One of the biggest mistakes billing staff can make is to "rebill" a claim without taking the time to call the insurance company to find out why the claim was denied. Rebilling once or twice is bad enough, but some employees take it even farther.
"I've seen where people literally have rebilled a claim five to seven times without calling," says Michelle Glad, operations manager at Aesthetic Center for Plastic Surgery in Houston, TX. "The insurance [company] sees that the claim was already logged in their system and immediately kicks it out as a duplicate claim. It's a real waste of time."
Whether that specific employee was negligent or simply ignorant, this scenario is a reminder for practice managers to be sure they have an up-to-date system to monitor billing staff.
To adequately monitor billing staff, the practice manager has to know what warning signs to look for and to constantly be on guard.
"The first thing I think an administrator should know is the practice financials, including the A/R," Glad says. "They need to know a pattern of the A/R and know the job descriptions of the people in the practice. Each billing person may be set up to do something different—one may be working Medicare claims, one may be working for one doctor, and one another. They need to get familiar about what's going on in the billing department before they start."
Once practice administrators have this vital information, they can better assess what each billing person needs to accomplish to meet financial goals, Glad says. If a policy isn't currently in place, administrators should be flexible until they create a plan that works for their billing group, which may mean rearranging job duties.
If a practice administrator can't analyze the A/R or read the EOB him or herself, they should hire someone who can to monitor the billing staff.
Most administrators do some kind of reporting at the end of the month. But if they just print out the reports and aren't reading or analyzing them because they don't know how, it's not effective, Glad says. "They can't figure out where the problems lie. If they can't see [that] this month we collected $10,000 but last month we collected $20,000, they won't know where to even start."