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.
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.