How Many Billers Should A Medical Practice Employ?

med-billing-and-codingWe’ve talked about in-house billing vs outside billing before. I even teamed up with my friend Chip Hart and devoted a full podcast to the topic. But we’ve never talked about billing staff ratios. How many billing staff should we have? How do we know if we are understaffed or overstaff?

Should we calculate the ratio based on charges and collections or should we base it on physician count?

Dr. Suzanne Berman, one of the many outstanding contributors to the SOAPM list serve and an avid supporter of the Survivor Pediatrics Blogs, jumped in to the discussion with excellent insight on how she staffs her office. Here is what she had to say.

One full-time biller could probably do 65% of our 5-provider practice. This would essentially involve simple in-and-out: convert all the superbills to claims, send ’em out, then post whatever she gets back, and send a bunch of statements, then deposit whatever we get.

A colleague of mine (who probably thinks I’m overstaffed) does just this very thing with a single part-time biller.

This physician is happy to collect 65% of his claims with hardly any effort and write off the rest — which also gives him hardly any days in AR (“oops, they didn’t pay for imms with an EPSDT? OK, I guess we’re writing that off. Next claim!”)

65% is the easy low-hanging fruit. Another FTE might do another 20% — but it’s the next hardest 20% (appeals, corrected claims, etc.) which require more skill. Another FTE will do the very hardest 10%. This gets us to 95% of collections, or so.

Then I have to decide if another FTE could get me 2-3% more collections, and is it worth it, and (perhaps most importantly) does that newly-added FTE have the skill set to squeeze out that very-difficult-to-get 2-3%? If I add another FTE, it needs to be a Claims Commando, not a “worker bee” whose main skill is being fast and accurate entering data on a 10-key

I’d like to jump in here and add that I think there needs to be a person in charge of working the patient balances. This is the person that is calling patients informing them of their balance, explaining to them why they have a balance, writing and sending collection letters and setting patients up on payment plans.

Dr. Berman brought up another very important point that one must consider when deciding how many “billers” an office should have. She writes:

The other related question is: who’s a biller? I know this sounds dumb, but a lot of the important billing functions revolve heavily on the front desk doing their job (at least, that’s how the work is divided up in my office):

  • validating insurance for each and every visit
  • collecting copays
  • getting correct addresses, phone numbers, email addresses, etc.
  • updating VFC status
  • figuring out which of the divorced parents is supposed to be paying

If you have receptionists who are not doing these jobs consistently, more work is going to devolve to the billing office to track down this information when the patient isn’t in the office. On the other hand, if you have an extra receptionist up front who does all the insurance validation the day before and runs a list of people coming in who need to be squeezed for $$, you can get by with fewer billing people. Or should I say, “billing” people. I think billing + reception = a constant (when it comes to total collections effectiveness, that is.)

Dr. Berman doesn’t answer the question, but with her approach, she is teaching us how to fish, as opposed to simply giving us the fish. I like this approach better.

But for those of you that don’t have the patiences, time or interest, I have something for you too. My friend Chip Hart also chimed in and he summarized it like this:

I usually expect at least 2:1.

Professionally I know Chip enough to know that with this statement, he isn’t saying this is a set in stone, hard-rule type statement. So don’t misinterpret his simple statement. He acknowledges that every office is different, different factors affect different things in an office. But if you want a hard rule of thumb, then the 2:1 (2 docs for every 1 biller), is a good start.

How many billers do you have in your office? What do you think is the right number? How many is too many? Does more billers equal better collections for your office? Drop a line. I’d love to learn from you too.

12 thoughts on “How Many Billers Should A Medical Practice Employ?”

  1. So while physicians are fearful of upsetting patients by asking for payment and billers aren’t great at it, patients get embarrassed and put off going back to the office for a visit and less gets billed to insurance. Around and around we go.

    1. Brian, do you think that the amount of embarrassed patients who do not return because of unpaid bills are significant enough to have a major impact on the practice? Or, are you left with a better base of remaining patients who are compliant with payment policies, etc.?

      1. Depends… how many are actually leaving?

        If too many people are not returning, then I believe the practice has another issue.

        But if only a few patients leave, then I don’t have a problem with that. Because like you said, the ones that remain are the ones that truly value the practice. And now, you can spend more time with them and not be distracted or consumed with the ones that don’t appreciate the work that one does.

