What to Do If You Lose a Biller

What to Do if You Lose a Biller at Your Medical Practice

At a private practice, the departure of an experienced medical billing professional can be more than just an inconvenient, unwelcome loss – it can be downright debilitating.

A small practice might have only one or two billers on staff. If one quits, management of the revenue cycle can easily get off track, stalling cash flow and causing serious consequences on the bottom line.

While a larger practice may have more bodies on hand to cover a sudden biller vacancy, certain specialized tasks – coding, say, or denial management – may have been delegated to the one who parted ways. Her absence could create a hole in the billing process and cost the practice money.

Administrators have been known to panic when a biller unexpectedly gives her two-weeks notice. If it happens to you – fear not. Power Your Practice has some tips on how to best tackle the transition.

1. Don’t Rush to Hire
When an important staffer quits, a manager’s first impulse is often to hurry to fill the open position right away. But immediately hiring someone to fill the exact job that was left behind can be a costly mistake.

This is especially true when the job is a billing or coding position. If your biller departs, it’s critical that you take some time to reflect on your practice’s needs before bringing in someone new.

To facilitate that, have a qualified employee (or two) cover your departed staffer’s duties or bring in a temporary employee. Buy yourself the time you’ll need to figure out what’s best for your practice.

2. Assess Your Performance
Medical practice challenges – like incidents of staff turnover – should always be treated as opportunities for improvement. When a biller leaves, take advantage of the pause in processes. Take an in-depth look at your billing operations and figure out where you need to make changes for the better.

Do an audit of your billing operations, retroactively evaluate your departed employee and observe how your office is handling the loss in staff. Measure your key performance indicators (KPIs) in all areas of billing and compare your stats to industry benchmark data from the Medical Group Management Association (MGMA).

Among other metrics, the MGMA finds that the average medical practice employs roughly one patient accounts staffer per every two full-time-equivalent physicians. It also found that top-performing medical groups average just a 4% claims denial rate. How do you stack up to those standards?

If your data is not on par with that of your peers or you’re not meeting your KPI goals in billing, a change is necessary to spur improvement. Filling your vacated position, even with a new hire of ideal skill and experience level, may not be the ticket to better billing.

3. Weigh Your Financial Options
If you were happy with your previous employee, you may be eager to recreate the experience with a new hire. But keep this in mind: in-house billing may be all you’ve ever worked with, but it’s not the only option available.

Many practices find that it’s cost-effective to utilize the services of a medical billing company. If your departed staffer constituted a one-person billing department, this may be an option worth considering.

Use the billing performance data you measured earlier to help you figure out whether rehiring or outsourcing is the best financial choice for your practice.

Billing companies can charge customers in various ways: via flat rate; by taking a percentage of overall collections; by billing per claim or per statement; or through combination of those. Investigate the going rates at several companies offering the services you may need, and calculate your metrics against their prices to figure out what you’d pay as a customer.

For example, if your biller was processing 1500 claims each month, and a billing service would charge you $0.90 per claim to process them, that adds up to a cost of $1,350 per month to outsource. Is that lower than the compensation and benefits you’d confer on a new hire?

4. Consider the Future
Look ahead and think about what changes are coming for your practice in the months and years ahead. Is your practice going to grow by adding new providers, expanding its services or welcoming new patients? Or will you be scaling down as a physician retires?

Keep this in mind: the last thing any new hire wants is to join a company just to be phased out his position shortly thereafter. It’s common for medical practices to outgrow the capabilities of their in-house billing departments or find themselves underutilizing staff when business slows.

If you foresee major changes coming down the pipe, using an outsourced billing solution could help you avoid cutting staff as your business evolves.

5. Make Your Move
If you’re happy with your billing department’s performance, find it cost-effective to take on a new staffer and foresee a smooth, change-free future at your practice, put up a job listing, ask for employee referrals and start interviewing.

Otherwise, since you’re already in a time of transition, capitalize on the opportunity to make some changes.

For one, you may want to consider moving to a more advanced technology solution for your billing needs. The best systems on the market perform many administrative tasks automatically, which allows medical billing departments to do more work with less staff.

If you’re interested in outsourcing, make some calls and field a few sales pitches from medical billing companies. Learn how they could improve your business by asking for stats on each company’s average first-pass resolution and denial rates. Get recommendations from other practice managers and talk to each prospective company’s current customers.

Don’t forget – if you still have a billing department structure in place, you can always fall back on rehiring, which puts you in a great position as a consumer. Take your time, negotiate rates and hold out for an excellent deal.

How have you dealt with losing a biller?