How to Hire the Right Billing Manager

Fri, Jul 18, 2014


Ask the candidate for credentials, education and about her goals for your practice.

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. (more…)

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Tips to Sidestep Problem Payers & Boost Your Billing Career

Thu, Jul 3, 2014


If you are getting incorrect denials, check the denial reasons the payer is providing you on your EOBs. 

 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.

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Boost Staff Retention with These Practical Tips

Tue, Jul 1, 2014


Know how two facilities changed their tactics to improve staff retention!

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 (more…)

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CEU Helper: Achieve Your CEU Goals as You Read Articles

Tue, Jun 17, 2014


You can use the coding newsletter you read to earn up to 24 AAPC CEUs quickly and easily.

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. (more…)

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