We're looking at changing functions and having billers only work denials and aging. If anyone's doing this I'd like to know how that's working. Any other opinions / suggestion / feedback is grealy appreciated, especially from those of you with great DSO.
That is a great idea, i do billing,coding and collections along with customer service, i feel that doing customer service really distracts my daily duties, if i could just focus on what i do best which is billing,and working on my aging, i could get alot done. Unfortunately,my boss cannot afford to hire someone else so, i find myself doing paperwork,along with the consolidating of documents etc.. So, yes great idea
In order to provide effective feedback, I am wondering what the current billing functions are? What aspects of the job are you looking at breaking apart aside from working denials and agings?
currently billers review claims for accurate medical necessity, verify RX is
valid, attach modifiers, correct claim entry for transmission (upgrades,
downcodes, bundled, etc...), add tax locations. Pretty much make sure before
we transmit that it's a valid, payable claim.
I would weigh your options based on your knowledge of your staff. You could have billing separated alphabetically by patient name, separated by insurance type or as you posted initially. I would suggest doing a pro/con list for different setups before making a major change.
If you break apart the functions and have billers who handle up to the point of transmission and billers who handle post transmission - how will you be monitoring that? Meaning, it could become very easy for a person who is handling the pre transmission claim to get frustrated, tired or even a little lazy knowing that if the claim gets denied it becomes the problem of someone else.
When I first started, 18 years ago, the company I worked for had their billing separated by payor source. We had separate Medicare, Medicaid, 3rd Party, Hospice, Wholesale and Private billing staff. When Medicare would pay a claim and it transferred to the secondary insurance it moved along to the next person to bill/work.
Personally, I tend to lead towards the alphabetic aspect. I need my billing staff to be trained in all payor sources. Plus, I always have adequate coverage during vacation and sick time. Also, if you would end up with a staff member who is not performing to an expected level it's easy to identify.
If I was still actively performing the billing functions today, I would want something that I could follow from start to finish and take ownership in.
Excellent answer DeeDee, we also use the alphabetical seperation of billers. I like your explanation of why this works so well.
Another note I would throw in, when seperating these duties away from Customer Service be certain that your billers train your Customer Service to spot problem areas BEFORE the equipment / supplies are dispensed. When I first made the seperation, I noticed significant increases in same / similar denials, wrong payor denials and failure of the new Customer Service Reps to get the secondary insurance correctly. It will put more pressure on your intake staff than you think! Those people who can collect just know what's requried from the start.
I agree about billers only doing billing related things, if possible. Some days our phone lines are so busy that billing has to step up and answer them, and it really distracts you from what you were doing. Not much billing gets done on those days.
I am still trying to train the intake staff to look for problems before delivery, like same and similar, and patients who do not qualify for nebs and O2, for example. It is definitely and uphill battle.
Billing functions
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