User Rating:  / 1

As we embark upon 2011, the necessity to improve the efficiency and profitability of our Medical Billing has never been more important. In the face of rising practice costs coupled with declining or stagnant reimbursement, the challenges presented to medical professionals and their billers will be daunting. Many billing operations have not kept up with the ever-changing challenges and the risks to their practices, and this will become very apparent in the New Year. Here are some suggestions to assist your medical billers and some deadly pitfalls to avoid.


  • Hire the right person for the job. With a myriad of "Get rich quick doing medical billing" courses being offered throughout our communities, the need has never been greater to insure a quality vetting process for hiring the best billers. Many of these medical billing courses are vastly inadequate in preparing billers for real world practices. Greater hiring success can be achieved by developing your own standardized testing for all new applicants as well as thoroughly checking references and verifying stated qualifications.
  • Use Your Practice Management System to its Full Potential. The days of your old management system are over! With the demands placed on the ever-changing billing software programs, having a modern up-to-date system in place and having people who know how to fully utilize it, is critical. Blaming a management system for all of our billing woes is easy, but inappropriate. Proper training of personnel and having a relationship with your software vendor is the key to solving most of system problems you face. Reaching out to other practices with the same software is another suggestion, to tap into their expertise and experience.
  • It's the Insurance Payers Fault! It is overly simplistic to blame the insurance payers for our increasing denials, more write-offs and reimbursement rates that have fallen off a cliff. The old adage that, "it is what it is", is unacceptable. What we shouldn't do is throw up our hands in disgust and accept poor payer performance. Look inside your own company for ways to tackle repetitive issues with different insurance payers. Keep journals for payer specific companies and what has improved performance. All payers are not alike and what may work well with one may have no bearing on another. Successful billers who deal with multiple payers will address both internal and external issues for increasing overall payer performance.
  • Prioritize-NOW. With a desk heaving over with work and 200 emails to read, the ability to prioritize and properly manage workloads is imperative. Developing schedules and checklists of the most to least important functions of the day can assist your billers, especially the newer ones. Being unable to recognize what is more important over what can wait, has been the downfall of many well-intentioned billers. Taking a logical and deliberate approach to your workload is critical to your success.
  • What Write off? Wouldn't it be so much easier just to write this off? NO! A common pitfall to new and experienced billers alike is to take the easy way out and write off denials. These inappropriate write offs cost practices thousands of dollars a year, that could just as easily be recovered with a little effort. It oftentimes seems like the insurance companies' front line of defense is to deny claims. Perhaps the lazy billers in our midst have propelled this practice into something that is now commonplace. Working denials and writing appeals should be a tool that is readily used by every biller. The result of this effort will either show flaws in your billing practices or educate your billers and physicians on what and how line items and even times, entire claims get paid or denied. When we understand the real reason for denials, then we can properly address those items, with educated practices that reduce the write offs and increase reimbursements. Don't take the easy way out!
  • The Perfect Billing Office. While we would all like to think that ours is the best, realistic managers know that there is always room for improvement in any operation. With the complex nature and demands in Medical Billing, the many little things degrading performance can easily be missed. Closely monitoring performance, in all areas of your business is the never ending key to success. Every office should develop a template of key performance indicators. This could include A/R, write offs (see above), aged trial balance or whatever you deem to be key indicators of performance for a specific account or practice. All participants should agree on the way information is gathered and input so this isn't an exercise in "garbage in-garbage out." A monthly monitoring and discussion is invaluable as well as sharing the information gathered with all involved and eliciting staff input for improvements.
  • Just a Cog in the Wheel. Understanding the duties and responsibilities of every aspect of the medical practice is vitally important to the efficient running of the entire operation. It does little good to have an outstanding coder when a physician won't complete his chart notes in a timely manner. When one aspect breaks down, it negatively impacts the whole practice. Maintaining consistent revenue is a goal that can only be achieved by seeing the big picture. The smooth relationships and interaction of all these cogs in the wheel, affect the ultimate outcome. Provider enrollment and negotiating contracts lays a critical foundation. All staff members understanding how their specific involvement and duties affects the entire process is imperative. Allowing one aspect to bog down is detrimental to the entire operation. Thorough monitoring and quick corrections to deficiencies and inadequacies should be job one for a successful office.
  • Welcome to the 21stCentury. With the increasing demands on our billing offices to achieve more with less, we are fortunate to have access to the latest technology. Offices that fail to keep up with the times and utilize the resources that are available will quickly become obsolete and fail. With the increasing focus on electronic medical records, having a quality EMR system is critical. It is foolhardy to not take advantage of the all the advances in current medical billing software that can complete or expedite many tasks such as scrubbing claims, electronic remittance, using predictive dialers, automating charge capture data, and many other applications. At the bare minimum, an office evaluation by a medical billing IT professional can help streamline your office systems and insure you are running at maximum efficiency.
  • Where Did My Money Go? Companies with fewer than 100 employees are most likely to suffer internal fraud. Small companies tend not to have adequate control systems to prevent theft, and individuals are put into responsible positions with relatively little oversight. Medical practices are especially susceptible to this type of theft with as many as two out of three physicians becoming victims of embezzlement at some time in their career. One reason medical practices can be vulnerable to embezzlement is that they often have numerous cash transactions for out-of-pocket payments, co-payments and deductibles. Many medical practices turn over complete control of their cash and checks to office staff, increasing the potential for internal theft. A medical practice can lose thousands of dollars because of just one dishonest employee. If your practice is not careful, your profitability could be jeopardized by a staff member falsifying records, creating fake patient accounts or conspiring with vendors. By establishing a strong, formalized system of controls to monitor money, employees will understand that honesty is both valued and expected.
  • Let's Go Paperless! With modern technology the idea of a nearly paperless office appeals to many, and is ever closer. Transitioning workers accustomed to the paper trail is a sometimes difficult process. Paper pushers tend to spend an inordinate amount of time managing all their papers. Their papers must be organized, highlighted, stacked, placed in folders, etc. Properly training staff in the efficient use of computer software intended to replace paper, leads to increased production and a streamlined workflow. Having policies and procedures in place that discourage needless paper and require more efficient work, are valuable tools in encouraging your staff to be more productive.


New Year's resolutions are ever so popular in our personal lives. The resolution to make your office more streamlined and efficient should be a daily vow. With the unknown impact of the changes in healthcare on the horizon, there is no time like the present to insure you are fully utilizing all of the technology and information available to make your office the best it can be.