1.) 6% of collections is more than the total yearly compensation for my most expensive staffer. I estimated it takes a 3/4 time staffer's worth of work to perform billing/collections, but it would be hard to quantify as my wife graciously does the work for owners equity rather than a salary, while doing other tasks in the office as well. Most of this is just posting the remittances to the accounts to whittle the data down to the dozen or so bills per month we have to send out, and if OfficeAlly (or future versions of AC) could do that automatically and compare against the expected contracted discounted write off ? it would take little time indeed. There is no additional software or IT cost, and postage is <$15 per month.
2.) I keep a spreadsheet for all payers (about 2 dozen ? but realistically 90% of our business comes from half a dozen), and a row for each E&M 99201-99215 (realistically, 90% of business comes from 99203 99204 99213 99214). When my biller posts reimbursements and notices that something increased, she updates this spreadsheet ? or if we are lucky enough to get an updated fee schedule from the payer, then we update this at that time. For Medicare, we just check the CMS website at the beginning of the year. We actually have entries for every CPT we ever billed and every payer, but those get updated haphazardly when we have a particular interest. For the most part, however, 6 payers x 4 CPTs = 24 entries for 90% of our billing. I average about 14 patients a day, not per month. My staff has standing orders from me as to which of those 4 most common E&M codes are most probable for a visit depending on the patient's age and complaint ? and the code chosen in the end is different <3% of the time. Lots of these are 99214s for interval f/u of patients on meds for 3 or more chronic problems. 2 days before the appointment, my receptionist calls the payer and finds out what the patient's copay and remaining deductible are, looks up the contracted reimbursement for the anticipated CPT service, determines the patient's share of cost, and calls the patient with a reminder that they have an appt 2 days hence and to bring the exact share of cost anticipated. Over the last 5 months my PM shows an average of 20 bills sent per month, corrected to 15 per month when accounting for multiple bills for the same DOS. Every month we refund about 6-12 patients when what the payer told us in advance was different from the eventual EOB we received. Although it sound like a lot of work for my receptionist, I think she keeps notes in their demographic tab of who has met their deductible or has no deductible, so a call to the payor for every patient is not necessary for those, which along with our capitated folks who only pay a copay, probably brings the payor calls down to half or less of patients to be seen. If we know the patient is coming back in <3months and there is a balance/credit due, most patients elect to just apply it to the next visit.
