Call us nerds but we’re fans of having policies & procedures. They’re not a magic bullet by any means, but they do provide a framework for operating that accomplishes two things: P&P force practice leaders to consider and document business standards and processes and they guide and remind employees about those workplace standards and processes. So, although they can be the bane of a manager’s work existence, P&Ps are our friends. The billing department is one place where we believe you really need robust P&P. Why? Because it’s the heart of the office.

We can’t tell you how many billing assessments we’ve done only to find out that Sally does things this way and on these days, and Henry does them that way and on a different timetable. These differences can impact the financial wellbeing of the practice because so many billing tasks are time-based. For those of you who tremble at the thought of writing stuff, P&P don’t need to be fancy. They just need to put forth the steps and guidelines of a process. Here’s a list of subjects you can cover in your policies:

  • The steps in the billing process for your practice – No need to get too nitty-gritty on the how-tos with screenshots (although that would be helpful in a training handbook), but cover the basics: when is billing done (preferably daily), how is it done (is the note reviewed? Do you use a superbill?), how frequent is claims f/u, what is the process and timeframe for denials, etc.
  • Financial hardships, courtesies and discounts – How do you handle these? Who can receive a discount? What can a biller or billing manager discount without authorization? What needs approval?
  • Payment plans – How do they work? Who can establish them? What size balance can be paid off in this manner? Will you collect a credit card and process payments automatically? Who is responsible for monitoring payment plans? How will that be done and on what timetable?
  • Delinquent accounts – How do you define this? What do you do with delinquent accounts? Will you refer a delinquent patient to collections? When does that happen – after how many collection attempts?
  • Refunds – Define when a refund may be due and to whom. Who can process refunds? Is authorization needed for any refund or only those over a certain dollar amount? What documentation is made in the system?
  • Patient statements – How often are they sent? How many statements are sent before an account is deemed uncollectable?
  • Write-offs and adjustments – Define these terms so their distinctions are clear. When are adjustments made? Are adjustments for contractual allowances, for example, done automatically? When is a write-off done? What can be written off automatically? Do write-offs require authorization? From whom?

Billing policies are not for the specific steps in performing the process but for the standards and rules of the department and practice. The more you spell out for your billers, the more effectively they can work because the parameters for using their judgment are clear. Think about the issues you cover with a newly hired biller and we bet you’ll have the topics for a basic billing policy manual in no time!