PFS Staffing for billing Medicare claims

[DanHobbs]

Interesting question LR... Ideally... the number is a fraction of an FTE... in a perfect world... Claims are billed at the touch of a button!  OK, buttons... one to download the claim transaction set to the ECM software and one to transmit the claims to the payer.  Knowing that none of us live in a perfect world, I would advise a client to track their claims reject (rejected claim edits in the ECM software) percentage and target that to be less than 5%.  You could call this a claims touch rate. 

You would then identify the reasons for the reject and work upstream so your billers would not have to touch as many claims.

So, we may have to staff to meet some organizational short falls but ultimately we want for claim production to be a must less resource intensive process and spend more time on claim follow-up.

Hope this helps!