Too busy to look at patient accounts?

I actually thought I was that busy myself early in my career. After all, there was a hospital budget to prepare, a seemingly unending stream of meetings to attend, performance appraisals to complete, AR reports to produce/review, a conversion right around the corner and a myriad of other priorities.
Then one day I was asked, “What is the work product of the revenue cycle organization that you manage?” That’s an easy answer, I thought….it is 3 things-cash, patient satisfaction and cost effectiveness. Then came a lightning bolt that said those 3 things are certainly objectives but they might not be the work product. I asked myself what I could do to ascertain that the revenue cycle team was doing the things every single day that help us achieve those objectives. Conclusion; look at accounts and think of that as a review of our work product. Include that as part of my management practice.

The protocol was more than a look at random accounts. Reports were designed that queued a specific stratification of patient type, payor, balance range, age and alpha split at intervals that would provide me with statistically meaningful samples.


I scheduled 3 consecutive hours each week to shut my door and review the designated accounts. The review was a discovery process so I looked at almost everything in each account history. When problems and/or questions came up, I would either call whoever in my organization was responsible, ask them to pull up the account and review it with them or else post a note to the account requiring a response. I was in a leadership position and had a lot of employees in several facilities reporting to me so these calls and notes came as a surprise to many until word was out that I had embraced this practice.

If I had to single out a management practice that effectively helped us improve revenue cycle performance and accountability, review of work product would be it. A number of positive things happened relatively quickly when this protocol was implemented. Here are a few examples;
    • We learned that many of the things we thought we were doing were not really being done consistently or in some cases at all. By surfacing these items, we could address them. You can’t fix what you don’t know about.
    • The entire organization, not just the management team, became engaged in problem solving. When account history patterns surfaced, the people doing the work typically had the right solutions but had not been asked for their ideas before.
    • It became apparent throughout the revenue cycle organization that account documentation was of critical importance. When I would call an AR technician to ask why no work was documented on an account, the response was often that the work was done just not documented. We had a teaching moment to reiterate “If it is not documented, it was not done”.
    • Managers who reported to me were out of touch with the work product of their employees. When I personally began to get involved at the detail level, they quickly realized they had better do the same. When I identified a problem by talking with one of their staff, I would then contact the manager to discuss the problem and how we might solve it. It was not long until they too began account reviews similar to the ones I was doing so that they could identify and bring opportunities to me rather than their folks telling me. They were a very good team when we started and were even better as a result of this practice.
    • I had always talked and written internally about what was important in our organization. However, I don’t think people embraced my guidance about what was important until they saw that I was investing my time focusing on lag times, wait times, quality of calls, frequency of contacts and other things I could see by looking at a patient account. As I shared in a previous BLOG, people decide what is important based on how we spend our time, not what we say or write in memos.
  • The whole process was not only revealing and educational but it was also fun! I got to know the people doing the work a lot better and enjoyed the collegial approach that grew from the process. I got a lot closer to the people in my shop.

As a revenue cycle strategist, I am critical of senior managers who are not attuned to the details of their operation. Patient account managers have to have a mechanism and the discipline to know what is happening in their offices.

Posted By: Nearterm Houston

What can revenue cycle professionals learn from military science?

As Revenue Cycle professionals, we are often asked to develop and present a “strategy” but we are rarely asked to address “tactics” per se. As a result, the defining line has blurred between the two. Take a moment to review the following and consider their importance and associated differences;




The science or art of military command as applied to the overall planning and conduct of large-scale combat operations.



The technique or science of securing the objectives designated by strategy, especially the art of deploying and directing troops, ships and aircraft in coefficient maneuvers against the enemy.


I submit that making this distinction is critical for healthcare revenue cycle and financial leaders. It is more than just semantics. The following illustrates its impact on how we approach things.


    1. Hiring:
      When asking job candidates interview questions about how they might handle certain situations or operating conditions, do you get a tactical response or a strategic answer? Perhaps if the candidate focuses mostly on tactics, you would consider them for different roles than if they provide more strategic responses.


  1. Managing Change:
    Your organization has acquired multiple facilities over the course of recent years and the question of centralized AR processing hits the table. Are you thinking about development of a strategic plan or are you speculating about how billing data will be transferred (and the multitude of other tactical challenges inherent in this initiative)? Unfortunately, businesses often “skip” strategic thinking and planning when addressing key opportunities. This often leads to the conclusion that the original idea was a bad one or that people have underperformed when the reality was simply that an absence of strategy caused a great idea to fail implementation.


So when you are considering a central business office, integration of physician billing, a computer conversion, a denial management plan, or any other initiative, develop and test a strategy before you leap into the tactical component.

We hope this and other practical experiences Nearterm has accrued over the recent 20 years will be of value to you. We have served in both strategic and tactical roles with our clients and we would welcome your call us at 281-646-1330 if you have questions.

Posted By: Nearterm Houston