How Many Billers Do I Need?

Question: We are trying to develop a budget for our central billing department that supports 20 physicians at nine different sites. We currently have 12 full-time staff posting all of the charges and payments, sending out claims, and doing A/R follow-up. Can you give me any insight regarding the FTE per provider for billing?

Answer: The Medical Group Management Association says multispecialty practices spend a median of 2.7 percent of net medical revenue on staff related to patient accounting, general accounting, and managed-care administration. Not exactly what you needed to know, but it’s a start.

They also list that a median number of 0.61 staff per FTE provider in these categories.

That said, here is what Physicians Practice recommends for billing staffing, by claims volume, where a biller is defined as anyone who touches the process from the time a charge becomes a claim until the claim is fully paid:

• Full-time billing employees per 100,000 claims: 10.45. (Claims are the basic work unit of a billing staff member, just like work RVUs are for a provider.)

• Payment posting/cash management FTEs per 100,000 claims: 1.9.

• Credit resolution FTEs per 100,000 claims: 0.4.

• Insurance denial and follow-up FTEs per 100,000 claims: 3.1.

• Patient follow-up and inquiry FTEs per 100,000 claims: 1.8.

One biller per 10,000 claims may seem a bit low, but if the claims are clean, then no billing staff intervention is needed at all. Therefore, the ratio is not just a reflection of how good the biller is, but how good the process is. Keep these principles in mind: Busier physicians generate more claims. Some specialties have more difficulty than others when collecting. Some patient populations are harder to collect from than others. Good staff can pay for themselves easily if they boost collections. Technology can make staff much more efficient.

The best benchmarks may be your own internal performance over time. If collections are poor now and you truly believe adding staff might help, it’s generally worth the money spent to reap even more.