger and perhaps busier, it may actually be less effective due to poor organization. In such a practice, 50 percent of accounts receivable may be older than 90 days-a red flag of inefficiency. Explanation-of-benefit forms may go unposted for days on end, causing a surge of rejected claims from a major payer to go unnoticed. The new hires may waste time chasing down $5 or $10 balances, while the senior biller doesn't share his important contacts at XYZ Health Plan.

One reason why a billing staff might work hard but accomplish little is rampant multitasking, reminiscent of a solo practice, says practice management consultant Deborah Walker Keegan in Arden, NC. "Everybody does everything, and nobody is accountable for anything," says Keegan, co-author of The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid.

Billing and collections is a practice-wide job

Lest you're tempted to focus only on the billing department, remember: It takes an entire practice to collect your money. Your appointment scheduler and receptionist need to gather complete, up-to-date demographic and insurance information about patients-the grist for claims. A front-end mistake can trigger a denial, and create more work later on. Likewise, the billing department can't send clean claims out the door if physicians code incorrectly.

That said, some billing responsibilities clearly belong to the billing department, chief among them submitting claims, posting payments, working old A/R, and answering patients' billing questions. Practices differ, though, in classifying charge entry. Some assign it to a front-desk cashier while others batch charge tickets for a biller to process.

Consultants generally favor the cashier approach toward charge entry. "When front-desk employees do it, they tend to be more accurate because they can immediately clear up any questions with the doctor," says Sharon Rentze, a former practice management consultant who oversees occupational medical centers in Missouri for Concentra Health Services.

A busy practice may need more than one cashier to ensure both careful data entry and personable customer service. That's the case for seven-doctor Acadiana Family Physicians in Lafayette, LA, where two cashiers work side by side. "They have enough time between collecting payments to key in charges," says clinic manager Paula Quebedeaux.

However you structure charge entry, don't delegate it to someone who also posts payments. A crooked staffer, consultants say, will find it easier to embezzle if he's able to adjust a patient's account on both ends of your cash flow. Play it safe by assigning charge entry and posting to different employees.

How many staffers do you need for billing?

The annual cost survey from the Medical Group Management Association provides a rule of thumb for a reasonable head count in the billing department. In 2006, single-specialty family practices employed .67 of a patient-accounting staffer for each full-time-equivalent physician. Pediatric and internal medicine practices reported staffing ratios of .60 and .61 respectively. In the MGMA survey, patient accounting includes employees who code, enter charges, post payments, cashier, and follow up on A/R.

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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health