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AAOS Now

Published 12/1/2007
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Karen Zupko

Hiring better billing staff

What to look for and how to find it

Picking the wrong people to fill business office positions is a very expensive mistake.

Because staff salaries are the largest component of overhead in any practice, you should focus on hiring staff who have the skills and talent to add to your revenues. Conversely, hiring less skilled or trained people will have a negative impact on revenues—no matter how hard you work. When you are looking to hire billing staff, the following guidelines can help you make a better decision.

Supervisory staff
Let’s say you are hiring a billing or business office supervisor who will be responsible for actually handling transactions, as well as for hiring, training, and monitoring others. The first step is to evaluate the skills and expertise required for this position in your practice.

Depending on the degree of practice automation, physician’s cooperation and participation in coding, number of transactions, and business protocols, the skills and expertise required may vary. Your interview should cover the following important subject areas. Listen for detailed, descriptive answers that outline a business process, including how problems were approached and solved.

  • Solid written and verbal communication skills: Errors on resumes and poor grammar in cover letters or monosyllabic replies won’t improve once the candidate is hired. Be picky on the first review. Test skills by asking applicants to write an appeal letter for an underpayment by a managed care plan.
  • Up-to-date knowledge of the industry: Experience in “billing” today can be both a plus and a minus. Someone with 12 years of experience and a “this is the way we’ve always done it” attitude has the capacity to hurt your operations rather than help it. Ask applicants about modifiers, multiple procedure discounts, and other concepts that anyone who has done surgical billing would know. (With the changes in CPT modifiers and fracture care in 2008, outdated knowledge will be very expensive.)
  • Well-honed analytic skills: Ask about what reports applicants relied on in their previous positions. If the only answer is the “aged accounts receivables,” you are in trouble. This answer indicates the candidate has no analytic abilities. A reply that mentions accounts receivable by payor, by doctor, or by location as well as a detailed review of adjustments, unapplied credits, charge entry time lag reports, and time of service collections is what you want to hear.
  • Technology-savvy: Although many doctors have invested in Internet connections and better software to run billing, it’s often true that staff don’t know how or are unwilling to use technology to improve performance. For example, many practices still do not check eligibility before the patient comes in for a first visit.
  • 360º view of the revenue cycle: Billing isn’t only a back-end function. If candidates can describe how they worked with the reception or registration staff to reduce front end errors, that would be a plus. The billing office and front office are attached like your hand to your arm.

Hiring billers and coders
Back office positions were once populated by staff with low skill levels who robotically keyed information from insurance explanation of benefit forms into the practice computer system. If this is still the picture in your practice, that’s a problem.

The explosion of rules, coding nuances, and technology requires “billers and coders” to have an educated skill set. Staff who are unwilling or don’t insist on attending coding educational programs are suspect. Those who are happy to work on DOS computer systems likely have a mind set as antiquated as the equipment they are using.

Payment posters and payment analysts are significantly different positions. In an office properly using technology, the posting of payments for CPT codes such as 99213 is automated and requires no human touch. Using electronic remittances frees staff to focus on the denials and spot downcoding.

Beware of credentials! Some doctors mistakenly feel as though all Certified Professional Coders are created equal. In addition to the American Academy of Professional Coders, organizations such as American Health Information Management Association are well recognized and provide credible training.

Questions to ask biller/coder candidates include “What coding courses do you rely on for education?” and “What online or software tools do you rely on to keep up with reimbursement changes?” Code-X from the AAOS and the American Medical Association’s Code Manager are excellent resources.

Screening candidates
Consider using the tools that most large companies and many practices use to screen out candidates with likely problems. An inability to deal with diverse patient or coworker populations, attendance issues, stealing, and a dislike of supervision are some of the tendencies that can be assessed using a variety of Equal Employment Opportunity Commission (EEOC)-compliant tools. Costs for those tools are low—between $25 and $45—and they are well worth the investment, especially when you consider what a bad hire costs you in terms of recruiting and training time.

Never offer someone a job after the first interview; always do a second interview. You may be surprised when their true colors emerge.

Background checks are mandatory. Have all candidates complete a standard application and sign a release for completion of a background check. Your employment application should have an attestation statement that says any offer of employment is contingent on the results of the background check.

A background check may find that the candidate claimed multiple degrees from high school to grad school that were never earned, has an alarming credit history, has employment gaps, or has multiple bankruptcies—not to mention felony convictions.

According to Nancy Drew of RHR Information Services, a company that provides background checks to a wide range of businesses, including medical practices, “One out of every three applicants provides false, inaccurate, misleading, or incomplete information.” Because you trust employees with patient information protected under the Health Insurance Portability and Accountability Act, as well as credit card numbers, you have a legal obligation to verify the background of the people you hire. Intuition is useful, but do not let it be your only tool in selecting and hiring staff at any level.

Your staff may be your greatest expense, but they should also be your practice’s greatest asset. A terrific team can make your day pleasant and patients’ experiences with the practice memorable; they can develop better systems and contribute to profitability.

Karen Zupko leads KarenZupko&Associates, Inc., a consulting firm that works with surgical practices on a wide variety of practice management, personnel, and reimbursement issues. She can be reached at kzupko@karenzupko.com