Use these guidelines when training billers

Many practices complain about the accuracy of the bills sent from their office, but how many are doing something about it by investing in a training program?

The rudimentary training most physician organizations give their billers does not teach employees how their job contributes to the entire billing process, says Donna Sherwin, president of PBSI, a Wayne, PA, firm that provides temporary and permanent staffing as well as testing and training to physician billing offices.

In addition, the lack of cross-training between billers and other staff members, such as coders and schedulers, makes it easier to overlook mistakes or inconsistencies because each person only knows his or her piece of the total reimbursement pie.

The first step to ensuring every employee in the practice has a basic level of competency and is working to maximize appropriate reimbursement while minimizing coding and claim errors is to start with a uniform and basic level of testing and training for every staff member. Then you should provide additional layers of selective cross-training, says Sherwin.

"This will not only ensure that all personnel are reading from the same page, but it will give your current employees knowledge that may help them move within the organization more easily," she says. "As a result, you will have created a much happier and more productive employee, from the front desk person to the accounts receivable management supervisor."

Sherwin has developed her basic approach to billing training over the past six years.

Provide care to all employees

"It is based on the belief that the organization will benefit from everyone striving toward the common goal: maximization of reimbursement through timely and accurate billing while maintaining an optimal level of patient satisfaction," says Sherwin. Because each office is different, she recommends it be customized wherever possible to meet each practice’s specific needs. "However, if a basic core is not provided to all employees, the success of the training program may be jeopardized," warns Sherwin.

Basic elements in Sherwin’s core training program include:

• core conceptual training for all staff members;

• basic system training;

• selective training based on positions;

• testing to determine whether objectives have been met.

Before implementing the program, you first need to determine exactly what it is you want every member of your staff to know, Sherwin says. One basic outline she suggests would be a patient flowchart starting with the initial call for an appointment and ending at the resolution of an account receivable item, including a review of the basic functions and positions needed throughout the process.

She also suggests a course including more technical information, such as key medical terminology a biller needs to be familiar with, the importance of CPT-4 and ICD-9 codes, and an introduction to self-pay and third-party billing.

Once the detailed elements of the training have been outlined, a document should be developed that clearly tests for the fundamental knowledge each staffer should know.

"Your core training schedule should then be based on the results you have determined you want to achieve," says Sherwin. "You also need to make a decision as to whether or not you will allow individuals to opt out of the training based on test scores."

Based on Sherwin’s experience, this basic training should take between 15 and 20 hours. Depending on the size of the organization, it could take several core sessions before all staff are trained.

To help facilitate the training process, Sherwin suggests you divide the core into several self- contained modules. For example, one module might be an introduction to medical terminology, with concentration on the terms most often used in your practice. Another might be on the importance of CPT codes, including a brief introduction to the CPT book and the most often-used CPT codes in your practice. A similar module might be presented for ICD-9 codes. Each of these modules could be presented in sufficient detail in two to three hours.

Sherwin says flowcharts are an excellent learning tool, particularly for visualizing how a patient flows through the system. The same applies to following a charge from initial data entry to resolution of the account.

"All trainees should be tested again to ensure that the training was effective and that your objectives have been met. I would suggest you establish a minimum acceptable grade, and that anyone who does not meet the minimum be required to retake the basic training," says Sherwin.

Once the core conceptual training has taken place, you will be able to review and apply the concepts taught through system training, and then begin cross-training.

Offices that are organized along functional lines, such as appointment scheduling, the registration function, and other duties can elect to have those individuals who are responsible for the function receive training in that function only.

However, Sherwin says each person should immediately begin cross-training in other staff functions after completing his or her core conceptual training. "If you are organized along product lines in which one person is responsible for multiple functions within one product line [physician, specialty, etc.], you will necessarily have to provide them with multiple function training," she points out.

At this point, participants need only learn how the system captures and processes the information they received during the core conceptual training. Knowing that all participants have a basic understanding of physician billing concepts will allow the system training to take place in a relatively short time. "Again, I would suggest testing at the end of system training to ensure that your minimum level of competency standards have been met," says Sherwin.

If done right, this training regimen will teach any entry-level employee to perform effectively as an appointment scheduler, a registrar, or a charge-entry person, while also "providing an excellent base from which to build payment posters and junior level collectors," says Sherwin.