Cath Lab Digest

      “No one will care about collecting your money more than you.” While that may seem to be stating the obvious, it puts all owners of practices in the position of making the decision as to who will take on this task. Do you delegate this critical task to a key member of your office staff or do you farm it out to an outside billing company?

     Whatever decision you make, it is essential to monitor the situation, gauging the effectiveness of your billing and collections, and the impact upon your practice.

     In some circumstances, it is an easier decision to make. For example, if you are starting your own practice, one option is purchasing a practice management system that includes billing software and hiring someone with billing experience who will also perform other office tasks. The other option is interviewing billing companies and selecting one to do your billing.

Asking The Right Questions Of Potential Office Staff

     Perhaps you are leaving an established practice and moving to a new area, or opening up your practice fresh out of a residency or fellowship. You either inherit the previous owner’s billing staff or you post advertisements and ask colleagues and friends to recommend staff for your office. You begin interviewing potential staff even though you may have never interviewed for a staff member who will be responsible for your billing and collecting. What do you ask? Who do you trust? What are they supposed to do? In order to interview and hire the right person, it is important to have some basic education in the art and science of medical billing.

     When you send a claim to an insurance company describing the service you performed for a patient, the insurance company processes the claim and then sends you a check (reimbursement) and an explanation of benefits (EOB) that describes how the amount of the check is calculated. The typical EOB will include the patient’s name, ID number, the date of the office visit, the procedure code, the billed amount, the allowed amount, the amount paid, the amount adjusted and the patient payment.

     When you interview someone for a billing position, he or she should be able to explain all of the EOB info. I like to ask questions that challenge a potential staffer’s knowledge. You could ask the following: “How come the insurance company only sent me $48 when I submitted a claim for $125? If I bill $125, why don’t I get paid $125? How much of the adjusted amount can I bill the patient?”

     The correct answers are, if you agreed to participate (par) with the payer, you agreed to accept the payer’s fee schedule. If you are par with the payer, you accept its payment and the patient’s co-payment as payment in full. You cannot bill the patient for the difference between the payer’s fee schedule and what you collected.

Why You Might Interview A Billing Company

     Say you find someone you like and he or she appears to be competent. You have checked his or her references, and hired the person. However, if you are just starting up a new practice and are seeing 20 patients a week, you do not need a full-time billing person. This person should also be able to fill in either as a medical assistant or a receptionist. In fact, if you are starting up a new practice and are not very experienced in billing, you should also interview a billing company. Billing companies will usually be able to offer more expertise and provide backup for a staffer who has to wear other hats in addition to handling billing for your practice.