How to Avoid Coding Blue Financially at the Office on Orlando Medical News

How to Avoid Coding Blue Financially at the Office

By: LYNNE JETER

Minerva DeJesus and Auriana “Audi” Reyes.

Because physicians are often too busy to keep an eye on every detail of their surroundings at the office, they hire staff to assist in maintaining a thriving business. Unfortunately, some employees take advantage of their position, occasionally to the point that employers face serious financial burdens, possibly even bankruptcy.

“An office manager is hired to oversee the practice and keep the waters calm,” said Auriana “Audi” Reyes, co-founder of Simple Solution Billing in Maitland and owner of a local ultrasound company. “This position comes with heavy responsibilities that require a certain level of trust. We all know that precise and efficient medical billing is what keeps the doors open. How can you maintain overhead if you aren’t being properly reimbursed for the services provided to patients?”

Much of the time, the office manager handles medical billing, if it’s done in-house.

“Turning a blind eye to what your medical biller/office manager is doing can be a costly mistake,” said Minerva DeJesus, co-founder of Simple Solution Billing in Maitland. “In fact, physicians that have been victimized have expressed how giving one person too much control and allowing them to make all the financial decisions can lead to situations that may leave you and your bank account in a critical state.”

Reyes pointed out a few red flags that may provide physicians insight that something isn’t right and perhaps needs investigation.

“Every medical billing program has an accounts receivables (A/R) feature,” she said. “If the physician goes to the office manager/medical biller and asks for the A/R report, which is only a click of a button away from printing, and gets the run around, that’s a red flag. A medical biller with nothing to hide has an updated A/R report at all times.”

If contracted discounts are higher than the A/R, that’s another red flag, said DeJesus.

“That could mean your biller is writing things off in lieu of appeals for reimbursement,” she said.

Another red flag: patients being placed in collections on a regular basis.

“This red flag means your employee is not aggressively working those patient balances, giving the collection agency the job of acquiring your income at their oftentimes staggering percentage rates, adding to lost revenue,” she said. “A patient should be put in collections only after your staff has done all they can to collect that balance for you. They shouldn’t be putting that work on someone else at your expense unless absolutely necessary.”

The most obvious red flag is if one or two months pass without any or low reimbursements. In that case, medical billing needs serious attention.

“When done correctly and in a timely manner, money should be seen daily, maybe weekly … not bi-weekly, and surely not monthly,” said Reyes.

DeJesus and Reyes shared tips to help practices avoid coding blue financially:

Don’t allow the office manager to hire their relatives. “This will only lead to disaster as the power will shift from the physician to the employees,” explained DeJesus. “Relatives working together will also increase your chances of being a victim of embezzlement. A person in a high position with bad intentions has a better chance of convincing a relative to do something illegal.”
Be leery of hiring your own relatives. They might feel entitled to your property and turn your own employees against you, especially if they don’t recognize their place in the office pyramid and take on more than they are qualified to do—if they do anything constructive at all. “Most times, mixing family with business is a recipe for financial ruin,” cautioned Reyes. “It can also hurt your familial relationships.”
A physician should meet with the medical biller once a week and review the practice’s A/R report. “At this meeting,” DeJesus urged, “ask if anything has been written off.”
If something has been written off, request the documentation backing up the reason why.
Accounts payable (A/P) and A/R should be handled by two different people. “This avoids one person handling all your finances,” noted Reyes. “A checks-and-balance system needs to be in place.”
Make the front desk accountable for every payment given to the office, with a financial logbook of patient name, payment, method of payment, and person handling the transaction. “At the end of each day, two people should close the books, accounting for every penny,” said DeJesus.
Office super-bills should have a space for payments; this information should match the financial logbook.
Compare actual deposit slips from the front desk with the financial logbook to be certain they match. “Remember, cash cannot be traced and dollars add up quickly, especially when they’re being taken from you,” advised Reyes.
Quarterly audits should be done by an outside service. “It shouldn’t be done by another employee, since you never know if both employees are involved in the fraud that might be taking place,” said DeJesus.
Never give blank checks to employees. “If you do, a copy of the check should be made after it has been filled out,” said Reyes, “and that copy should be attached to the invoice the check was covering.”
Open your own mail. “Sometimes, patients or contracted services will write a letter to you about their experience with your practice,” explained Reyes. “If your staff has the authority to open your mail, you’ll only hear about the positive, never getting the opportunity to know about the negative. Some physicians have an outside post office box, allowing them to pick up their own mail. This prevents staff members from looking through it and giving you only what they want you to read.”
Never trust anyone 100 percent of the time with finances. “It can be,” cautioned DeJesus, “a grim misstep.”

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Audi Reyes, Minerva DeJesus, Most Outrageous Rejected Claim, Simple Solution Billing

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