Every medical practice requires continuing education for even the most experienced staff. Standards of performance need to be set up for each of the following criteria. Billing staff need to:
• Understand and follow all billing and collecting procedures
• Be capable of explaining insurance benefits to patients
• Be aware of patient/physician confidentiality and follow guidelines
• Have a firm grasp of medical terminology
• Understand and utilize all functions of the office computer system
• Be accurate in posting all charges, payments, and adjustments to each patient account
• Understand ICD-9 and CPT coding on all claims
• Show ability to retrieve billing and coding information from the patient chart
• Comprehend rules and regulations that apply to submitting claims
• Be able to prepare and file medical claims accurately, follow up on those not paid in 45 days
• Know how to apply appeal procedures for unpaid or underpaid claims
The above list can be used to evaluate performance and identify areas that staff need continuing education.
However, remember cross-training of employees is just as important!!