Improving billing and collections department efficiency

To operate the billing department effectively and efficiently, practices need to recognize that billing and collections require good management. Some techniques to improving the billing and collection efficiency may include:

Establish expectations. Expectations need to be set with the patients, payers and staff. A common problem practices face is getting patients to pay their bills, deductibles or copays. Although nearly every practice has a financial policy covering when payment is due and how it can be paid, patients often don't know about it.

Communicate to the patients when they register as new patients the financial policies. State what the practice is going to do about time-of-service payments, how to handle collections later, and anything else they may need to know.

Expectations also need to be set for billing and collection staff. This can be done by adopting policies and procedures regarding how the practice will handle past due accounts, including addressing questions such as when patients should be called about their past-due accounts and when to send an account to collections. If a practice calls the patient about the account and tells the patient to call back in 14 days or their account will be sent to collections; but the practice doesn't look at the account for a year (because the patient never called), how can the account ever be sent to collections? Failing to define follow-up protocols means that work may never be done and renders the financial policy meaningless.

Practices should also strive to set expectations with the payers. Don't think that once you receive a contract from the payer that it has to be accepted as is. Negotiate the terms of the contract. For example, the contract may have a 45-day timely-filing provision; state that you want it to be 60 days. Define the expectations. Look at what the practices' billing office protocols are and go back to the payer and say you need 15 more days to file the claim. You can also negotiate the fee schedule set in the contract.

Establish accountability among the billing staff. Practices should organize their billing offices so staff know their responsibilities and can be held accountable for their work. A suggestion is to organize the billing department by payer. If you have someone who really knows and understands Medicare, for example, and that person is very familiar with the contract and guidelines, they should be the one to submit the claims, look at the claim reports, review the remittance edits and work the rejections. By having this specific biller working these specific claims the practice ensures that the biller, who is familiar with the original claims, follows up. They have the knowledge to compare what was submitted with the report and find what occurred and make the appropriate changes. The billing supervisor would be responsible in assuring the workloads are balanced out between the billers.

Avoid batching work. Organizing work in batches may hold up production. Compiling work in piles to do later causes bottlenecks. For example, a practice has some problems with claims with a particular payer. Every time the problem occurs, it's recorded in a log to eventually be discussed with the payer. However, the problem isn't getting solved.

We recommend setting a time to handle problem claims on a weekly basis. Take the time to focus on the problem and decide how to improve the process and complete task. By spending a few minutes solving the problem it will save problems down the line thus reducing workload and stress.
Acknowledge the billing staff and make them part of the practice team. When does the billing/collections office, actually talk to patients, usually when the patient is upset about a bill. When do they talk to the providers, probably when they have to confront them about needing a better code for a service.

Make the billing /collections part of the practice team and not an isolated problem place. Sometimes billers feel that they are being dumped on by everyone. This is a huge source of stress and job dissatisfaction. Billers should be recognized as the important members of the team, which they are.

Thank you notes from the provider or management staff to the biller who worked hard in solving a problem claim or saying "I'm proud of you," or "great job" to the collections team for meeting their requirements for the period makes the staff feel more a part of the team.

Applying these management techniques to the billing and collections process can help the practice avoid common problems that will eventually result in reduced revenue.

MAB: Founded in 1995, the Medical Association of Billers is the premier training and credentialing association for medical billing and coding. The MAB curriculum has been approved and licensed by the Commission for Post Secondary Education and MAB is an approved vendor for Federal agencies.
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