Billing Network – Accountability and Support – Part 2

by Erez Lirov

Workbench and Accountability

Once the staff is committed, they must be actively managed and made accountable. One way that a Billing Network can ensure staff accountability is to provide a rigorous mechanism for information exchange between the practice and the billing service. Instead of calling the practice and leaving messages when common billing issues arise, the Billing Network electronically records information requests to the practice. These requests accumulate in a “workbench” that the practice can monitor any time.

We are often asked about the “workbench” and the amount of “extra work” that it adds to a practice. The workbench’s function is precisely to make the staff accountable and help the practice owner manage the process without having to look at every claim. The workbench effectively “opens the billing drawer” and exposes all the claim rejections and unpaid services that are typically hidden by billers and billing companies. Successful practices implement a policy whereby no one leaves the office until the workbench is clean.

Reconciliation

Another pitfall is lack of reconciliation. Many client issues stem from a misunderstanding about how the Billing Network computes the monthly invoice to the client. In our example, Billing Precision receives and posts both EOB and ERA (electronic EOBs) without confirmation of whether the money actually was deposited into the provider’s account. The reason is simple: Billing Precision has no access to the provider’s account and therefore completely depends on the provider to reconcile their bank statement to the monthly check report to make sure all the money was deposited by the practice.

Any provider that does not reconcile their payments runs the risk that the insurance companies make a mistake and send ERAs without sending the money, or worse, that checks and EOBs are received by the office, but that the checks somehow get lost before being deposited. This could quickly lead to a misunderstanding where the office believes they are being overcharged for money that was posted as collected by the Billing Network, but was not actually deposited into the provider’s bank account. It is therefore absolutely imperative for the practice to reconcile their statements at least on a monthly basis and notify the Billing Network immediately if any checks are posted as paid in Vericle but not received by the practice.

Support Protocol

Finally, practices often have an unrealistic expectation of how quickly a Billing Network can respond to their support requests. Billing Precision and Vericle support a complex organization of technologists and billers who are constantly working to improve the technology and follow-up on claims. Constant phone interruptions by practices decimate productivity of all Billing Precision and Vericle employees as they struggle to switch between the tasks that they are trying to accomplish and the problems and questions posed by the clients. On demand phone support also leads to long hold times (average hold time for BCBS NJ is 22 minutes!) and very frustrated clients.

Billing Precision believes in empowering clients to find solutions on their own and at their convenience. Providers and their staff must be willing to take initiative and search the available web resources for their answers. Of course, we recognize that sometimes the information needed is simply not available in the online resources. In those cases, offices can register and join the daily QA sessions and ask their questions in a group settings. Alternatively, they can open a ticket directly from the Home screen and let the appropriate team respond within 1-2 days.

Summary

After reviewing these items with the doctor, I suggested that he take some time and really think about whether his practice is a good fit for our service. Does he understand the benefit of joining a Billing Network? Does he want to contribute to the greater good and help all members benefit from his experiences, just as he benefits from theirs, or will he expect perfection and leave at the first sign of trouble? Does he have the complete commitment of his staff? Are the staff members “self-starters” that can try to resolve issues on their own or simply open tickets and wait for replies, or will they demand instant hand-holding and instant results?

The doctor took a deep breath and thought for a moment. He tried to visualize his staff grappling with the workbench while trying to learn a new system. He imagined their frustrations and complaints at having more work to do. He considered whether he really believed in the concept of doctors banding together and learning from each others’ mistakes through a unified system. Then, he thought about the insurance companies and how unfair it was for them to be able to benefit from their large scale and all the data available to them. He thought about hundreds of billers in India fighting for his claims and using the aggregate knowledge gained from processing hundreds of thousands of claims every month. He thought about our successful client and how he was able to rally the troops and implement the system quickly and efficiently. He imagined his practice discovering a flaw in the process, and working with Billing Precision to correct the flaw and help hundreds of practices across the country avoid the same mistake.

His decision, at the end, was a personal one. Whether he decided to join the network or go it alone is not nearly as important as the thought process behind it. For the Billing Network to benefit everyone, all providers in it must be “on mission”. As Aristotle put it “The whole is greater than the sum of its parts.” Or, if you prefer: “All for One and One for All.”

Read more about the Billing Network – Part 2

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