Billing errors can cost your practice thousands every day, but finding the time to address them on an organized basis probably seems daunting. And yet, in reality it’s a simple process and one well worth the time you spend on it. Plus, with audits by Medicare looming large in everyone’s windshield, improving your processes now could prevent many headaches down the road.
Here’s a quick outline of a process you can follow to identify and correct billing issues:
1. Identify the Most Common Problems
The first step is to analyze your billing and coding to see what the most frequent problems are. You may be able to generate a report from your medical billing software to see where you’re getting the most frequent denials and rejections. Review this list or one compiled manually to insure that you understand where the bulk of the problems are. Fixing these issues will benefit you much more than focusing on unusual or uncommon problems. It’s the well-known “80/20 Rule”—80% of your problems will come from 20% of your coding.
2. Change Processes or Staff as Needed
Once you’ve identified your most common billing problems, decide how to fix them. Ask your billers and coders for suggestions—since they’re on the front lines, often they have ideas for solutions, and if they’re experienced, they may have encountered a similar problem before. If the problem is staff-oriented, consider what staffing changes need to be made. Is a staff member better suited to another task, either due to temperament, skills or burnout? Sometimes a job change can improve an employee’s outlook and their performance.
One key area to review is communication: Miscommunication can lead to charges being missed or to charges being billed when not required or medically necessary. Be sure physicians understand the importance of communicating correctly and exactly, and this includes their notes as well as any verbal communication with staff.
3. Train Effectively and Include All Staff Involved
If you decide to change processes to eliminate errors, be sure to effectively train staff on the change. Document the new process, review it with staff and let them ask questions. Often the medical school model of learning will help reinforce the behavior: “Learn one, do one, teach one.” When you teach your staff some of the more complicated new processes, have them try it with you present to help and answer questions, and then have them teach someone else on staff. This method has been demonstrated to improve retention.
Don’t forget to include medical staff in the training as well as office staff. Keep the training as concise as possible, but make sure the providers understand what changes they need to make to their daily routine.
4. Evaluate New Processes or Staff Changes
Set a period of time after which you will evaluate the changes you’ve made. While we’d all love to assume that a problem is fixed and we can move on to other things, it’s important to review the change after a reasonable amount of time and see whether you have actually addressed the problem and whether the improvement is at the level you were seeking, or whether additional changes are needed. Be critical so that you get the results you want—if you’re only partway to your goal, then repeat steps 2 & 3 above and decide what additional process changes are required. Keep in mind the time staff needs to adapt, but be demanding in achieving your goal of eliminating or reducing billing errors.
Make this process a regular part of your operations, reviewing your billing for the most common errors on a regular basis. You may start out doing it quarterly and then after some time, you may be able to go to twice a year or even once a year. The key is to have a regular review, with frequency determined by the accuracy of your billing rather than by workload.
These types of internal audits and process improvements may seem daunting to some medical offices, or the physicians may feel it’s a distraction from patient care. But remind physicians that as the treating provider, they are on the hook for any mistakes that occur in coding. And with Medicare audits becoming a guarantee rather than a vague threat, they need to be invested in ensuring the billing process is as correct as possible and that procedures are in place for consistent improvement.
With a regular system in place for improving billing processes, a visit by the RAC may seem less intimidating and give you the confidence you need to get through an audit with less stress.