Medical Billing Blog

Medical Billing Teams: A Success Story

  

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While there is  no denying that medical billing is complex and sometimes confusing; we tend to make it "rocket science" instead of developing strategies to cope simply and clearly with insurance and lawmakers demands that are thrown at health care billing operations every day.

The story is told that NASA, at the height of the American/Russian space competition, spent millions of dollars creating a pen that would write in 0 gravity.  What did the Russians do?  They used a pencil. The KISS principle was utilized, keep it simple and straight-forward.

This story has never been lost on me, and as a health care billing specialist, I strive to find the obvious and simple answer to the dilemma's facing health care.  Let me give you a couple of examples: 

Several years ago we were asked to take on the management of a large billing office. 175 docs, a multi- specialty facility and an aging AR. The management at the time decided to work the AR on the basis of special projects to try to clean it up.  Staff had little direction, except that they went from one special project to another, leaving the current AR to age and exacerbated the problem. The directors office was filled with stacks of claims with notes on the top indicating the special projects that needed to be done.  The management spent too much time trying to figure out who was working and how much they were working. A manual system for "counting" what was being accomplished by whom to incentivize employees took up all the supervisors time. All the docs were complaining about collections, the clinic was fraught with in-decision and cash flow was on a down-ward trend.  The daily volume of charges kept coming in.......the payments and denials teams were behind in posting; it was over-whelming.

So what was the answer......how could we dig out of this huge crater of a hole that was created?

It was impossible to believe that the insurance reps could keep up with the daily tasks and incorporate new procedures to ensure timely working of accounts receivables.

We divided the staff into two teams; a current team and a rundown team.

We made the decision to create of new data-base for new charges coming in that would be worked by a team of insurance specialists.  They had one clear task, what comes in today is worked today. No more counting who did what......no more incentives......they were being paid to do a job.  Work the denials the same day they were posted.

The "old" AR was worked by the rundown team. Their task was equally clear.  Work the aged trial balance that was sorted by balance and age.

We simply ignored the special projects and put an end to the staff going from project to project.

If the current team worked the denials as they were posted, the special projects would be addressed account by account as they worked the denials.

The backlog team would address not volumes of denied claims, but accounts.  The reasoning for this was simple.  Most patients had multiple transactions on their accounts. By attacking the AR from an account level instead of the claim level, the entire account could be addressed at one time.  These multiple transactions were being addressed by multiple people at various times and the account as a whole was never "fixed". We also ran some reports looking for "low hanging fruit".  Those easy to resolve problems that could be quickly worked and paid.

Now please do not get the impression that everything went smoothly and money came flowing in the door immediately.  It took time to work the rundown, about 18 months.  But the good news was, the aging was stopped as the current team was working efficiently and did accomplish the task of working denials as they were posted.

At the same time, we looked for opportunities to improve productivity with automation.  We used supervisors to accomplish this goal.  Now they began to actually work as supervisors in their areas.  They had the time to examine procedures and make recommendations to improve efficiency and productivity. 

After 6 months, we were invited to address a physician meeting to report progress.  Cash was beginning to flow, the rundown was working the aged AR and the current process was keeping the AR from aging. We brought simple graphs to show the progress of both teams.  The physicians were impressed with the outcome, a potentially explosive situation was tamed and by using simple clear objectives, the AR was brought under control.

My suggestion to you facing multiple AR problems and over-whelming odds is ....Look for the KISS solution......Keep it simple and straightforward.  Give the staff clear objectives, give them the opportunity to feel a sense of pride in accomplishment. You will be amazed at what can be accomplished by using a pencil.