The medical practice administrator has an extensive list of responsibilities covering everything from policy and procedures to hands-on management of providers and staff. Ultimately, however, the manager is accountable for the practice's bottom line—keeping costs under control and maximizing revenue through efficient billing and collections procedures.
Whether your medical billing functions are handled in-house, or outsourced to a medical billing company, the medical practice administrator has a lot of input on how well the process performs. For practices who have outsourced their billing, however, the practice manager plays an even more essential role. Here's a look at how the medical practice manager can effect better cooperation and outcomes in an outsourced medical billing environment.
Choosing the Right Medical Billing Company
This may seem obvious, but it's the critical first step in improving your medical billing processes. The practice administrator's job is to determine the most important criteria for a billing relationship, evaluate proposals, and select the best partner to accomplish billing objectives. This means eliminating those with no experience or clients in the practice specialty, those with little known or incompatible billing software, and those who don't grant authority for the practice to run independent reports to monitor the billing company's processes and performance.
The practice administrator's job also includes developing and executing a company contract that lays out service guarantees and remedies, as well as establishes a process for transition.
Liaising with the Company to Coordinate Processes
Every practice and specialty has unique medical coding and documentation requirements; some are multi-location and multi-specialty with locum tenens providers, some require extensive medical decision making and medical necessity documentation, and some have complex procedural coding issues that must be effectively communicated to the billing lead to keep rejections and denials at a minimum. The practice administrator can proactively work with the company to develop procedures and address issues as they come up.
Ensuring Smooth Operation of Day-To-Day Front Office Tasks
This is the key to effective coordination between the billing company and the practice. In general, the practice administrator must be sure that:
- Patient schedules are accurate and available on a timely basis to the billing company.
- Charting and documentation comply with standards and is complete and easily accessible to the billing team.
- Window collections are tracked and reconciled for posting.
- Daily, weekly, and monthly reports are prepared and reviewed and timely follow up undertaken for any discrepancies or areas of concern.
Related Article: Are You Spending Too Much on Medical Billing Services?
Assessing Performance and Results
Once the decision to outsource has been made, and performance standards are agreed upon, the practice administrator should have access to data and information to monitor and assess the company's performance against the agreed upon standards. This means, at a minimum, tracking the following information on a daily, weekly, monthly, quarterly, and/or annual basis, depending on the metrics:
- A/R aging reports
- Days sales outstanding
- A/R by location, provider, and payer
- Total billed claims
- Adjustment reports
- Total charges
- Collections percentage
- Medicare payments and allowable charges summaries
- Missing documentation reports
These reports give the administrator a snapshot, as well as more detailed information, into the activities and effectiveness of the billing service company and allows them to measure actual performance against service guarantees. If there are remedies in place for underperformance, the administrator initiates the process. He or she is also responsible for monitoring contractual service payments to the company and ensuring that they match the terms and performance.
If you're considering making the switch to outsourced billing from an in-house system, and you're not sure how your existing staffing and management structure integrates with a new billing process, we're happy to discuss your situation and show you how our service works with you. Contact us today for a free consultation and billing analysis.