With the increasingly restrictive Medicare regulations and declining reimbursements, it’s important for practices to hire top-notch billing managers now more than ever. Effective billing managers must think globally and also be able to manage four key relationships – that of subordinates, physicians, insurers, and patients. Read on for some key tactics on how to hire billing managers who fit the bill completely.

Qualities to look for when searching for a billing manager

Knowledgeable and Continues to Learn: Experience is key but you should not overlook someone who is knowledgeable and continues to educate herself. Ensure she has the knowhow and expertise in your specialty area. Ask for credentials, education and about her goals for your organization.

Expertise in Coding and Billing: In the end, the physician is responsible for coding, but a good billing person should be able to detect coding mistakes and provide corrective action. Enquire whether she has any coding credential such as Certified Professional Coder (CPC). She should also have a clear and complete understanding of claims processing and other billing issues.

Compliance Preparedness: See to it that the candidate is familiar with the provisions of a practice compliance plan and HIPAA as they are related to billing. It’s also important that she knows the requirements for electronic claims submissions (ECS) and basic confidentiality guidelines. Make sure they have resources to stay current as rules are finalized.

References: In case there are no job references, ask the candidate to provide references from teachers, associations or course instructors.

What questions to ask your candidates

• What type of reports do you normally generate and analyze and – how frequently? And what information each of these reports provides and how it’s helpful to the job performance, and to the practice?
• How will you follow up on claims?
• How would you check capitation utilization in relation to capitation revenue?
• What kind of billing software are you familiar with?
• What collection procedure do you follow?
• What type of appeal system do you use?
• Are your coding resources updated?
• What’s your personal management style?

Also ask the candidate to take a test!

How to find strong billing manager

You can zero in on the right candidate by networking, asking other practices, staying away from hospital billers, promoting from within, and providing on-the-job training.

 If you are a biller, you have most likely faced problem payers who can wreak havoc on your billing and practice’s reimbursement. Check out these steps from experts to defeat problem payers successfully and bring in desired money for your physician’s services.

Investigate the original claim

When you realize that you have an issue with a payer, do the research. If you are witnessing payment delays, figure out the reason. If you are getting improper denials, check the denial reasons the payer is providing you on your explanation of benefits (EOBs).

• Lookup online to see if you can find any relevant information about existing problems with particular payers.
• Check whether the payer made an error

If you received a denied or unpaid claim, ensure that the rejection is not a result of the way you filed the claim. To do that, heed these steps:

• Read denial codes on the remittance advice to figure out the payer’s reason for denial/underpayment.
• Assess all the coding documentation
• See to it that the documentation supports what was billed.
• Determine that the payer made a mistake.

Once you have realized that the payer made an error, write a letter citing why you think your payer should pay the claim. Note: For Medicare, you need to file your request within 120 days of the date of the initial determination notice. For private payers, you can ask them about the time limit for payment appeals.

Get in Touch with the Payer

Your next steps would be to contact your payer. To discuss the issues your practice is facing, call either the provider relations number or your payer representative. It’s been observed that 90 percent of denials, wrong payment amounts, delayed payment, can be turned over by a single phone call. The reps at the payer are not as equipped as we would like to think; so usually by just quoting terms of your provider’s contract, CCI edits, proper coding, and the like, you can get your claim issues taken care of.

Key: Document as much information as you can.

Refile if Required

You will most probably want to refile your claim whether the issue is a payment delay or an improper denial. For payment delay, resend your claim and include a letter explaining when you sent the claim and informing the payer you anticipate timely payment. Also, you can include a proof of timely filing from your clearinghouse. Moreover, you should be getting a report (997 Acknowledgement of Receipt) from your clearinghouse confirming receipt of the claim by the payer.

Found this article helpful? Read similar article in Practice Management Alert.

If your organization has seen a lot of attrition of late, you need to stop and ponder what could have gone wrong. Many organizations adopt one-size-fits all approaches to improving staff levels. However, this may backfire with more employees ready to walk off for better working grounds. So figure out how to fix staffing levels in your organization.