        For example, in our practice, we don’t have a single un-happy patient. ‘Cause all the un-happy patients already left.

        Thank you for taking the time and leaving a question.

        Brandon

        On Tue, Apr 30, 2013 at 7:32 PM, Pediatric Inc

      2. It’s impossible to quantify how many patients put off care because of owing money. It’s probably not as big an issue in Pediatrics because when your kid is sick you’ll do anything to help them, embarrassment or not. But derm or dental?
        There’s a fine line between having a firm financial policy and dismissing too many “bad” patients from a practice. I think if patients are honest about their finances most practices will work with them. It’s the patients that don’t respond to internal efforts that practices have such a hard time with.
        Credit card on file programs are great but I think most practices are uncomfortable asking for payment at point of care.

        1. It’s impossible to quantify how many patients put off care because of owing money. It’s probably not as big an issue in Pediatrics because when your kid is sick you’ll do anything to help them, embarrassment or not.

          There probably is some truth to that. Except many parents forgo the visit and prefer for the doctor to answer questions about what to do when their child is sick over the phone. In other words, they want free advice. We have a problem with this. Not with people that owe money, but people that have high deductible or high copayments.

          There’s a fine line between having a firm financial policy and dismissing too many “bad” patients from a practice.

          I don’t think there is a fine line at all. What do you mean by firm? Having to pay what you owe? Restaurants have a firm financial policy, so do hotels, and airlines too. If you don’t pay, you don’t get service.

          And what is wrong with telling those that can’t pay for your services that they can’t continue getting service unless they pay for the “hard” work the doctor has done in order to provide healthcare for their child.

          For those that can’t afford to pay at all, there are plenty of options (at least in our State) like public health clinics and the suck. But if a practice is a private medical practice that doesn’t get any subsidizes, tax break, special concessions, or even a discount on their rent, why should they be left with the cost, the burden and the risk of treating people for free?

          I think if patients are honest about their finances most practices will work with them.

          Absolutely. We will work with anybody that is willing to work with us. And I would be willing to bet that most pediatric offices would to.

          It’s the patients that don’t respond to internal efforts that practices have such a hard time with.

          And this effort is highly distracting. It takes resources from patient care. Not to mention it is expensive.

          Credit card on file programs are great but I think most practices are uncomfortable asking for payment at point of care.

          And this needs to change. We should not be uncomfortable. And patients need to stop getting all bent out of shape about being asked to pay for medical services that were already provided for weeks or months before.

          Thank you for your comments. Interesting discussion indeed.

  2. Ohhhh that dang last 5-10% that goes uncollected. How much of that is patient balances and how much of it is denied claims etc.? I’m thinking more of it is pt balances with high deductible health plans being more the norm. What’s troublesome is I’ve found that many physicians are happy to just send monthly statements for eternitiy or hope to collect it when the patient comes back in for a visit.
    While some billers are capable of following up on patient balances most are not. Why? Because they tend to focus on collecting from the payers first then collecting from patients when they have time. Another problem is that in small offices billers know the patients and it’s awkward for them to ask for payment.

    1. You’re absolutely right, Brian.

      That 5 to 10% is way harder to collect than the other 90 thus, most offices just let it go. Especially the smaller offices.

      The way to get around that, however, is having a credit card on file program where balances are automatically put through. This is a hard sell. Patients don’t like this. But we don’t like giving away 10% of our revenue either. So something will have to give sooner or later.

      Thank you for stoping by and leaving a comment.

      @PediatricInc

      On Thu, Apr 4, 2013 at 10:08 AM, Pediatric Inc

        1. What compliance laws?

          If there were, then hotels, car rental companies, iTunes, Comcast, AT&T, Amazon, my gym, etc. could not keep customer’s card on file.

          B

          On Tue, Oct 22, 2013 at 1:27 PM, Pediatric Inc

  3. For a little supportable detail, here’s what I can offer:

    – iirc, the mgma uses about 10k claims/biller/year. Ymmv.

    – a busy Ped sees 4-5k visits a year.

    2 x 4-5k gives you 10k visits, or one biller for every 2 docs.

    All round numbers.

Comments are closed.