Organizational Structure

Organizational Structure

Centralized Business Office vs. Decentralized and Staffing Levels

Decentralized business operations often do not emphasize economies of scale, enhanced process standardization, development of payer and functional expertise and greater visibility into payer issues. However, smaller organizations may not be able to cost effectively centralize the business office. For these organizations (50 physicians or less), pieces of the business office may be outsourced such as billing, collections or customer service.

Physician offices show significant variation in staffing levels. Some groups staff as many as 39 FTEs for every 100 physicians, while others report as few as 18 FTEs per 100 physicians. The right staffing levels may depend on payers, specialty and revenue. Best practice organizations devote a significant amount of FTEs to AR recovery. For multi-specialty groups of 25 or more physicians, payer and specialty experts can be grouped into teams focused on two to three specialties, thereby leveraging both specialty and payer specific billing knowledge.

Tasking CBO staff with payer and customer service responsibilities is often detrimental to overall performance. Staff often prioritize payer recoveries over customer service calls – which results in frustrated physicians, patients and extra strain on employees. For these reasons, deploying specialized customer service staff is critical for effectively managing call volumes, supporting self pay and after insurance collections, and maintaining a high level of patient satisfaction.

Buisness Office, Customer Service or Clinic Liaison

Multi-disciplinary billing teams should include commercial and government payer specialists. Teams may also need contract knowledge. Each physician practice should have a designated business office liaison from within these groups to establish a central point of contact.

Customer service specialists should resolve inbound patient inquiries in a single touch, this requires deep knowledge of physician billing and patient collection protocols as well as strong collection and communication skills. Customer service should be separated from AR recovery. 

Organizational Realignment

​HWS can realign your organization chart, optimizing staff while leveraging technology. Policies, procedures and job tasks can be realigned around high impact pressure points. Productivity standards and templates to complete job duties can be established and rolled out to staff.

Example performance objectives for customer service staff:

1. One touch resolution philosophy

2. Answer all incoming phone calls and respond within 24-hours

3. Request and accept patient payments, including prior balances

4. Place outbound calls to patients regarding payment resolution 40-days after service

5. Able to make payment plans

6. Refer patients to collection agencies or charity based upon protocols.