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Traditional medical billing systems are generally organized according to either function or payer, with each person who works in the billing office being responsible for performing a specific function.
An alternative — and potentially more efficient — way to organize the billing process is to appoint a product-line manager for each specialty. The product-line manager would be responsible for ensuring the various steps in the billing process are completed for their related claims, suggests Heather Auld, director of training and consulting services for Physician Billing Solutions, Inc., of Wayne, PA.
Under this product-line approach, one person essentially assumes responsibility for the major components of the billing and accounts receivable process for one of the specialties or "product lines" in a group practice. The product line manager, for instance, completes the processing of charge entry claims, rejection posting, and resolution, along with any needed follow-up, notes Auld.
The major benefit of making a single person responsible for the complete billing process is that it increases accountability and sense of ownership in the job. "When numerous individuals are responsible for completing the billing process, it is sometimes hard to pinpoint the source of a problem when individuals try to shift responsibility or blame around," notes Auld. "But, when one person is responsible for the specialty, they have to take ownership and final accountability."
Another advantage of the product-line approach is that because individual managers must immerse themselves in the details of their specialties, they develop a wider perspective. That helps them see and anticipate potential billing and claims processing problems unique to their specialty. "Ideally, they learn something new each time they get a claim rejected in their area, which will help eliminate the problem and reduce the payment turnaround the next time that kind of claim is submitted," says Auld.
The product line approach can help improve morale among billers by creating new opportunities for career growth. "The traditional data-entry position provides little opportunity for advancement. But, as a product-line manager, employees assume more responsibility and experience, which expands their long-term job possibilities, plus encourages the practice to employ higher-caliber personnel," she notes.
In a multispecialty practice, the best option is usually to organize a product-line billing system by specialty. If a specialty is large, you can appoint more than one individual to the task. This can be done by dividing the specialty according to provider, or by appointing different product-line managers within the billing office.
However, it may be wise to keep some duties traditionally segregated in the billing process separate. For instance, payment postings and collections can continue to be handled separately in the interest of volume and speed. Ultimately, "each practice will divide duties and specialties based on the demands of its payer mix, number of doctors, patient base, accounts receivable, and how fast employees can successfully assume their new responsibilities," Auld says.
Other factors to be considered when making the shift to product-line billing include:
• Training. Physician Billing Solutions says it takes three to six months of training before employees are fully ready to assume their new duties as a product-line billing manager.
• Equipment. As your employees undertake their new duties, you may find that they need different equipment to perform their job (e.g., better computers, fax machine, etc.) All this new equipment requires space, which means you may need to physically reorganize the office, as well.
While patient scheduling and registration remain the responsibility of workers on the so-called front end of the billing process, these employees are accountable to product-line managers for the accuracy of the information they give them. For larger, multispecialty groups, each specialty can be a different product line. Depending on the group’s size and number of specialties, the account lines can be divided among different designated product-line billing managers.
Some ways to divvy up the different product lines include by provider, location (inpatient vs. outpatient), or experience (senior vs. junior line managers). Each line manager is responsible for charge entry claims processing, rejection posting, resolution, and follow-up of all claims in the specialties for which they are responsible.
To facilitate proper preparation of electronic claims, inpatient charge entry responsibilities should be transferred from data entry to a product-line manager. "Because of the complexity of some modifiers, it’s very helpful to have a more experienced person who’s more conversant with the billing and bundling process to be in charge," notes Auld.
The product-line manager is also responsible for reviewing the monthly trial accounting balances for his or her specialty to prioritize accounts receivable. However, when it comes to individual self-pay patients, all these accounts should be assigned to one person to avoid having different product line managers from the various specialties calling on them.
Finally, a single supervisory product manager should be assigned primary responsibility for all main billing and accounts receivable functions.