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Even a Pane of Glass Has Multiple Facets

Many may look at a pane of glass and believe there is only one side, the side one looks through. Another may think there are two, each side of the glass.

I believe there are six; as I include the edges, they strengthen the entire pane regardless of thickness.

When faced with an issue, I approach it holistically, multi-faceted. Facing the subject, I see two sides of the problem. Naturally, I would evaluate both sides thoroughly. Once done, I address those issues and take appropriate steps.

However, as a leader, I know there is more; even if they do not appear as large on the surface, they are no less important to the entire pane of glass; the edges. I close my eyes and run my fingers over each edge using my other senses (talents) to “feel” if there are imperfections my eyes (the main source of input) may miss, regardless of the size, that may jeopardize the entire pane. I continually search for “cracks or splinters” that can weaken the pane even though they may “feel” small. Once satisfied, I clean and polish the glass, ensuring a clear view.

One may ask, “What does that have to do with Revenue Cycle Management?”. To which I answer, “Everything.”

· Competency and Community Goodwill.

See side one as Competency, how the public sees your level of performance, and side two as Community Goodwill, how the community feels you see and treat them.

Some believe that if these two sides are clean and clear, all is well, and revenue will flow as intended. Focus is properly given to what is being perceived by the patient. The perception by the patient that a provider is inadequate, ill-equipped, or incompetent can be influenced by how a patient feels about their treatment. The wrong perception can place a “film” on side one, making things cloudy and unclear, resulting in an improper or dim view. Likewise, if a patient feels they are seen as nothing more than a number, treated curtly, not listened to, or disrespected will negatively impact how your attempts at Community Goodwill are perceived.

· Examine the Glass’ Edges

Edge One - Patient Access

Patients do not come to a provider as a luxury. Especially in these economic times, though things are improving by some accounts, patients put off seeing a provider because of the cost. They may reluctantly come in only when it seems inevitable. Factoring in those feelings, patients are not in the mood to deal with what they perceive as a misstep with their information. The patient isn’t feeling well, is under stress, not thinking clearly, or is reluctant to provide information for fear of a breach or misuse. Anything done incorrectly results in the perception that the provider or its staff “doesn’t know what they are doing.”

Therefore it is essential to have best-practices methods in place to ensure the correct information is gathered, DOCUMENTED, and provided, then directed to the appropriate partner department for processing.

Edge Two - Claims Billing & Coding

Things to check when it comes to claims billing: What is your claims volume; is timely filing met; are claims held in scrubber; what are your core issues; what is your clean claim rate?

How many days are between discharge and final coding; what is your correct coding percentage; are co-morbidities being considered; does your team have partners and contacts to call upon when there are issues beyond its purview?

Add to this when a patient feels they have provided the correct, or even enough information for a claim to be billed properly, it was not billed properly or at all. The patient cares not about the reasons, only that the provider doesn’t know what it is doing.

Edge Three - Denials Management

Do you have the right person in the right position? A team member asking the right questions with the knowledge to refute the push-back from payors successfully is critical.

What are your productivity metrics; are they realistic and based on quantity or quality?

In the early 90s and still today, productively is based more on how many accounts were “touched” daily. While this can be a benchmark, it lacks successful claims final adjudication.

Here is an example. A team member touches 50 to 75 accounts per day which, on the surface, seems highly productive; however, when examing the accounts, it is found that too many accounts are being “touched” too many times without final adjudication.

Conversely, a team member that touches 30 to 45 accounts may be incorrectly admonished for not hitting the productivity mark. However, when examining the accounts worked, it is found that each account is touched only two or three times before it is finally adjudicated—this is optimal when considering the AR amount is resolved and no longer outstanding.

A balance must be struck between quantity and quality upon which realistic goals and metrics are based.

Edge Four - Patient Accounting (Customer Service).

A 256-bed facility takes an average of 50 to 80 calls per day. The calls range from inquiries about an unexpected bill to the final amount owed, corrections to demographics or providing or updating insurance information, and calls from insurance payors about claims.

A team member in this department must know patient access, billing, coding, and denials management to address the various call types adequately. Additionally, this team member MUST be paired with a contact partner in the previously discussed departments upon whom they can contact and rely on providing up-to-date information, policies, and procedures. Team members in this department also directly influence how a patient feels the provider sees them; as a number or a person in need.

Scripts are useful as they help the team member properly open a conversation, listen attentively, offer correct information, resolve the issue, and close the call. In other words, team members in this department are the Ambassadors of Goodwill to the community. They are the team members holding the Patient-Centric cleaning clothes that will clear away the film and improve the community’s visibility.

These team members should be consulted about common issues, tones of the calls, volumes, and other matters. That information should help create appropriate and innovative ways to interact with patients. They should be equipped to “walk in the shoes” of the patients, to empathize and problem solve while supported by their leaders who are seen, approachable, and present.

Their actions directly influence the satisfaction or dissatisfaction of the patient.

Lastly, deviations in these categories cause micro-fractures in the edges of the pane of glass. Though they are not always immediately visible, when left unchecked, they weaken and eventually show as a visible crack in the pane of glass that needs to be repaired. You determine the cost.

Leaders; manage time, resources, and revenue; partner with your TEAM.

So, what is the condition of your “Pane of Glass?”

Even a Pane of Glass Has Multiple Facets

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