Whenever I’ve gone on site, no matter the size of the hospital, I’ve always been struck by the fact that business office staff are organized by payer. Either billing and follow-up actions are done by one person, assigned all of the accounts for a certain payer, or billing and follow-up tasks are separated, but staff work the accounts by payer.
HBI research has shown in the past that 29% of organizations are not set up this way. Instead staff work a specific follow-up task, in an assembly-line type scenario, or staff are assigned accounts based on an alpha-split, or staff are not specialized at all. These strategies, in most cases, are simply not as effective as splitting staff up by payer.
When staff are specialized by payer they become uniquely familiar with the requirements of that payer. Codes that cannot be billed together, timely filing deadlines, and more, become a part of each person’s skill set. They also know the status of each claim that sits with that payer and may be more successful when following up with the payer. Aligning staff in this manner also removes some translation problems. When multiple people work a claim there is time lost reading and attempting to understand the notes the previous person wrote in the EHR, explaining the status of the claim.
Though organizations have been trending in this direction, I want to make it clear, in most cases, this setup works. Not only are billers and follow-up staff effective, they also feel empowered and have the chance to become experts in the practices of a particular payer.
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