Avoiding Billing Headaches in a Growing Practice

By John Wallace, PT, MS,  Senior Vice President, RCM and Member Value, WebPT
Twitter: @WebPT

Many growing practices need help scaling their people-driven processes, including billing workflows. Sometimes these issues are tied to processes needing to be documented or systematized. Other challenges arise when practice owners take a hands-off approach, relying on technology or KPIs only. The solution: streamlining billing operations without relying solely on software.

The impact of messy billing practices

As your practice scales up, poor and inefficient billing practices can cost you precious time and money, while also causing:

  • Lost revenue. The estimated average cost to rework a denied or rejected claim was about $25 in 2017, which is likely even higher now due to inflation. In some settings, the estimated cost of a denied claim can rise to a whopping $117.
  • Surprise denials. According to the Change Healthcare 2020 Revenue Cycle Denials Index, 26.6% of claim denials are due to registration and eligibility issues. A lack of prior authorization is another avoidable trigger for claim denials.
  • A frustrated workforce. Inefficient billing practices create extra work for staff. When billing processes are unstructured, those responsible for filling them out can feel overwhelmed and eventually may burn out.

Clearly define roles and responsibilities

While billing may be a team effort for many practices, a lack of defined roles can make it difficult to determine accountability for claims submissions. Therefore, the first step to optimizing your billing processes as you scale is defining the roles on your billing team. This may seem simple, but when your clinic’s billing to-dos aren’t assigned to a specific person, they can easily get overlooked.

Help your practice stay on track by establishing internal controls that determine who is responsible for each of the many critical functions within your business. A practical way of doing this is to make one person responsible for each billing function (e.g., posting copays and co-insurances at the end of the day, making collection calls, or reverifying patient benefits). It’s also best practice to have one person in charge of ensuring that errors are corrected promptly—or not happening in the first place. With a thorough understanding of internal processes, they then become responsible to train other team members. This approach is especially helpful when it’s time to onboard new employees as billing needs increase over time.

Assigning responsibility for each aspect of your billing department promotes efficiency and accountability. Importantly, it also means you’ll have the specific safeguards, checks, and balances in place to avoid avoidable claims rejections.

Build your process around technology

Manual billing processes can get in the way of consistency. Automation provides the fastest and least burdensome way to go about billing processes. For example, a billing program can automate payment reminders for patients. It is also the key to error-free billing, no matter the size of your practice.

However, a common problem that many practices have is the failure to leverage technology properly. This often happens when a practice tries to fit its old system of doing things into new software (think square peg, round hole), instead of organizing a new system within the technology’s framework. A better approach is to build your billing processes around your software’s capabilities, including any time-saving automation features.

Before unleashing any billing software’s power, you need to know what it can do for you. Understanding your billing software features can allow you to customize your workflows better and minimize complications. When selecting a software system, look for a company offering free training or a comprehensive knowledge library so you can jumpstart your practice’s workflows. Then, keep up with functionality as it is released by your vendor.

The problems that come with ineffective billing practices can snowball as a practice grows. Since this can lead to lost revenue, surprise denials, and a frustrated workforce, it’s worth addressing them. Fortunately, improvement doesn’t need to be complicated. A few tweaks to your current setup can help you find the balance between technology and hands-on workflows as you scale up.