Your organization needs to ramp up opportunities for career development and provide higher salaries and perks. You could focus on providing education that paves the way for job advancement such as:

• A certified course for your organization’s staff – plus additional training.
• Training on organizational skills, conflict management, and career development.

 Keep tabs on employee satisfaction – and factors that lead to attrition. You could consider these:

• Conduct exit interviews and take what people say very seriously.
• Have an outside company survey employees about their job satisfaction every three to four years.
• Then use the information to plan ahead for the next couple of years.

Real-world scenario: A facility followed these steps and as a result its attrition rate dropped from about 45 to 48 percent initially to under 20 percent for the last three years.

Spending too much on staffing incentives? Get more results for the money you invest

Another facility spent more than $1 million annually on a variety of staffing incentives and turnover costs.  Yet the situation was terrible. And when the facility administration took a closer look at what was going on, they discovered that the incentives it was providing were in reality leading to some of the staffing problems.  For example, the facility provided sign-on bonuses that actually compensated people for taking the job and then the money and leaving. Moreover, the facility was paying extra for people to work when others called in sick. It also had a “Baylor” program when caregivers could work two 12-hour shifts each week and get paid for 30 hours.

The consequence was that staff could get more payments more working [on a per diem basis] and get bonuses for picking up extra shifts when the facility was short. And this created resentment among the regulars who always turned up for their shifts and consequently received less money than those who received the bonus. The facility also had the majority of its licensed nurses working part-time. However, those are the people who provide supervision and continuity of care in the facility.

A smart move changed the facility’s fortunes

The facility stopped the sign-on bonus and gave staff who agreed to work fulltime a hike of 20 percent. It also traded the sign-on bonuses for retention and referral bonuses. The administration also started paying more attention to the quality of people they got onboard, and how it welcomed new staff. Now the facility has full-time nurses and a list of applications from licensed nurses who want to work there.

If you are a Certified Professional Coder (CPC) through the American Academy of Professional Coders (AAPC), you know that each year you have to continue enhancing your coding knowledge by obtaining continuing education units (CEUs). This includes continuing education in your chosen field as well as staying up-to-date with the latest medical coding updates, compliance rules and government regulations.

Challenge: With the demands of a job in coding, this is not always easy. Attending audio conferences, webinars, seminars and live conferences are great ways to earn CEUs but are not always feasible due to time and financial constraints.

Good News: You can use your coding newsletters to earn CEU credits quickly while boosting your coding acumen.

Using the Coding Institute’s Coding Alert articles is a great source for getting CEUs and staying informed. It encourages coders to read the articles that are so informative to their career and specialty. If you are subscribing to any of the coding newsletters, you will not only get information relevant to your coding and career, but at the same time get opportunities to earn 24 free AAPC CEUs each year.

How it works: You will have to pass quizzes from Coding Alert (6 CEUs), SuperCoder Bolt (12 CEUs), and webinars (6 CEUs). For further details, you may contact customerservice@supercoder.com or call 1-866-228-9252.

If you have questions about approved content, CEU requirements and how to submit CEUs, refer to the AAPC’s CEU information page.

While some practices have tucked ICD-10 readiness into the backs of their minds, CMS wants to keep it on the forefront of yours.

Although the ICD-10 utilization deadline isn’t until October 1, 2013, CMS continues to remind practices that preparation now will prevent desperation in 2013. To that end, CMS has introduced a free service that allows you to receive an email notification whenever the information on its ICD-10 page is updated. Therefore, when the agency announces an ICD-10 webinar, transcript, article, or tip sheet, you’ll get a notification via email to check the site for more information.

Most recently, the site posted an executive summary of its April 27 ICD-10 vendor conference, at which vendors told CMS that “they have implementation plans in place for both Version 5010 and ICD-10, and are confident that they can meet the implementation deadlines.” However, vendors did express concern “that there is no testing period for ICD-10 prior to the Oct. 1, 2013 implementation deadline.”

To that end, vendors were eager to hear about what the payers are doing to prepare for ICD-10, because any snags on the MAC side could slow payments to practices.

In addition, vendors noted that medical providers — particularly those in small- to mid-sized practices — aren’t focusing on ICD-10 yet, but the vendors strongly felt that providers should prepare now for the transition, because “if you do not comply, you will not be paid.”

