Category Archives: News

“I promoted the best AR Specialist in our organization to a management position – oops!”

Here is a story from one of our clients that you may find interesting;

Things were in good shape in our revenue cycle management process. Metrics and the Dashboard indicated that we were current in billing, follow-up, and cash application. Denials were under control. Days were low. Patient complaints were handled promptly. You get the picture.

I attributed a lot of this sustained success to one of our team members (let’s call her “Julie”) who had been with us a long time and had worked effectively in patient access, billing and denial management. Julie was very knowledgeable about our system, got along well with coworkers and had good social skills. A model employee!

Passing the Patient Accounts Torch

When our Patient Accounts Manager retired, we were tasked to fill the vacancy. The Patient Accounts Manager had done a great job so this was not a “turnaround.” He was a natural leader, knew the technical side of the business and understood the multidisciplinary processes and relationships that are so important in RCM.

We thought Julie deserved a shot at this position and that she could apply her technical knowledge in a management capacity. Our management team was unanimous that we should offer her the opportunity, so we did not initiate a search nor did we engage an interim manager. It was understood that the management team would all mentor her in the transition. We offered Julie the position and she was flattered and delighted to accept so we introduced the change.

After a short few months, performance began to slip. Morale declined. Julie was stressed and unhappy. Team members and colleagues came to grips that they had made a mistake promoting Julie to a management position.

The result was that they

  1. lost Julie, one of their best technicians
  2. burdened the organization with poor management
  3. are now in the costly process of recovering.

5 Lessons for Filling Vacancies

Here are six learnings that can be applied when vacancies occur:

  • Consider the entire universe of talent that is available to fill the vacancy instead of limiting your search to internal candidates. It is not about who is deserving or qualified – it’s about who is best.
  • Give yourself time to make informed decisions that will serve you well in the long term. It is often advisable to bring in interim management services to get you through the vacancy transition until permanent leadership can be identified and hired or promoted.
  • Recognize that being a great technician is an entirely different skillset than being a great manager but no less important. Other countries have embraced this and redefined culture so that technicians can advance their “status” and compensation on a scale equal to managers.
  • Succession planning is not just for the C-Suite. Every position in the organization is important or you probably would not have it there in the first place. Design a plan that addresses what you would do in the event of vacancy for each position. It is not necessary to name a successor, but it is important to have a plan. For example, would you promote from within, reorganize, engage interim help, rely on internal recruiting or go outside for talent acquisition? The answer may vary from one position to the next.
  • If you have your eye on a candidate for internal promotion, assess training and development needs well ahead of offering the promotion. Let the person know what development goals they would have to accomplish in order to advance and invest in them.
  • If you are in a rural community or a location where the talent pool is limited, you have a “make or buy” decision when filling a vacancy. If you decide to “make”, it is imperative that training resources are prepared and that you have the time to allow an inexperienced person to get up to speed. You must also be prepared to quickly assess the capability of the new hire to absorb the training and be effective in your organization. Hiring inexperienced staff is expensive and can be a distraction to the rest of the team. However if you decide to “buy”, you should expect highly trained candidates with strong experience. The training curve is minimized and you have the opportunity to vet a range of talent. Often, you can introduce interim management resources that strengthen your human capital “gene pool” and elevate overall performance that is sustainable.

Perhaps these ideas will help you avoid losing your best technician while making an ill-advised promotion.

Posted By: nearterm-admin

SILENT IMPRESSIONS

Every encounter we have with another person or a business results in an impression. An encounter may be conversation, email, voicemail, text, social media, appearance, hygiene and others. Some of the impressions we form based on these encounters are stronger than others and because people are all different, reactions vary. Some impressions are indelible and others can be replaced by subsequent impressions. Every impression formed by a person, either positive or negative, can be called a “moment of truth”.

However in any case, impressions are actionable in terms of future decision making, willingness to start/continue a relationship, buying services and drawing comparisons to other people and/or businesses. When impressions are favorable, the likelihood of a continued relationship increases and the opportunity to strengthen such a relationship is available.

The problem is that when they are negative, we rarely know about it – ergo “silent impressions”. Business potential and new friendships are blocked by the negative impressions that have been formed. Worse yet, these impressions are often shared with others who then form their own impressions based on hear-say.

The Impact of Healthcare RCM on Your Brand

As leaders in healthcare revenue cycle management, we have responsibility for millions of these “moments of truth” every day. Every patient encounter, phone call, visit, email and snail mail represents an opportunity for a patient, visitor or family member to form an impression.

Same goes for the physical appearance of the hospital facility and work areas.  However, the presentation of our bills to payors and patients is a big part of the revenue cycle work product and “silent impressions” formed about those items can result in disregard that leads to the electronic (or hard copy) trash can instead of your lockbox. Of course, you have reports and data designed to alert you to claims denials, trends and edits etc. – all good. However, if you are relying too much on external feedback to evaluate the efficacy of billing or other functions, just remember that those “silent impressions” are out there and you will not likely hear about them.

I have blogged before about the value of conducting a “moment of truth” audit in your hospital. I would be very interested to hear of the results if you have. If you have not and would like to talk about methodology and the benefits, please contact me online or give me a call at 888-646-1330.

Posted By: nearterm-admin

Improving Denial Management in Healthcare & Medical Billing

denial management in healthcare

When insurers deny medical claims, it takes a bite out of your revenue every year. Nationwide, this annual loss amounts to $262 billion, according to Modern Healthcare.

