Focus your reimbursement department

Tuesday, September 30, 2008

Q. What is the best way to organize our reimbursement department to effectively bill and collect our accounts receivables?

A. Reimbursement departments are typically organized where everyone is working on a little of everything and no one has a single focus. The end result is usually lagging cash flow and increased accounts receivables. To avoid this, you should have a minimum of two divisions within your department: billing and collections.

The billing division’s focus should be on ensuring clean claims submissions for both hard copy and electronic claims. This should include a review of proper billing codes and corresponding modifiers along with complete patient billing information. Another important role is to confirm that all required certificates of medical necessity, insurance explanations of benefits, sleep studies, etc., are attached to claims, if required. The billing phase really should require minimal work and staff.

While getting clean claims out the door sets the stage for optimum claims processing, there are always going to be claims that get denied, get partially paid or never get a response. This is where the collections division comes in. These individuals must have a consistent and aggressive approach to ensure the claims are going to be processed and that payment is on the way. Because of the volume of payers involved, the collections division needs to be organized based upon payer complexity, total accounts receivables outstanding and current performance.

To be able to effectively organize your staff, you really need to know your staff’s strengths, as this will allow you to determine who will perform best in each of these roles. Assigning staff based on their expertise will not only allow them to excel but also result in increased cash collections.

Lisa Cusick is the corporate consulting manager with Bargmann Management, LLC. Reach her at <a href=