Early in my Revenue Cycle Management (RCM) career before I went into RCM consulting, I was an RCM Executive with a hospital chain and had responsibility for 14 hospitals.
I actually thought that I was too busy to look at patient accounts. After all, there was a hospital budget to prepare, a seemingly unending stream of meetings to attend, performance appraisals to complete, accounts receivable reports to produce and review, a system 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, so I thought…it is 3 things – cash, patient satisfaction and cost effectiveness. Then came a lightning bolt that revealed that those 3 things are certainly RCM 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 our RCM objectives. Conclusion; look at patient accounts and think of that as a review of our work product and include that as part of my management practice.
The protocol I established for myself 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 whomever in my organization was responsible, even by-passing their managers. I asked them to pull up the account and reviewed it with them or else posted 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. It answers the question, “Are we methodically doing all we can every day to reduce outstanding receivables and increase collections?”
A number of positive things happened relatively quickly when this work product protocol was implemented. Here are a few examples;
- Is What was “Done,” Really DONE? We learned that many of the things we thought we were doing were not really being done consistently or in some cases not at all. By surfacing these items, we could address them. You can’t fix what you don’t know about.
- If it is Not Documented, it was NOT DONE! 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”.
- Work Product Improvement Soon Becomes a Team Effort. 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.
- Managers MUST be Involved. 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.
- Lead By Example. 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. I have always believed that people decide what is important based on how we as leaders spend our time, not what we say or write in memos.
- Enjoy a New Found Team Spirit. 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.
So lesson learned. Success lies in the details of patient accounts.
Now as a revenue cycle and financial management consultant and strategist, I stress to senior managers how very important it is to be attuned to the details of their operation, especially the work product. No matter how “busy,” patient account managers must have a process in place to review the quality of their work product and the discipline to know what is happening with the team in their offices.
Principal, Nearterm Corporation