Put emphasis on quality billing

September 1, 2004

With so much emphasis over the past year on HIPAA and concerns about the downward spiraling reimbursement rates from Medicare and commercial insurance carriers, very little attention has been focused on internal auditing and compliance efforts.

With so much emphasis over the past year on HIPAA and concerns about the downward spiraling reimbursement rates from Medicare and commercial insurance carriers, very little attention has been focused on internal auditing and compliance efforts.

I've also seen a significant increase in calls to my office from dermatologists who are being investigated by the Feds (complete with complimentary crime scene tape in a few cases), or who have full-scale audits in progress with payback requests averaging in the hundreds of thousands.

Here are some questions I received in the past several months about some of the above-mentioned issues.

Q: How many billing staff do I need to have in my practice? I go to many dermatology meetings and speak with colleagues about this issue. Some have solo practices, but yet employ five or more people in just the billing component of their practice while others have some lady come in part time to do their billing. Is there a magic formula?

Sincerely,

Abracadabra

A: Dear Abracadabra:

There is absolutely no magical solution to this question or even a standard that you can use as a starting point. Dermatology is such a dynamic specialty that no one practice is the same. How many staff you need depends on so many variables; the least of which is how many providers there are.

For example, if you have three full- time providers who each see about 25 patients per day, one knowledgeable part-time employee may be all you need. Compare this to a two provider practice where each physician sees 60 patients a day and those same two providers also do cosmetic services, sell over-the-counter products and employ aestheticians, physician assistants and/or nurse practitioners, you could potentially need five to 10 employees. You can see how varied the need between the practices would be. I know of one solo physician who employs more than 32 employees.

Factors that determine how many billing staff you may include:

1. Total number of patient visits

2. Total number of Current Procedural Terminology (CPT) codes billed (do you bill one CPT code per visit versus three?)

3. Total number of contracts with third-party payers you have such as Medicare, Aetna, Blue Shield, etc. (The more contracts; the more work.)

4. Quality of your computer. Do you do manual charge entry versus scanning? Do you post payment manually versus automatic remittance? Is your data entry performed in real time or days (maybe weeks) after the fact? Do you have a paperless electronic medical record (EMR), or do you still file and retrieve charts manually? How do you store explanation of medical benefits (EOMBs), demos, insurance information (e.g., filing cabinets versus scanning)?