Physiatry Practice Management Resources

Behind every successful practice stands a good doctor and behind the doctor, a good billing staff.

Without a qualified billing staff to support a doctor, a practice cannot run efficiently, experts say. Yet finding and keeping the right person for the job can be complicated.

Hiring decisions are among the biggest decisions one can make in a medical practice, and right now the labor market for third-party billers is very tight.

"Good billing people are extremely hard to find," says Sherry DiDomenico, a consultant with The Health Care Group, based in Plymouth Meeting, Pa. "Part of the reason for that is that they are treasured where they work."

But there is an upside to that notion, she is quick to add. With reimbursement shrinking, the billing person often gets blamed when it's not their fault. "That's actually an opportunity for practices if they can find someone who's not treasured where they work, who's good and not getting the credit for it," Ms. DiDomenico says.

But before you spread the word or place an ad in the local paper or a trade newspaper, you need to figure out exactly who it is that you're looking for. "The first thing to do is make sure that the job description is defined," says Ms. DiDomenico.

Outline what you need, and establish skill requirements and expectations of the position before hiring. Keep in mind certain personality traits that are essential for the type of work that an insurance biller will be handling.

"Good billers are incredibly organized and persistent, almost to the point of compulsivity. They have a sense of ownership for the accounts receivable. They typically take it personally if an insurance company rejects claims and they doggedly pursue reimbursement," she says.

Ms. DiDomenico also says it's important to establish a rigid chain of command. Muddling through the bureaucratic nature of the industry, especially HMOs, can be aggravating. Having a set chain of command within the practice can not only improve billing efficiency but also make the biller's job a little easier.

"The billing person's job can be a very difficult one because they have to constantly explain what is going on with the life and blood of the practice," says Ms. DiDomenico. "It should be agreed within the practice to whom that person reports, and the chain of command needs to be respected. If it's the managing doctor, then it's the managing doctor and not the other partners in the practice."

Todd Welter, a consultant with the Medical Group Management Association in Denver, says it's important to differentiate years of experience with current experience. Someone who's been doing it for 20 years may be stuck in an old fashioned way of doing things, he says, which can be dangerous.

"Experience in the current market is very important because of the rules and regulations, the moving and shaking," Mr. Welter says. "These days it's not so much the size of the dollar -- it's the quickness of the return. It's cash flow that makes a practice successful. You want someone who understands an aging account and can work it -- and will work it -- diligently."

He also suggests you look for someone who has current experience in the type of healthcare market in which your practice is involved. For example, does your practice work with a lot of HMOs or PPOs? Do you handle a lot of capitation, or have no capitation and no managed care? These are the kinds of questions he suggests thinking about before hiring a billing person.

"Experience is more important than certification," says Ms. DiDomenico. However, she believes that it is a big plus to have a certified coder in the practice -- and not many practices do. Though certifications exist for coders through organizations such as the American Academy of Professional Coders and the American Health Information Management Association, there isn't any such certification for billers.

And, just as doctors take continuing medical education classes, billers are encouraged to stay abreast of new billing practices by attending billing courses or seminars. "They tend to pick up a lot of other things too, in terms of networking with other practices and their billing mangers," Ms. DiDomenico says. "People share information and it's very, very valuable."

Another qualification that's necessary is computer aptitude. Over the past few years, technology has been restructuring the healthcare industry, especially in the area of electronic payments and claims processing.

"Experience with computers and a penchant for working with computers -- an affinity for it -- is needed," says Ms. DiDomenico. "You need a little bit of technical knowledge and a little experience with billing systems, which is crucial. Basic financial management is also necessary -- experience and/or education."

As with most jobs today, salary depends on location. Ms. DiDomenico says to not go below $13 per hour. Mr. Welter offers a range of anywhere between $12 to $20 per hour. He also recommends paying the market price for your location, if not a few dollars more for a good worker. The cost of constantly retraining someone just to save a few bucks on salary will result in lost revenue.

"If they really shine, give them a few bucks," he says. "I think a lot of doctors don't understand the cost of turnover in their practice. That cost is not a real dollar figure, but it's enormous."

Setting up an incentive program is one way in which to compensate your biller. Mr. Welter suggests giving them a goal, such as having no insurance payment outstanding above 120 days. He advises having your accountant come up with a simple ratio between what you bring in a month and what you billed, say, two months earlier, so you're talking about the same money.

"You just have to make sure that the incentive works for everybody," he says. "I've seen some offices say we'll pay you a bonus if you don't have anything over 120 days. That's fine, but what we've found out is that all they do is just write them off."

Ms. DiDomenico offers an alternative solution. Offer a billing person slightly more flexible hours than the other people in your practice -- as long as it doesn't create rivalry among co-workers.

"With a billing person, they may be calling patients, which is more easily done in the evening. They may be sending electronic claims, which can easily be done after-hours, actually more easily in a lot of cases," she says. "If it works for the practice, some billing work can be done at home."

Mr. Welter says that doctors should establish strong communication with their staff to make them feel comfortable with their job and working with the doctor.

"You need to find out how they think they're doing and if they're happy in their job," says Ms. DiDomenico.

Mr. Welter has worked with practices where staff were afraid to talk to the doctor about any problems, for fear of getting into trouble -- a good example of how a lack of communication can a hurt a practice.

"The doctor's not going to yell at them, they just want to know. When you have a situation in which the doctor, even for a second, believes that they just fill out a superbill and it goes into a black hole and never hears anything again -- that's a really bad thing. Eventually it's going to come back and bite them."

He recommends the physician and billing staff get together every 30 days, even if it's just a quick meeting. In that case, he says only a six-month evaluation would be necessary, but if there are no 30-day meetings then a three-month evaluation should be performed.

The most qualified biller, Mr. Welter says, will take a 'this is my money and I want to collect every penny for my doctor,' approach to their job. "Loyalty is a huge thing," he says. " It can overcome lots of sins if you have a real loyal staff."

Written by Virginia Guariglia