Improve Your Reimbursement Results
by Gary Collins, President, Professional Reimbursement, Inc.
Over the years I have had the opportunity to assess many infusion billing departments. These evaluations have included not only personnel but also the processes and systems in place. In most cases I find the billing staff concentrating too much on the small details and missing the big picture. Departments get divided into “billers” and “collectors” and take on an “us against them” philosophy with very little synergy between the front-end and back-end of the reimbursement process.
While it is very important that the claims go out timely, it is more important that they be submitted correctly--including all the information required of the payer. So often the emphasis is getting the claim out the door. This results in careless mistakes that have to be corrected and resubmitted which causes a higher number of claims to go unpaid. The collectors should serve as quality assurance piece of the process. Whenever charges are denied or payments are reduced, the collectors should identify the reason. If it involves how the claim was submitted, this information should be shared with the billers. The collectors are gaining the knowledge to make the billers perform a better job. For the process to run optimally, both areas must work closely together and communicate.
One approach I like to take in our business is to periodically switch the roles of the biller and collector. By allowing the front end to learn first-hand what the back end is experiencing, and vice versa, we develop a strong sense of teamwork, increase our productivity, and improve our results. If you do it right the first time you may never have to see that claim again. If you do it wrong that claim may haunt you forever.