by Edward Morrow

Generating more profits without also taking the time to enjoy life can be stressful. This three-step process will reduce headaches and ensure claims are processed accurately and more timely, specifically for SOURCE/CCSP for Medicaid and private-pay invoicing.


Medicaid: Billing starts with the case management company. Build a relationship with your case managers. Extend that same caring attitude you give to the individuals you serve. If you build a strong bond with them, they will bend over backwards to correct prior authorization, modifier or unit conflicts for you.

Next, if you have a scheduling/billing software, you want to make sure that your records are set up properly. If the communication aspect is not together, then the billing process can become a time-sucking vampire.

Private Pay: Be upfront with your payment terms, method of payment and invoicing frequency. QuickBooks Online is an excellent tool because it has a merchant account feature that allows a business to accept credit card payments at a low fee. Create a billing/invoicing help sheet that helps your staff understand each process.


Medicaid: Implement a batching process only after you have mastered the area of proper communication. Batch billing without a strong foundation will create a nightmare for your agency. As a business owner, always find a way to streamline a routine task. This is key to decreasing overhead costs and creating time to focus on revenue-producing tasks. Your scheduling/billing software may have batch-billing capabilities; if not, you may have to check with a third-party software provider.

Private Pay: You may be able to generate invoices from your shifts. If you use a scheduling software and QuickBooks, you may be able to import your shifts into your accounting software. There are applications that allow you to mail invoices directly from QuickBooks, so it is possible to create and mail invoices with a few clicks. QuickBooks also works well for creating cost share/co-pay invoices. Typically cost share amounts remain constant, and QuickBooks has a function to create an invoice one time and have the same invoice auto-generated at a desired frequency. These are called recurring transactions.

Some employees may view automation as a bad thing, and refrain from optimizing their processes. This is understandable because they may feel that automation will reduce their hours, or make their positions obsolete. As a manager or owner, always have a game plan. It is your job to figure out which new tasks will now become priority items for your team. For example, with a systematic automated process, you can create more time and reemploy your staff to help strengthen other areas in your agency.


Medicaid: Have billing staff log into the Medicaid portal and recheck billed claims. This step depends on the strength of your software—some billing systems allow you to upload an 835 file from the Medicaid portal. This file will populate a client’s file and show what was paid and/or denied. Or you can create an Excel spreadsheet of all service hours and use that to check claims.

You can take this a step further and use conditional formatting to create a color-coding system to notify you of the status of a particular claim. This is helpful especially if you have more than 50 clients.

Private Pay: Use an A/R aging report to check outstanding balances. As a rule, invoice early and make collection calls if necessary. I like to call clients as soon as their checks hit the office. This makes them feel appreciated, and it was a great time fto get feedback.

Create a workflow calendar so that there are no surprises. Document or record a training video for core tasks. The beauty of video is that they reduce any single point-of-failure risks. This gives you the opportunity to get processes and procedures out of your head, and make them easily accessible for other members on your team.

This is powerful because you have now created a standard procedure that is visual.

Implement these processes in order to improve your billing workflow. The idea is to reduce the time you spend billing while increasing the speed and quality of revenue coming in.