Billing for the disorganized

[williamportor]

Hello- I have 2 billing clients that are understaffed and disorganized. I had Client #1 billing and posting running very well for over 2 years, I had everything caught up, and it was easy to keep things that way, then he fired his office manager last year, and has his ex wife working part time trying to fill in (She's a nice lady, but It's a full time job and she simply can't keep up)  Client #2 has one very overworked office manager, who also does LMT work, she tries to keep up with everything, but this is a 2 person job (there are other issues but I think you get the idea) This naturally leads to the following problems in both offices:

* When I log into their system's remotely, patient and/or insurance information is sometimes incomplete or missing altogether, the same with codes, initial dates of service etc.

* When they fax EOB's to post, some are incomplete (perhaps 2 out of 4 pages on the EOB) when I call for the rest of the EOB info. they tell me they'll get around to it (and they don't)

* I ask for office notes to send in with the PIP claims, and they either show up a week or 2 later, or not at all

And the list goes on. Paper claims waiting for office notes, Incomplete EOB's and the number of patients I need insurance information on are piling up, and I'm getting farther behind every week.

I want to do a good job with billing and posting, but cannot do so without complete information, and these folks just don't have time to get it to me. These are my 2 highest paying clients and I don't want to lose them. Any suggestions??

[Michele]

I totally get it.  You are in a tough position.  Many people will say you just have to tell them to get their act together, but that really isn't going to happen so you either figure something out, or lose them.  So you have to try to figure out ways to correct the issues as best as you can.

For the eobs, I would recommend signing up for ERAs.  That way you are not relying on them to give you the EOBs.  Of course they have to be ok with that but you could say something like "listen, I'm going to need to sign up for ERAs.  It's a big problem for me not getting all of the EOBs and all of the pages and since you really don't have the staff to make sure I get them this is the best solution".

As for the office notes, if they are coming within two weeks that ain't terrible.  I would probably leave that alone since it's not bad and there are other issues that are more of a problem.

As for the bad information, I would try to explain that you know that they are short handed but that if the up front information isn't accurate it can really mess up their income.  If you make it about them, not about you, it may hit home.  Explain how they may lose money and that you will do what you can but it would be great if they could try to be more careful.

That's all I can really suggest.  Just take each issue one at a time and try to figure out something you can do to make it better.  If you can work on some of the issues the other issues won't be as bad.

[PMRNC]

You seem to be very organized in what they need to do to be organized. So the best, and most efficient solution, IMHO, and based on having done this so much. I do what works. HIT them in the wallet, as that is the only way to enact change. I would gather all info on how their inefficieancy is costing them money. Next I would offer them 2 Options:  1) you charge consulting rate, shadow the in-house staff or if they are understaffed, offer to interview and prep for new hire. Maybe make few extra bucks offering to train..who better to train than the person they will report to? Option #2) Begin charging them, if they don't want to pay you to help organize them. Write a letter outlining all the areas that they need help in. Ammend your contract and charge them for the extra time. If you charge a %, consider switching to a flat fee based on an hourly rate. YOUR income should not depend on them being efficient or reckless. What you describe is one of the many reasons I stopped doing % years ago. The only way you get practices to comply is to him them in the wallet. By extension the provider feels the crunch of ineffective or lack of staffing and they will take notice every month when they get your invoice.

[williamportor]

Michele and PMRNC - Thank You folks for the guidance. Very much appreciated.