As a matter of fact, insurers deny an average of 9 percent of claims overall, which means that your staff is engaged in a continual process of managing and appealing to collect on patient bills. While hospitals do eventually manage to collect 63 percent of the amount of denied claims, the denial management process costs an average of $118 per claim — not to mention the loss of time from other operating tasks.

Furthermore, you stand to lose more than just the dollar amount of your medical accounts receivable due to denied claims. When your claims denial management system attempts to collect the unpaid amounts from patients, you’ll alienate those patients and affect your brand reputation. Here’s a brief overview of the medical denial management process and the best-practice steps you can take in mitigating your losses.

What Are the Most Common Reasons for Claim Denials?

Each health organization is different, and the causes for claim denials will vary depending on the situation. Here are the top reasons:

  • Invalid subscriber information: This can be due to expired policy information or errors introduced by manual entry of patient names or ID numbers.
  • Non-covered services: The list of allowed services associated with each specific diagnosis by each insurance company are in a state of near-constant flux.
  • Coding errors: These include improper use of modifiers or inaccurate reporting of bundled services.
  • Timing errors: Failure to submit claims in a timely manner, or to obtain pre-authorization.
  • Pre-existing conditions: These are any conditions present before the policy was purchased.

Steps to Managing Claim Denials

The following steps can strengthen your hospital denial management system and also reduce the number of future denied claims:

1. Teach Your Patients How to Solve the Issue

In this way, you align your hospital with patients’ financial interests, and communicate the fact that you’re on the patient’s side. Patients and their families are stressed and often have no understanding of the insurance denial system. You can be their resource while also protecting your own bottom line.

2. Track Your Denials

In a busy hospital, claims denials can get sidelined and misplaced. When you install a system that keeps track of every denied claim, you’ll be able to see where problems arise. You’ll also increase your revenue because claims revenue won’t disappear.

3. Keep Your Appeals on Schedule

The process of tracking your denials includes a clear timeline. Insurance companies set appeal deadlines for hospitals, so those dates must be integrated into your medical billing denial management process.

4. Identify Reasons for Successes and Failures

Every hospital copes with unpaid claims. When you are transparent about this process, you can use analytics to learn the reasons behind claim denials and why they are or are not successfully followed up in your system. You can also track denial trends. Armed with this information, you can predict the most effective tactics and strengthen your process in the future.

5. Consider an Outsourced Solution

It is often most cost-effective to rely on the services of denial claims experts, rather than training your staff to track and appeal each denial. Denial management professionals have the time and dedication to learn how to negotiate with insurers and to understand the context behind each individual denial. When you find an outsourced claims denial solution that also provides a high level of customer satisfaction and responsiveness, you and your staff will have more time and energy to focus on other aspects of running your hospital.

The right professional approach to managing claim denials can make the critical difference in building your long-term financial viability. Contact our expert team to learn more about how you can leverage our healthcare revenue cycle management services to reduce your claims denial losses.

Posted By: nearterm-admin

Revenue Integrity & Capture – Who’s Herding the Cats?

Cross functional processes can be difficult to manage in hospitals. One reason pertinent to Revenue Integrity is that typically, the organization structure is a series of vertical disciplines with differently defined focus (HIM, PFS, PATIENT ACCESS, ANCILLARY DEPARTMENTS, MD’s, et.al.). This structure can be and is very effective in many hospitals. However, revenue integrity management doesn’t always “fit”. It requires that all of these disciplines (a) agree on work definition, (b) have consistent education addressing CDM changes, compliance matters and related topics, (c) have the tools in place to manage their performance (d) are clear on current state and change opportunities that require attention (e) communicate routinely specifically about Revenue Integrity matters.

We all know the obvious – if revenue is not captured, coded and billed correctly we risk HIPAA violation consequences, cash flow, cost associated with denials and duplicate handling of work, patient satisfaction and P&L impact. So in an environment where cross functional processing challenges exist and the expressed risks are critical, “WHO’S HERDING THE CATS” in your organization to ascertain that you are banking every dollar that is coming to you? Who in your organization is charged to remain contemporary on what you can bill for and what you cannot bill for and related implementations as change occurs? Is that responsibility spread among various stakeholders and if so, do all disciplines in the revenue capture continuum agree or is there a need for conflict resolution – who identifies and handles that? Who is the leader?

Some hospitals have a staff position designated to lead the revenue integrity charge. In order to be effective, this role must be defined such that it carries authority that crosses organization lines. Other hospitals have established a committee or team consisting of representation from key stakeholders. The committee or team is usually lead by the CFO, VP Revenue Cycle or COO. Either structure or even some hybrid can be effective.

However, many hospitals have not embraced this field with a well-defined multidisciplinary plan that has a specific function as part of the organization. When we are asked to consult with those hospitals about revenue issues, it is usually because they are experiencing symptoms like inordinate denials, decline in same-store revenue, cash flow issues and sometimes conflict regarding coding policy. Our initial discovery work is designed to identify current state, confirm those “symptoms” and address what has caused them. As a result, we can introduce early wins and sometimes interim leadership but the more strategic solution often requires organization change that establishes Revenue Integrity discipline and accountability. It is rewarding to facilitate and see transformation in Revenue Integrity practices at hospitals that previously focused more on symptoms than development of a strategic approach.

If you are working on charge capture, CDM or another component of Revenue Integrity and have questions or if you have in place relevant best practices you are willing to share, please post to this BLOG so that others can benefit. Our healthcare management consulting experts are always available to answer questions or assist you regardless of where you are on the path leading to Revenue Integrity.

Posted By: nearterm-admin
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