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Billing: Put it together like a puzzle 

Billing: Put it together like a puzzle 

Q. How can we better organize how we adapt to changing customer and payer behaviors? 

A. These changes force owners to upend their business practices to stay ahead of the game. There are valid reasons why these disruptions are prevalent, but most are attributed to ineffective past practices. An initial step is a root cause analysis to define the areas of neglect. Once areas are identified for improvement, the organization and management of that data will require time and attention. Unfortunately, if the training program is less than stellar, inaccurate or non-existent, it bleeds into every department in the business, infecting them slowly over time. As employee turnover and lack of accessibility to experienced staff continue to climb, attention is drawn to deficits that acknowledge the necessity it plays in the program's overall functionality.  

Understanding the components of all processes for each claim in the RCM (beginning to end) is like putting together a puzzle, having all the correct pieces to create a positive result, and is acceptable to the provider and the payer resulting in payment. For example, organizing the initial receipt of audit letters is essential so as not to cause a delay in processing. Assigning the responsibility of the audit activity to an employee to review, trend, train and manage the results will provide great insight. Some issues fall on the patient, the commercial payers, particularly Medicare or Medicaid. The importance of payer education, for example, must run parallel with the development of new protocols. 

The application of solid, process-based trends, continuous analysis of payer behaviors, and the maintenance of those new payer protocols will result in factual reporting. Obtaining accurate and current trending behaviors allows you to proactively conduct necessary internal audits. 

Kit Shellhouse is vice president, ECS North. Reach her at 



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