For more information on ICD-10, visit www.cms.gov/ICD10/02b_Latest_News.asp.

Be a medical coding hero: Sign up at Supercoder.com, and join the coding community at the Supercoder.com Facebook Fan Page.

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Putting learning ICD-10 off? CMS wants you to take preparation seriously.
While some practices have tucked ICD-10 readiness into the backs of their minds, CMS wants to keep it on the forefront of yours.
Although the ICD-10 utilization deadline isn’t until October 1, 2013, CMS continues to remind practices that preparation now will prevent desperation in 2013. To that end, CMS has introduced a free service that allows you to receive an email notification whenever the information on its ICD-10 page is updated. Therefore, when the agency announces an ICD-10 webinar, transcript, article, or tip sheet, you’ll get a notification via email to check the site for more information.
Most recently, the site posted an executive summary of its April 27 ICD-10 vendor conference, at which vendors told CMS that “they have implementation plans in place for both Version 5010 and ICD-10, and are confident that they can meet the implementation deadlines.” However, vendors did express concern “that there is no testing period for ICD-10 prior to the Oct. 1, 2013 implementation deadline.”
To that end, vendors were eager to hear about what the payers are doing to prepare for ICD-10, because any snags on the MAC side could slow payments to practices.
In addition, vendors noted that medical providers — particularly those in small- to mid-sized practices — aren’t focusing on ICD-10 yet, but the vendors strongly felt that providers should prepare now for the transition, because “if you do not comply, you will not be paid.”
For more information on ICD-10, visit www.cms.gov/ICD10/02b_Latest_News.asp.
Be a medical coding hero: Sign up at Supercoder.com, and join the coding community at the Supercoder.com Facebook Fan Page.
Where in the world is Supercoder Girl?
Twitter: @supercodergirl
Facebook: http://www.facebook.com/supercodergirl
Path:

Avoid getting stuck in the non-management rut.

Are you ready to take the next step in your medical coding career, but you’re not sure how to grab your boss’s attention and show him you’re ready for upper management? No problem. Follow these tips:

1. Do your job well. There’s no reason to give you more responsibility if you can’t handle what you have now, right? Get your superiors to notice your potential by excelling in your current supervisor position. Turn parts around in your department faster than other departments, maintain a perfect quality record in your department, and do your best to keep your department accident-free.

2. Do your homework. Learn more about what upper managers do in your company. Find out what their responsibilities are. If you know someone outside of the company in a managerial position, ask him to describe his job to you. You want to get a sense of whether you can handle the job.

3. Develop people skills. Your ability to get along with and effectively manage people will be even more important when you’re in a higher position. Respect your employees, be diplomatic with supervisors from other departments, and get your workers to work hard for you because they respect you, not because they’re afraid of you.

4. Show initiative. Unless your boss is a mind reader, he probably has no idea you’re looking to move up the ladder. Show him that you’re ready to move ahead by offering to help with projects like managing the year-end new code training, by volunteering for any opportunities like planning the company picnic, or by working on an employee-relations committee.

5. Ask. Show your boss that you’re really interested by asking him what opportunities are available. Don’t wait for him to come to you. Even if no positions are immediately available, he’ll keep you in the back of his mind when a position opens up. And because most companies like to promote from within, you’ve got a good chance.

Be a medical coding hero: Join the coding community at the Supercoder.com Facebook Fan Page.

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Try these easy networking tips for shy people.

Networking is high among conference attendees’ list of benefits. If your shyness might be preventing you from reaching out to fellow medical coders, pull yourself out of that corner and try these networking tips:

• Realize that you’re not the only one who’s shy. Even big executives can be shy people. The next time you’re at a coding conference event, scan the room for someone standing by herself. If she were an outgoing person, she would probably be mingling. Chances are, she’s a shy person who’s waiting for someone to come talk to her. Take the opportunity.
• Enlist your extroverted friends’ help. Stick around your more outgoing coworkers at conference events and meetings, and get them to introduce you to fellow coders or coding consultants. They can help you start the conversation and back you up during moments of silence.
• Practice networking skills at your next family reunion. Chances are, there are many members of your family who you don’t know well. Think of your family reunion as a conference. Walk over and introduce yourself to your family members who you don’t know very well and strike up a conversation with them.

