Few physicians actually enjoy the nuances of billing, but fewer still dislike the payments that billing brings. Whether you enjoy it or not, you know deep down that it's always a good idea to keep your billing practices clean, straightforward and error-free. Here are a few common mistakes you can avoid and a few early steps you can take to make the billing process run more smoothly.

1. Use a professional.
Perhaps unsurprisingly, the top piece of advice to doctors from a professional coder who conducts seminars for others in her profession is that physicians should hire certified coders. "Certified coders ... have a better understanding of the risks involved in not using appropriate compliance and regulatory tools to do their job," says Sheri Poe Bernard, CPC, CPC-H, CPC-P, vice president of member relations at the American Academy of Professional Coders in Salt Lake City. "You've got to be sure you're obeying the laws, or they'll lock your practice up!"

Physicians might be tempted to hire a niece or a family friend, but a nonprofessional won't know how to research coding issues or where to find the latest code updates, Bernard says. For example, nonprofessionals won't understand the National Correct Coding Initiative, which prohibits certain sets of codes from being used together, she explains. And sometimes a professional's credentials come in handy. "When it comes time to go to a payer and argue for an appeal, the payer is going to take a professional more seriously."

2. Document everything.
This advice is hardly new. But according to Bernard, if you ask a roomful of professional coders what their No. 1 on-the-job problem is, they'll say, "Medical documentation." Without thorough documentation, you may not be able to establish the full medical necessity, which means your payment is subject to denial. "Once you're audited once--and denied [payment]--it's very tough to come back and say that you did do that," she says.

What about the notion that keeping cryptic documents can protect doctors from legal trouble? "There is no way that documenting well can get you into trouble from a malpractice point of view or from a reimbursement point of view," Bernard says.

3. Learn your computer system.
With any office computer system, "a charge might not get saved, or there just might be a breakdown in the process that is very innocent, but can cost the practice a lot of money," says Lee Maddocks, CEO of Modesto-based Phycom, which serves more than 100 physicians' offices. "You can lose precious revenue if you don't compare your schedule or your personal notes with your day sheet on what actually posted on the computer."

Checking up daily on computer postings can prevent income from simply vanishing. "If an item never gets posted and nobody checks the schedule against the postings, the office has lost a charge," Maddocks says. "That's a big-dollar charge if the doctor is doing surgery. The biggest example is when you lose a whole day--a whole batch can get filed and never posted."

4. Study your EOMBs.
Insurance carriers' explanations of medical benefits contain a wealth of information that can reveal a lot about how things actually work in your practice--and how things might work better. "You can really learn about the health of a practice by just taking a week's worth of mail once a year and analyzing it," Maddocks says. "The staff kind of grows a brain of their own in terms of what they should be doing, and they can [begin thinking] that the doctor doesn't want to be involved in some decisions."

Use a matrix to compare how different carriers pay you for the same service, Maddocks says. "When future payments come in from, maybe, nonmajor payers, and they underpay or overpay, it helps you either appeal your underpayment, or if it's an overpayment, it might help you in future negotiations with major carriers."

5. Calculate the cost of doing in-house billing.
It's not that doctors get into trouble by not using a billing company, but that they don't get paid as quickly or as well, says Sharon Hollander, president of STAT Medical Consulting in Encino, which serves about 25 solo and small-group practices. "Once doctors sit down to figure it out, it's cost-effective for them to use a billing company, because they're probably spending anywhere from 12 percent to 17 percent to do it themselves," she explains. "Overhead costs are what they are, and my experience is that it's always harder to do it in-house, because depending on the volume of clients, we save them at least one full-time employee equivalent."

6. Get current patient data.
Office staffers often don't capture demographic information, such as birth date and Social Security number, or they don't check patient eligibility for insurance, Hollander says. Missing demographic information delays claims processing. "Eventually you might get paid, but the claim might not go out for 72 hours, or even a week, and that money could've been in your pocket," Hollander says.

Regarding eligibility, expect a state of flux. For example, eligibility "for Medi-Cal changes month to month, and insurance companies can't keep up with the demand to update identification cards," Hollander says. "So, a lot of the time, patients are walking around without insurance, and if no one's checking them, their insurance isn't in effect."