Behind the Scenes: Central Billing Office

Located in two separate facilities, the KVH Central Billing Office covers a range of services and responsibilities. We sat down with three long-time CBO employees for a glimpse at the work they do to serve our patients, the community, and the organization itself.

Photo (L-R): Tara, Kelly, Leah

Leah, you and Jill and Yvette are the faces of KVH Hospital. What’s a typical day for you?

L: As a Registration Clerk, I register hospital patients for all the different areas, like lab, imaging and emergency. I also train our staff on the patient registration process.

Does everybody in Registration work the main desk and ER?

L: Yes. We train everyone to work at both.

What was it like for you when you first started here?

L: Well, I’ve worked in healthcare since I was 18. Before I came here, I worked at Swedish and at Overlake Hospital. So I was able to draw on those experiences.

So, say somebody comes up to your window and they don’t feel well or they’re upset. How do you deal with that?

L: I’m very compassionate with patients. Some come regularly for care. One patient comes to mind who, when she checks in, she could be crying or happy, but I always reach out my hands for her to grab onto, and she feels better right there.

A lot of folks get comfortable with you and they don’t want to go to anyone else to get checked in. I try to do everything I can.

Tara, what is the billing office like?

T: No day is the same, with the constant changes in payers (entities paying claims, such as insurance) and healthcare.  We review claims for errors and fix them, submit claims to payers, do claim/denial follow up, post payments, send patient statements, and do self-pay follow-up and collections.

And as Billing Office Supervisor, what does your team look like?

T: We have three billers for primary (main) insurance, two billers for secondary insurance (which happens, for instance, when a patient has insurance through their work and also has coverage through a spouse’s insurance – one insurance is primary, the other is secondary), two self-pay financial counselors, a revenue cycle clerk who collects patient payments, and a cash poster who posts patient and insurance payments.

Kelly, what do you do?

K: I’m the Charge Master Coordinator. Tara and I’ve been here just about the same amount of time – 14 years, and some change.

I manage the charge master, which is a database. Anything that could possibly be charged, for clinic and hospital care, is housed either in our charge master or in the pharmacy’s charge master. I work closely with Coding and Billing to ensure every CPT (Current Procedural Terminology) code is attached to a charge, that the codes are correct, that they’re hitting the bill correctly, and that we’re not overcharging.

I audit a lot of accounts. The Quality team reaches out if they need a chart audit done. So by the time it hits my desk, there’s a problem or it’s one we didn’t look at. And then they’ll have denials or claims that won’t get pushed through because something’s wrong. So I look at those, as well.

When people ask, “What do you do?” I’m like, “It’s probably easier to say what I don’t do.”

How have you spent your 14 years at KVH?

K: I started actually in Revenue Cycle Management, which at the time also covered nighttime registration. I did a lot of the cash posting and chart auditing.

T: I started working as a Registration Clerk right out of high school, and also worked for a short time in Home Health before I came to Billing.

So, you all spend a good amount of time on the phone in your jobs. How do you feel about that?

L: It’s more about how the patients feel, right? Until recently, when folks called for Imaging, we’d answer the phone, then they’d be transferred to Imaging’s phone tree. It was backwards. Now, when you’re calling the hospital, a phone tree picks up with options for Billing, Imaging, Lab, HIM (medical records), and ‘Other’. Callers can select ‘Imaging’ and connect with a live person in Imaging. It’s so much better for patients.

Tara and Kelly work in traditional office settings, but your work environment is…

L: It’s like the mall. (Laughter)

With busy times and quiet times. What do you do when there’s no one to register?

L: We have other duties, and we try to do them when we can, but it’s tough to get things done between patients, so we do more on the weekends and early mornings and evenings.

So you didn’t mention the mail, you guys do mail?

L: We take mail out in the morning and then I take it in that afternoon to the post office. 

I’m sure it’s fun when somebody does a massive mailing.

L: Like Marketing. (Ouch!)

What are the challenges of your jobs?

T: One of the biggest challenges we have is keeping up with the changes in healthcare as everything effects our department.

K: People don’t think about us until the end. Absolutely everything that happens upstream stops with us. If it’s broken, if it’s not working right, if the charge didn’t drop, if the documentation isn’t there to support the charges, if there’s the wrong information on the claim because it was registered incorrectly – things that if looked at upstream would make our jobs a lot easier.

T: We have really been working to improve the communication between departments organization-wide. We have implemented weekly and bi-weekly meetings with other departments to discuss any current issues we may be having.

As billers, we are wired to correct issues regardless of where they originated, so we can quickly get the claim out the door. Because of this, we’re not always the best at communicating those issues. That’s why we’ve implemented Registration and Coding work queues, and are able to send any issues we come across back to the departments for corrections. Plus, when we implement changes like these, we see our AR decrease.

L: For registration, the challenge is making sure things are done accurately from the start, with the right insurance and demographics for the patient. Our CFO recently told us our self-pay list went from 4% to 2% after all the training we did at the clinics. That’s a good improvement to help with Billing’s challenges.

In your roles, you’ve got to be compassionate, but do you ever feel like you are absorbing people’s stress? Are you there for each other?

L: Definitely. We also have good bosses. In Registration, Yvette is there whenever we need to troubleshoot or be encouraged.

T: We’re a family. We really are. We’re pretty blessed with our departments.

So you kind of tiptoed into the next question: what are some of the rewards of working in your areas?

L: I love challenges in my job. If there is an issue, I usually can fix it. And when my shift’s over, it’s over. I can go home and be with family and leave work at work.

How do you see what you do as being part of the mission to provide patient care?

K: We talk the patients through complaints a lot of times before they even get to Quality. We’re able to work out billing issues, charge issues, things like that. If we keep the patients happy, we keep them coming back. You know, times are tough right now. Just having a conversation is helpful for many patients, who don’t necessarily understand their insurance, let alone charges from the hospital. Just giving them that additional information, then they’re like, okay, I get it. Nobody wants to pay those bills, but they get it, you know?

T: Even though we’re not providing direct patient care, we are the last department that the patient encounters, so we have a huge responsibility to meet their needs – whether that’s explaining their charges or insurance benefits, or helping them set up payment arrangements. One of our biggest challenges is that most patients don’t understand their insurance benefits.

Anything else you’d like to share?

K: It’s always important to remember what it was like before we got involved in healthcare: how much did we really know? You know, you presented your insurance card and you didn’t worry about it. Remembering that, and having understanding and compassion for patients is so important.

We all feel that way, and it helps that we work with a really good team of people.