You’ll build your skills to do that at your next coding conference.

• Find ways to have people come to you. Volunteer to be a greeter at the next big meeting or conference. Attendees can just come straight to you. All you have to do is start the conversation.
• Look for ways to break out of your shell a little. Constantly look for ways to build your conversational skills. Read up on the subject, and strike up a conversation at work with coders you don’t know that well. Pop culture, anyone? The opportunities are out there — you just need to grab them.

Be a medical coding hero: Join the coding community at the Supercoder.com Facebook Fan Page.

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Tessa Bartels

“Being a coder is a lot like being a detective.”

Medical coders: If you feel like you’re someone who can work miracles with a magnifying glass, trench coat, and your coding manuals, then you have a lot in common with F. Tessa Bartels. But if you’re not following this ever-changing field, you could be letting your inspection skills go to waste.

With CPC and CEMC credentials, Bartels is currently the reimbursement manager at the Medical College of Wisconsin in Milwaukee, WI. Her career started there in 2000. She has also worked as a coder in pediatric critical care. In other words, she jumped into coding and never looked back.

Here’s what happened. Prior to working at Medical College, she had a career as a travel consultant but needed a change. She took a position as a transcriptionist at the Medical College — but only did that for about two days before being introduced to the world of coding.

“It was my second day on the job. My supervisor told me she was going to have the person who did the coding cross train me, so that in the event of her absence, I could fill in,” explains Bartels.  “Little did I know that this coder wasn’t just planning a short vacation, she was leaving her job. In any case, I jumped into her job and found that I absolutely loved it. I applied for and was granted a transfer.”

So, what do you enjoy about your job? “I really enjoy the variety of work; the interaction between a wide range of professionals and the public; and the  ’problem solving’ (it feels a little like detective work at times).”

How did the TCI training camp help you? I had taken a basic coding course offered by the Medical Society of Wisconsin, but my experience was really limited to a highly-specialized practice (pediatric critical care). When I applied for my current position, a requirement was that I had to get my CPC within six months. The Coding Boot Camp was invaluable in preparing me for the exam because I learned specifics in areas where I had no experience (i.e., radiology, cardiology, OB/GYN); I passed the exam on the first try!

Have any advice for people interested into going into this field? Understand that this is an ever-changing field. No matter what your level of experience or expertise, there is always something new to learn. Be open to challenging your ways of doing things. Also, you will need to interact with a wide range of people – physicians and other healthcare providers, managers, co-workers, insurance representatives, patients and more. Always be professional in your demeanor, work ethic, appearance and don’t forget to maintain your CEUs and certification.

Tips for exam taking. First – prepare by using practice exams. Don’t over think the responses. Pay close attention to guidelines. Answer all the questions that you feel confident about first, and then go back and tackle those that require more thought.

When Tessa isn’t coding, you will probably find her at one of her four (yes, four) in-person book discussion groups, or chatting online with one of three. She’s a voracious reader and an active community volunteer. She serves on two non-profit art boards and enjoys going to the theatre and musical events with her husband. She also loves to travel and to cook. “My husband and I will eat anything (at least once) that isn’t moving too fast,” she jokes.

Be a medical coding hero: Join the coding community at the Supercoder.com Facebook Fan Page.

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If you’re baffled by something, admitting it may impress your colleagues.

You’re surrounded by experts, including medical experts, billing experts and management experts. But you’re an expert too. Sharing your expertise with others is an art form in itself. Some of the world’s greatest experts never learn this art, but it’s easy.

Just remember to:

Tell the truth. Don’t exaggerate what you know, or make up an answer when someone asks you a question. Don’t be afraid to admit you don’t know the answer to a question. Real experts always admit when they don’t know something. Just ask Supercoder Girl about peripheral vascular coding.

Keep it simple. Whether you’re explaining a complicated filing system or a medical procedure your office performs, use plain language and simple sentences. Break the subject down to the basics and go through it in simple terms. If someone has to hide behind jargon and can’t explain a concept simply, chances are that person is only a pretend expert.

