by Rhonda Buckholtz, CPC, CPC-I, CPMA, CGSC, CPEDC, COBGC, CENTC
On any given day a medical practice has a large amount of stressors related to patient care. Providers place a great amount of attention on quality and in any given situation must adhere to multiple payer rules and regulations, and balance the best patient outcome based on those rules and regulations.
Unfortunately, because so much attention is placed on outside stressors in most medical practices, internal issues may often go unnoticed, leaving the physician practice in a financial lurch. Simplifying your systems and performing an audit of billing and coding can keep the practice happy and healthy. It does not need to be an overwhelming process, and once an auditing program is started it becomes simple if it is kept up.
Billing and coding reports need to be submitted regularly and reviewed by someone with authority in the practice. A summary can then be provided to physicians or other administrators depending on your practice layout. Even if it is not a requirement in your practice to provide billing reports to management or providers, you should be presenting reports to hold everyone accountable.
First and foremost, adherence to a security triangle is a must and should be reviewed to make sure it is being enforced. This means the same person should not be opening the mail, handling cash and deposits and allowed to post money and perform write offs. In smaller practices this is sometimes harder to maintain but can be solved with attention to details.
Setting up some boundaries and guidelines for billing staff can help make some sense out of payer policies and the contracting process as well. It is essential that you make sure that not only your billing staff but also those you contract with perform the duties assigned.
Set up policies for write-offs. Make sure all write-offs performed get permission from senior staff or management. Those staff members who are allowed to perform write-offs or adjustments should also maintain separate categories for items or services that need to be adjusted. This helps practices plan and prepare for future needs as well as identifying any issues they may have or services that need revising.
Setting up your practice management system is also a key area for billing and staying organized. Set up allowable payments for each health plan you are contracted with to ensure proper payments are being received. Most systems allow you to set up alerts that notify you when the payment being posted is not what was received; although this requires work to set up, once done it is easy to maintain. It works well to keep you informed and can help you trend payment issues you may have with any plans.
Don’t underestimate the importance of policies and procedures in the billing world. A good set can help the practice set up parameters and keep the practice running in the direction of good financial health.