Marian from Northwestern Women's Health Associates

Introduction

Office managers are essentially the glue that holds a practice together and keeps it running like a well-oiled machine. Oftentimes, office managers handle everything from billing to personnel to operations. However, at some practices (usually dependent on the size), the office manager just oversees the front office duties and there is a different manager that oversees medical billing.

We wanted to take a look at that practice set up. So, today’s Q&A features Marian, the medical billing manager at Northwestern Women’s Health Associates. This Illinois-based OBGYN practice has a team of dedicated and passionate healthcare professionals who are committed to providing exceptional healthcare services to women in and around the Chicago area.

As the billing manager, Marian ensures that patients understand their benefits and oversees the billing operations and collections process at her practice. Marian’s practice has mastered the billing process, thanks to Marian’s guidance. And we were fortunate to have the opportunity to speak with Marian about how she is able to handle and streamline her practice’s billing processes so efficiently and effectively.

So, let’s jump right into the Q&A segment!

Q&A

Q: Can you tell me a little bit about your practice?

We specialize in obstetrics and gynecology, and we’ve been in business since 1989. We do our own billing here. The thing is, I know that a lot of practices have challenges on how to get certain things paid. But, so far, I think that our practice is doing very well, and our A/R is pretty much current. We have no issues on what needs to be billed and how it needs to be billed out. The billers are excellent at what they do.

Q: Your practice is doing in-house billing, and it sounds like you have a good team of billers. So, what is the key to finding and recruiting the best talent?

Pretty much what we look for is the knowledge of ICD 10 and CPT coding - and with obstetrics and gynecology, knowing that there are various codes that need to be billed out, especially dealing with obstetrics where there are multiple codes, considering genetics, all of that. When we interview, we create our own questionnaires on what would you do in this situation. We do a test claim, and we have them fill out the information. We’ll even take the ICD 10s and place them in the wrong spot. We look for someone to knows what diagnosis goes with what procedure codes.

And when we do an interview for a new hire, a lot of them don’t know that. So, I think that it makes it very difficult when you’re interviewing someone and they come in and tell you that they’re a biller or that they know ICD 10 and CPT coding but, actually, a lot of them just pretty much know basic things. They don’t know in detail how to make sure that a clean claim goes over to the insurance company and get processed right away. I mean we can do claims today and it will be on our Blue Cross Blue Shield on Monday, so our turnaround is less than five days or less than a week.

Q: It’s impressive that you have in-house billers who are so knowledgeable. You mentioned earlier that your A/R is current. So, you don’t have any backlogs?

We have things, but it’s considered the state of Illinois. The state of Illinois is behind in making their payments. We have people calling from other offices asking us questions on what we do and on how to bill. When I started, it was about 22 years ago. And it’s pretty much straightforward; we have no issues. The only issue that we do have is getting the insurance companies to pay for genetic testing; that is pretty much not covered under the member’s policy. We do our own prior authorizations, we do our own billing payments, and everything, from the beginning to the end. We don’t have any problems like everyone else does; and the issues that some do have, they call us. And we do kind of help them out when they call us, and we give them an overview of how we bill things.

Q: What are the challenges that you face as an office manager?

At this moment, none. I’m in billing. So there is an office manager, but I’m in charge of the billing. There are about five people that do just billing. The only challenges that we have are our genetic screening codes or genetic testing that the insurance companies don’t pay for. But that doesn’t fall on the insurance companies, that falls on the employer, where they actually don’t have that added into the policy. But that’s about it; that’s the only issue that we really face.

Q: How do you tell your patients that a service is not included in their insurance?

What we do is, after the doctor discusses everything that they need to discuss with the patient, then they come here to billing. We give them procedure codes and diagnosis so they can contact their insurance to see if it’s a covered expense. If it’s not covered, we have them sign a waiver. We still do the prior authorization or do the pre-determination to see if it requires prior auth. We let the patient know before the test is done. If she wants it done, then she signs the waiver and she has the test done. If the insurance company covers it, we make sure that all of our I’s are dotted and our T's are crossed. Then, we submit the medical records and we just wait for the authorization to go through.

Right now, we really don’t have any issues like other offices do. I mean, we don’t get denials. All claims are scrubbed before they go to the insurance company. We make sure that all the modifiers are there and all the procedure codes have a diagnosis, and we don’t have any issues. The only issue we have is with genetics, and whether or not the insurance company is going to pay, and making sure that the patient is aware of that. But anything where a claim goes over and is not paid because something is wrong with it, we don’t have that problem.

Q: You mentioned that you’ve been the billing manager for 22 years. Have you been with the same practice that entire time?

Yes, and so have the billers. The billers have been here just as long as I have.

Q: If there was someone who was thinking about stepping into a role as a billing manager, what advice would you give them?

I would just say that it takes a lot of patience. You need to step back and take a look and see everything. You have to have patience in order to do this job. You have to because it can get very overwhelming looking at all the different things and the changes, because there are changes every single day. There is always something changing. You just have to step back and take it all in.

Final Thoughts

From tips on how to successfully recruit talented and knowledgeable medical billers to insightful advice on how to be a successful billing manager, we were able to learn so much from Marian. We’re pretty sure that the information she gave us will benefit not only billing managers, but also managers in general who are having a hard time overseeing the operational or financial part of a business.

Running a medical practice is difficult, yet office managers & billing managers work hard to keep the practice running efficiently and continuously bringing in revenue. Honestly, that’s quite remarkable. I mean, it’s not easy to plan budgets, oversee the billing operations, and manage a team of people. For seasoned managers, like Marian, it may come a little more natural. However, that’s not the case for everyone. A lot of managers struggle with the billing process - if you fall into that category, check out our new guide on the top billing mistakes to avoid. Hopefully, it will help you ease the medical billing burden at least a little. Keep an eye out for the next Q&A blog in a few days!

Interested in participating in our Office Managers blog series? Email our interview coordinator, Adrian, at adriand@drcatalyst.com to set up an interview.

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