Category Archives: Thoughts & Musings

Nearterm shares its thoughts & musings on subjects universally applicable to hospitals, physicians, and other healthcare organizations.

“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

Revenue Cycle Processing Backlogs Are Not “NORMAL”. It’s time to raise the bar – eliminate BACKLOG TOLERANCE!

I talk every week with Revenue Cycle Leaders from all types of hospitals around the country. When I ask how things are going, there are many common responses that reflect current concerns and challenges they are facing. These include conversion issues, staffing constraints, volume fluctuation, talent acquisition/retention, cooperation among stakeholders, change in payor practices and training, just to name a few. Here are some recent quotes that typify their remarks:

“We are preparing for a conversion. The training and build distractions have resulted in backlogs and performance decline. After the new system is implemented, there will be a learning curve and modifications to make for the new system to do what it is purported to do.”

“Budget constraints require me to do more with less every year. This year, we are struggling to keep up with processing volumes, especially billing and follow-up. We are getting behind. Our aging looks awful.”

“Our Revenue Cycle Team is great but it seems like every day we learn of new HIPAA and other rules imposed on us that require change, training and personnel shifts. For example, we have about 12 days of DNFB and can’t seem to get a handle on it. Chart assembly and completion are also behind. If we can’t get it coded on time, we can’t bill and collect on time. But it’s been that way for some time now so nothing new.”

“Denials are killing us! We have done some analysis to determine root causes and we have a feel for that but we just don’t have the resources to address those causes. We devote our existing FTE’s to working current volumes but the denial backlog is growing and it is a real problem for us. Not only are we not getting paid by insurance and Medicare, but patients complain, citing that we are to blame so until the denials are resolved, they are reluctant to pay patient liabilities like deductibles and coinsurance.”

“We are doing OK. We have backlogs in various areas but we know that we are in a community with a limited talent/labor pool so we are always working hard to balance make or buy decisions. Our days, DNFB and denials are higher than facilities in other communities but we just don’t have the technology or budget to compete with their benchmarks.”

Identify and Eliminate BACKLOG TOLERANCE

You get the picture. We have developed what I call BACKLOG TOLERANCE. We know backlogs exist and can usually identify why, but we just can’t seem to address the root causes effectively. Furthermore, we can’t eliminate the backlogs and sustain current processing designed to prevent recurrence. Instead, we often change the standard.

eliminate backlog

This condition would not be acceptable in other industries and in my opinion; it should not be tolerated in ours. Sure, every business experiences episodic conditions that result in temporary backlogs from time to time – understandable. But when they do, they scramble immediately to meet the problem head-on and take definitive steps to resolve the issue. They implement the technology, invest the human capital and embrace preventive design aimed at making sure the backlog was in fact temporary, and not a permanent “NEW NORMAL.”

Of course, many hospitals have been very progressive and certainly are not tolerant of backlogs. They proactively anticipate influences that might result in processing challenges and they reinvent their organizations well ahead of impact. I always learn from them and have great admiration for their approach, vigilance, creativity and the leadership they have in place that enables their success.

If you can relate to my comments, I would love to hear from you. If you are in a hospital with some degree of BACKLOG TOLERANCE, I would welcome an opportunity to talk with you about solutions you are working on that might help others. If you have “recovered” from “BACKLOG TOLERANCE DISORDER” (Is there a code for that?), please share your plight – I am sure your colleagues would appreciate hearing ideas that might be helpful to them.

Posted By: nearterm-admin

Revenue Cycle Management In 1951: It Used to be a Lot Easier…Or Was It?

Revenue Cycle Management In 1951

The above image is an actual hospital bill and accompanying explanation of charges used in 1951. Just think of the things that we didn’t have to manage back then. A short list might include coding, claim edits, massive denials, contract payment compliance, Medicare/Medicaid (both started in 1965), managed care contracts, HIPPA regulations, “patient-friendly” billing initiatives, use of technology, and outsource considerations.

We now embrace in stride all of the complexities that have evolved since this bill was produced. In fact, increasing complexity is the “new normal” in our business. The explanation of charges that accompanied this bill was actually pretty transparent for the time and was largely designed to help patients understand the difference between hospital and hotel costs. It was easy to understand the bill and the explanation. However, the expressed complexities that have emerged today make itemized bills almost unintelligible and our explanations often lead to more skepticism than acceptance. It’s not easy anymore!

In our company and in your hospital, we are attuned to customer service management and its importance in the revenue cycle continuum. Among revenue cycle and financial professionals, part of our jobs back in 1951 and presently today has always included the mantra “cash is king.” But today, more than ever, patients are decision makers. I can remember a time early in my career when my boss imparted to me that our “internal client” or “customer” was the physician because it was the physician who drove patients and therefore revenue to our facility. Now we have several customers, which is yet another added complexity.

However, in the shadow of all the differences one can enumerate between 1951 and today, there is one glaring similarity. Healthcare revenue cycle management success is still about blocking and tackling. It still means the presence of a compassionate patient access process that results in a positive patient experience, while simultaneously recording data that enables us to populate a clean claim and collect revenue. It still means timely, accurate revenue capture and billing. It still means effective follow-up on billed AR and prompt recognition of collectability. Like you, our consultants, interim leaders, and staff augmentation specialists at Nearterm realize the importance of keeping our eyes on the prize – CASH IS STILL KING.

Oh well, maybe things haven’t changed after all! ?

Jim Matthews
Principal, Nearterm Corporation

Follow Jim on LinkedIn

Ask the RCM Experts

Posted By: nearterm-admin

The Characteristics of Leaders and Successful People

Jim Matthews RCM & Healthcare Financial Management Consultant
Jim Matthews, Principal, Nearterm Corporation

I don’t know about you but I am growing immune to the voluminous “LISTS” I see in social media about leadership and success. LinkedIn, social media forums such as Facebook, and blogs are recently inundated with posts about leaders, leadership and successful people. For example, just this year alone 167 Habits, 340 Behaviors, 62 Graphic Musings, 35 Qualities, 53 Differences and 111 Characteristics have shown up on my monitor.

The above estimate is based on sampling of posts since January 1, 2017 and suggests that 768 pieces of sage advice have been shared so far this year. Much of this content is repetitive or duplicative but the actual posts are not. Each one is unique.

Here is the point: have you ever tried to function based on 768 pieces of advice? It would be overwhelming. The best personal example I can offer comes from a golf pro giving me a much-needed lesson one afternoon.  He watched me swing the club a few times and I then asked him to tell me everything I needed to do differently. Instead of giving me 768 pieces of advice (my swing was so bad, I could have used more), he said this;

“All I want to do is tell you one habit you should lose each time we get together. It’s the Pareto Principal. That is, 80% of effects come from 20% of causes. If I can help you lose only a few bad habits, your game will improve dramatically. Besides, if I told you everything I see that might improve your swing, it would take up our entire hour and you would get worse trying to remember it all. Practice losing the bad habit I point out today and when you have buried that one, call me for another lesson.”

I advocate one piece of advice or wisdom. Be honest with yourself as you identify your worst habit or behavior and bury it forever. This might require a combination of introspection and perhaps feedback from colleagues, family, and others that you trust to be honest with you. Then repeat this exercise for the rest of your life.

This may not make you a leader because at the end of the day, leadership is more of a talent than a skill, but it might make you more successful at what you do.

Jim Matthews
Principal, Nearterm Corporation

Follow Jim on LinkedIn

Ask the RCM Experts

Posted By: nearterm-admin
Managed RCM