Speak up. If you know what you’re talking about, don’t hide your light. Share your expertise with others. Be confident, but not cocky. Real experts are humble but forthright.

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A smart registration process can prevent claim-submission headaches.

If you’re trying to grow your practice, you’ll need to have a logical, simple form to obtain data from your new patients. Not only is a new patient form valuable for gathering important insurance information, but it can help you find patients who owe your practice money and perform collection activities when the patient is present.

If it’s been a while since your practice updated its new patient registration form or you’re creating one for the first time, follow these expert suggestions to make sure you can find patient billing information quickly and easily:

1. Keep the Form Simple

Ask key questions on the patient information intake form that you require all new patients to fill out. Make sure you have basic demographic information such as:

• The policy name and number
• The insured’s name
• Social Security number
• Dates of coverage
• Secondary-insurance information (Households with more than one income often have more than one insurer. The patient must designate which payer is primary and which is secondary.)
• Guardian or responsible party name
• The name of the person or physician who referred the patient.

It may seem obvious, but if your form does not ask patients for their fax, cell phone number, or e-mail address, you could be missing out on valuable information.

Heads up: Limit questions to patient demographics and insurance information. Usually, the form should not include any questions related to medical conditions; its purpose is insurance and payment-related information and/or general marketing data.

Best practice: How you request this information often determines how willing patients are to complete the form. If your request is firm and professional without being aggressive, chances are you will get your required information. “The more patient-friendly and simple and concise, the better,” says Zia Clarkson, a billing consultant and educator in Long Island, N.Y.

Having patients update their forms every year is crucial, as is keeping records up-to-date in case of an audit.

2. Copying the Insurance Card is a Must

In addition to having the patient fill out the new patient form, be sure to ask for, and make a copy of, his insurance card. “Always make a copy of the patient’s insurance card, front and back,” says Brian Fornataro, a billing professional with Medi-corp in Cranford, N.J. “This contains vital information on where to send the claims correctly the first time, cutting down on denials and obtaining revenue faster,” he says.

Since you’ll make a copy of the insurance card’s front and back, you don’t need to ask the patient to provide that information (policy number, group number, phone numbers, etc.) on a form.

Tip: You should ask for the card upon each and every visit by the patient. Insurance information can change frequently, and the patient may not even be aware of the change. “Some payers have different addresses for different specialty billing,” Fornataro points out.

Hint: Make an enlarged copy of the insurance card on your copier. This makes the small print much easier to read.

3. Get Referring Physician Details

When a new patient arrives because of a referral, be sure you have clear information on the referring physician as well. When the patient arrives, a staff member should be reviewing referral data for accuracy. Be clear, Clarkson says. Ask questions such as, “I see Dr. Jones referred you. Is that Dr. Donna or Dr. John Jones?” Clarkson advises.

4. Move Your Forms Online, Too

Consider offering an online form that your patients can fill out before even coming to your office. “Being able to register with the practice online is a great way to have patients offer demographic information,” Clarkson says.

Patients can fill out the forms in the privacy of their homes, where they have all the necessary information readily available — insurance and Social Security cards, for example.

Secure Web-based forms also reduce patients’ waiting time in your office.

If Web-based applications are not an option for some patients, consider mailing out a paper copy in advance — up to a week or two if possible. The patient “can review it and fill it in at their leisure” and submit or return it to the office ahead of time or bring it to his appointment, Clarkson says.

Pointer: Still not sure your forms are hitting the mark? “Have someone outside the practice look at the forms, and get feedback,” Clarkson says.

5. Make Your Practice’s Information Available

The patient will be more open to sharing data with you if you openly communicate office policies and procedures. You may want to discuss with the patient the following:

• Basic services for the condition and your practice’s fees
• The patient’s financial responsibility for services provided during the initial visit
• An estimate of the costs for a new comprehensive history and physical examination
• How the patient can pay for the initial visit (HMO/PPO copay, cash, check, credit card)
• Future-visit payment policy
• Whether the patient needs financial counseling before the visit.

@ Medical Office Billing & Collections Alert

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