Billing: Ensure biller capabilities

A. The verb “make” implies constructing something by combining substances; and, that is exactly how to make a “good biller.” Good billers are observant, detail-oriented, able to communicate complex thoughts and ideas well, find solutions to complex problems and, most importantly, are studious.

In the world of billing there are many details that need attention: contract terms, fee schedule variables, modifier usage, payer specific billing requirements and much more. The main point is that billing is not for everyone. If you are building your business with just anyone simply because they need work, regardless of their experience or lack of, you could be setting your business up for failure.

Billers need to continually “sharpen the saw” by reading the contracts of payers to understand their unique billing requirements; studying the payer's billing companion guides that instruct on data requirements for billing certain medical devices; knowing the local coverage determinations when billing Medicare; and understanding how payers adjudicate claims and return their decisions on an ERA. In addition, possessing understanding of medical terminology is beneficial for proper interpretation, coding of claims and determination of medical necessity when reviewing physician documentation.

Biller training, whether online or in a classroom, is a good start if the educators are providing a quality program. Some educators, if you can call them that, are providing no real skills and are nothing more than agencies collecting money from unsuspecting people with good intentions. You can be helpful to your billing team by requiring them to study their denials to develop solutions and validating their findings directly with the payers, other team members and yourself.

Ultimately, it is your business and it is imperative to understand your billers' capabilities and what they are up to. Ensuring that your team is equipped with skilled billers is key to your success.

Ted Jones is CEO of bflow Solutions. Reach him at ted@bflowsolutions.com.