for resolution of both kinds of problems, the required processes and systems are very different. Content problems tend to be specialized and therefore they lend themselves to a more structured, almost template-driven solution approach. Process problems, in contrast to content problems, tend to cover a wide variety of knowProcesses involving large volumes of complex billing transactions require effective mechanisms for problem assignment and tracking. Without such mechanisms, billing personnel cannot be held accountable for problem resolution, resulting in loss of revenue and increased compliance risk. While medical billing industry has developed specialized systems and processes for resolution of content problems, little attention has been paid to billing process problem resolution methodology. This article outlines a process and a technology for integrated billing process problem resolution methodology.

Billing Content and Process Problems Require Two Different Tracking Methodologies

Medical billing exceptions can be categorized into content and process problems. Content problems have to do with claim content and patterns of processed claims, such as terminology, medical necessity, patient eligibility, denial followup, and regulatory billing compliance. Process problems have to do with claim formatting, system interfaces, entry of patient demographics, posting of charges and payments, printing and mailing or faxing of required information, provider interaction procedure, systems access, and HIPAA compliance.

While streamlining and transparency are important attributes for resolution of both kinds of problems, the required processes and systems are very different. Content problems tend to be specialized and therefore they lend themselves to a more structured, almost template-driven solution approach. Process problems, in contrast to content problems, tend to cover a wide variety of knowl

eloped specialized systems and processes for resolution of content problems, little attention has been paid to billing process problem resolution methodology. This article outlines a process and a technology for integrated billing process problem resolution methodology.

Billing Content and Process Problems Require Two Different Tracking Methodologies

Medical billing exceptions can be categorized into content and process problems. Content problems have to do with claim content and patterns of processed claims, such as terminology, medical necessity, patient eligibility, denial followup, and regulatory billing compliance. Process problems have to do with claim formatting, system interfaces, entry of patient demographics, posting of charges and payments, printing and mailing or faxing of required information, provider interaction procedure, systems access, and HIPAA compliance.

While streamlining and transparency are important attributes for resolution of both kinds of problems, the required processes and systems are very different. Content problems tend to be specialized and therefore they lend themselves to a more structured, almost template-driven solution approach. Process problems, in contrast to content problems, tend to cover a wide variety of know

Two Different Tracking Methodologies

Medical billing exceptions can be categorized into content and process problems. Content problems have to do with claim content and patterns of processed claims, such as terminology, medical necessity, patient eligibility, denial followup, and regulatory billing compliance. Process problems have to do with claim formatting, system interfaces, entry of patient demographics, posting of charges and payments, printing and mailing or faxing of required information, provider interaction procedure, systems access, and HIPAA compliance.

While streamlining and transparency are important attributes for resolution of both kinds of problems, the required processes and systems are very different. Content problems tend to be specialized and therefore they lend themselves to a more structured, almost template-driven solution approach. Process problems, in contrast to content problems, tend to cover a wide variety of know

rocess problems have to do with claim formatting, system interfaces, entry of patient demographics, posting of charges and payments, printing and mailing or faxing of required information, provider interaction procedure, systems access, and HIPAA compliance.

While streamlining and transparency are important attributes for resolution of both kinds of problems, the required processes and systems are very different. Content problems tend to be specialized and therefore they lend themselves to a more structured, almost template-driven solution approach. Process problems, in contrast to content problems, tend to cover a wide variety of know

for resolution of both kinds of problems, the required processes and systems are very different. Content problems tend to be specialized and therefore they lend themselves to a more structured, almost template-driven solution approach. Process problems, in contrast to content problems, tend to cover a wide variety of knowledge domains, precluding specialization.

The difference in solution methodology drives the difference in problem tracking. For content problem resolution methodology the reader is advised to consult companion articles on metrics, straight through billing, and billing transparency. The remainder of this article focuses on process problem tracking.

Billing Process Problem Tracking

A general-purpose tracking system allows opening problem ticket, its assignment to specific team member, its re-assignment or escalation, change of status depending on problem resolution stage, convenient reporting about sets of tickets in different states or assigned to different team members, and continuous notification of everybody involved about change of status. Therefore, such a tracking system (e.g., web-based TrackLogix) is constructed around three basic reports, notification mechanism, and a concept of ticket.

Problem Tracking Reports

The reports show

1. Tickets I owe to others
2. Tickets owed to me
3. Status - a summary table of the team participants with statistics of tickets in different states

Other reports may show and compare individual productivity and responsiveness.

Problem Notific