Using BI to create partnerships between billing and the rest of your practice. Watch your cash collections go up!

By Jeffrey DiLiddo

The most successful practice billing operations (or practice/billing company relationships) are built on a partnership that fosters constant communication and training from the billing department to contract management team, front desk, PM system managers, providers, and coders.

In order for the revenue cycle to improve, every part of the front end needs to be constantly fed by meaningful, actionable data from the back end (aka the billing department) and that’s where the challenge lay.

When things aren’t going well, there’s too much blame to go around.  Cash is down and everyone is pointing fingers.   The Providers are blaming the Practice Manager, the Practice Manager is blaming the Billing Manager (or outsourced billing company) and the Billing Manager is blaming the front desk and the providers.   The reality is most likely that they are all correct.  Everyone has a part to play in the revenue cycle.

I had a conversation with a former billing company colleague who is running a practice in New England who stated, “Actually, we don’t really get that many denials. Cash is great!”  I was immediately intrigued.  This is not a common story.   When pressed with how she’d accomplished that she had one word in response, “training.

My former colleague elaborated, “We’re constantly training the front desk and the coders.    Our front desk staff spends a week being trained by the billing department before setting foot in front of the patients, and then they come in weekly to review the denials to see what they missed.  It’s the same with our coders.  We have an open meeting with the coders and the providers to find out where we’re getting denials, and more importantly where we might be under coding and losing revenue.   All of those conversations start with the denial data we’re compiling in the billing department.”

This highly successful medical practice achieves optimal results by creating a partnership between the various parts of the revenue cycle, with information and training stemming from the denial data that they are receiving routinely in their payer remittances.

The same holds true of the most successful billing company/practice relationships.   Success is driven from business relationships that are more “partnership” than they are “practice/vendor”.  As a billing department or external billing company, this starts with providing denial data that is up-to-date, trustworthy, meaningful and maybe most importantly… actionable.

  • Up-to-date data gives your team insight as to what happened last week or last month. Front desk staff, coders, and providers can’t get data that is months old because it was either unavailable or took too long to produce.
  • Trustworthy data comes from a reliable source and eliminates any question that the presenter of the data has modified the results in their favor.
  • Meaningful data allows your team to laser focus down to the source of the denial. It identifies the facility, location, department, provider, CPT/HCPC, and payer… even the patient and encounter.
  • Actionable data enables your team to enact change, either at the employee or the process level. There’s no question about the cause of a particular denial or underpayment

So where should you start?   Out of the gate; start to create a culture in your practice that takes “blame” out of the equation.  Instead of wasting time finding who was at fault, build a cross-departmental team with the mission of eliminating denials and underpayment issues for good.

The role of Remittance Business Intelligence

There’s no shortage of data for you to use out there, but finding that up-to-date, trustworthy, meaningful and actionable data can be time-consuming and frustrating.      Practice Management (PM) Systems and Clearinghouses are adept and reporting your top denials by code, but if those codes are not categorized to meet the intricacies of your practice, or billing clients it can be difficult to identify larger denial trends.

Sourcing the denial data is critical, but without specific claim examples to give back to your PM system manager, front desk, coders, and providers, it can be difficult to correct the source issue.   Look for systems and solutions that possibly do the analysis for you and then track your progress over time.      A business intelligence system designed around  and customized to your denial data can provide insights that are too time consuming to glean on your own from the standard denial “reports” you’re getting from your PM or Clearinghouse.

I’ve analyzed tens of millions of claims and in all of that experience; it’s almost always true that the top 5 denial reasons constitute over 65% of the practices entire denial volume, with the top denial typically being upwards of 20-30% of the total.    If you can get the relevant information you need to eliminate just the top 2-3 denials in your practice you will have made huge progress.  If you cannot isolate them to a facility, or service, department, provider (NPI), location or team member though… it’s going to be difficult to eliminate them for good.