We’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.