Practice Management Alert

Your office may never have enough employees to run a tight ship, but with these organizational skills you can at least get the most out of your understaffed workforce.

Even offices scraping the bottom of the barrel can improve their office productivity with realistic goals and effective trimming. Make good with what you've got: Turn your resources into assets with a multi-faceted game plan, says Jennifer Darling, compliance officer, insurance & collection specialist and owner of BBC Medical Management Services in Dallas.

You must begin, above all, with timely filed claims, Darling says. Your office should be filing claims daily, and if not, no less than once a week. The faster you get the claims out, the sooner the money comes in or the sooner you can appeal the denials, Darling says.

Here are nine additional proactive steps to improve how quickly your office gets claims out the door, whether for the first time or in response to a denial:

1. Split your task force into groups, Darling says.

Collections: Working the AR reports and handling patient accounts (30 percent of employee resources).

Charge posting and auditing: Verifying accuracy of charges and high-level physician visits as well as correct diagnoses and procedures (30 percent).

Receivables: Posting EOBs and write-offs, tracking denials and forwarding incorrect payments and denials to the collection group (20 percent).

Special projects and other tasks suitable for your office (20 percent).

Consider separating out the patient-due portion of collections from other tasks, one billing expert suggests. When people focus on a specific task and don't "change gears," they increase productivity, he says.

2. Hire educated and aggressive coders. You want coding professionals either coders, biller, or both who encourage and assist physicians to code correctly. Make sure your coders are also qualified and understand the importance of coding and that they are "detail-oriented people," Darling insists. With educated and determined coders, you'll file clean and accurate claims the first time, which cuts at least 40 percent of unnecessary work from the collection process.

Assign each coding professional to a group of doctors and arrange coders by specialty, she says. If your coders know the idiosyncrasies of the physician and specialty, you've mastered a "large player" in claim payments, Darling says. Assign one-fourth to one-half of your coding professionals to review the dictation, and make sure billing matches documentation before claims get sent out, she adds.

3. Assign each employee to the position that fits her skills and your needs best. If you don't have the luxury of hiring new staff, make sure each of your current staff members is well placed, Darling says. If you reorganize or review the team for the reallocating positions, have each employee write down her best attributes in this business of insurance. Find out what they want to do and what their goals are for themselves in your practice. Find out if they want training, and be open to providing it.

4. Swap coding and billing. Consider combining your coders with your billers, making it one job. The actual billing is not as time-consuming as coding and could feasibly be combined for one person, she says. The swap also gives your coder knowledge of billing for insurance companies, "which can and does differ from coding for the certification exams," she adds.

5. Delegate collections according to payer and physician. The more nebulous regulations become, the more important it is that you have an insurance/collection specialist who knows a specific payer's rules inside and out. "Combine this knowledge within a specific physician/specialty and you have a tight control on the insurance's quirks, payment routine and denial habits," Darling says.

Assigning collection specialists to specific insurers expedites the appeals process because the specialist knows the fastest way to get paid, she adds. And, when an insurance company can put a face with a name that represents your office, the insurer is more willing to respond to your calls or e-mails, Darling explains.

In a large group or for a large single account, it is beneficial to call a face-to-face meeting with your carrier's provider representative or your IPA representative to work on large issues with a single carrier. Such meetings can be "instrumental" in fixing major issues, "flagging your account for specific payment guidelines" and in handling issues that "cannot be resolved by the standard customer service representative that answers the phone," she says.

6. Ask your receivables posters to glance over the accounts they are posting, Darling says. Without doing involved research, the AR team can quickly note problem accounts or funny-looking situations and pass them on to the correct collection specialist, she says.

In large and understaffed offices, your posters may simply resubmit claims that are more than 60 days old, if they have not been worked. Tell collectors to document everything in a local place if not on the line or claim itself, then in the system so your posters and receptionists can eye a particular claim and see the problem or if it was already rebilled.

Consider having your collectors post the charges and make it a single job, just like combining your billing with your coders, Darling says. "Your collectors are better collectors when they are able to post the money as well," she insists. They are able to see payment trends and denial habits and can create an effective plan of attack.

7. Cross-train. Everyone in your billing department should know the basics of every position. That way, your employees will "have an understanding of how their mistakes affect a number of people," Darling says

8. Don't forget your receptionists. "These are key employees," Darling says. When you find a good one, do what you must to keep him. This is not just a person who answers the phones. The receptionist greets the patients and sees them as they leave both important collection opportunities. They are integral in collecting copays or deductibles when the patient is in the office. If difficult situations arise, they also call specialists to discuss it with the patient, she says.

The collectors should work closely with receptionists, informing them of unpaid patient balances. Have the collector review the receptionist's schedule the day prior and note which patient is due, she says. The collector can tell the receptionist to speak with the patient before he leaves preferably before he goes back to the examination room. "Collecting face-to-face and meeting the patient goes a long way toward cooperation from the patient," Darling says. And it starts with your receptionist.

9. Set up an automated phone service. Get an automated system that prompts callers with the most common questions and then links them to their rep's voice mail, Darling says. Some people may have aversions to automated systems, but we are all used to them and know that we can always get to a live person by pressing zero.

You should note in the system message when calls are returned and between what hours. Be sure to provide an option to speak with the operator and have her triage the call and send it back, or take a personal message, she adds. Provide options to reach a specific representative when you have asked the caller to call you back so patients don't have to go through the entire menu, she says.

You can use your automated service for outgoing messages supplying information for the patient, experts advise. The automated outgoing response system is a means for "touching more accounts and getting responses from patients," one billing expert says. Set up the phone to dial in the evening when the office is closed to avoid overtime expenses for staff, he adds.