From the trenches of accounts receivable (A/R), the biller's desk offers a vantage point that most executives rarely see. Practice leaders often focus on high-level metrics—days in A/R, collection percentages, EBITDA. But what's missing is the granular view of the daily grind, where billers battle with payers and wrestle with denial codes. Here's what every practice leader should understand about the world of A/R from a biller's perspective.
The Real Cost of Denials
Denials aren't just a data point on an Excel sheet. They're time sinks. Take denial code CO-45, for instance—charges exceeded the fee schedule or maximum allowable. Rectifying this isn't just about a phone call. It involves pulling old EOBs, comparing contracts, and sometimes, even challenging the payer's logic. On average, each denial takes 10-15 minutes to resolve. Multiply that by dozens of daily denials, and billers are spending entire days on what should have been seamless transactions.
The Payer Portals: Necessary Evil
Payer portals are supposed to make life easier, providing instant access to claims status and eligibility verification. But anyone who's actually used them can tell you—they're far from perfect. Each portal has its quirks. One payer might update every 24 hours while another lags by two days. This inconsistency requires billers to track multiple timelines and follow-up patterns meticulously. You can't just rely on auto-generated reports; manual checks are necessary.
Hold Times: The Hidden Enemy
Ask any biller about hold times, and you'll hear groans. Spending 40 minutes on hold is not unusual—and that’s just to fix a minor claim issue. Multiply this across multiple payers throughout the day, and it becomes clear why tasks pile up. The "efficiency" of a single call doesn't measure up to its actual impact. Every minute on hold is a minute not spent on other tasks.
Coding and Compliance: Not Just a Checkbox
Leaders may see coding updates as straightforward checklists—train the team, implement the changes, and move on. But for billers, coding is a minefield. Changes like the annual CPT updates require understanding nuances. A slight misstep can lead to rejected claims, which means rework and re-submission. Moreover, keeping up with local coverage determinations (LCDs) and national coverage determinations (NCDs) is not just dictated by CMS but varies by local MACs. Billers must stay constantly vigilant to ensure compliance.
The Emotional Toll: More Than Just Burnout
Let's talk about the emotional toll. Dealing with constant denials and payer pushbacks isn't just frustrating—it can lead to burnout. Billers are the unsung warriors of practice revenue, often working under pressure to meet collections targets that don’t account for payer obstacles. They face abrupt payer policy changes and arbitrary denial rates that seem to defy logic. When leadership fails to recognize these stressors, it can lead to decreased morale and higher turnover.
Technology Gaps: Not All Solutions Are Equal
Implementing new technology is often seen as a panacea. Yet, without input from those on the front lines, these solutions can miss the mark. For example, an AI-driven denial management tool might look great on paper, but if it doesn’t integrate well with existing systems or requires an arduous learning curve, it ends up complicating workflows rather than simplifying them. Billers need user-friendly tools that enhance their work—not tech for tech’s sake.
Communication: A Two-Way Street
Communication barriers often exist between billers and upper management. Billers are rarely consulted about goals or targets, yet they are the first to take the brunt when numbers fall short. Regular check-ins and feedback loops can bridge this gap. Leadership should encourage open dialogue, where billers can express challenges without fear of reprimand. Understanding their daily frustrations can inform more realistic goal-setting and lead to more achievable targets.
Takeaway for Leaders
Understanding the reality of A/R from a biller's perspective is more than just a nod to empathy. It’s about aligning business strategy with operational realities. Leaders can drive more effective revenue cycle improvements by considering the barriers billers face every day. Empathetic leadership paired with actionable insights from the trenches can transform challenges into opportunities for growth.
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