Deploying a system that increases actual billing (in addition to reducing inventory, eliminating obsolescence, and staff documentation time) is gratifying and rewarding. Helping hospitals identify where they may be missing data and/or actual billing, however, can be a challenge. The challenge, however, isn’t finding the data—it is often encountering resistance and some defensiveness along the way by supervisors, managers, department directors, and patient finance in providing it.
Hospital professionals take pride in their work; they do not want any hint of lack of oversight or competence when reviewing processes. This can lead to less-than-open communication between hospital departments, and between hospital staff and outside firms. In addition, some processes, like billing, are mind-bendingly compartmentalized and complex overall. Many participate in it, but few are exposed to all facets of it, and still fewer truly understand how other staff and departments collect/analyze and process data to finally make it to a patient’s bill. In hospitals it is typical to presume all aspects of documenting, collecting, coding and entering are completely optimized. It is a shock to find one or more aspects may present gaps. Even executives, after participating in lengthy ‘lean process’ projects, frequently assume ALL aspects of billing have been optimized when perhaps only a single facet (like cleaning up the Charge Data Master) has been ‘leaned out’. The good news is that there is frequently untapped opportunity at increased revenue—without requiring top-line volume growth—if a hospital is willing to be open to truly reviewing its processes and current baseline results (i.e. what is making it to the bill now vs. what could have been).
How can a hospital assess what opportunity might be present without managers, directors, analysts and/or billers feeling like their job competence is being reviewed?
Here are a couple of suggestions for ‘giving cover’ to staff requested to help identify if/where you may be missing documentation or billing in specialty areas (Cath Labs, Interventional Radiology, Operating Rooms):
1. As an executive, give staff permission to find/report current data and processes, regardless of result.
Most hospitals use the latest processes or technologies available at the time to collect and record documentation of items used and/or procedures done in a patient encounter. Human error in missing data due to manual recording or bar coding often rises to 20% or more; It is not the sole fault of the nurse/tech doing the recording, nor the operating physician documenting, nor the audit staff reviewing, nor the coders on the back-end of the billing process deciphering devices used and procedures performed if the PROCESS has built in areas where critical data may be missed. Let the staff know up and down the food chain that it is OKAY to identify manual steps, areas of ambiguity, areas where a digit can be mistyped or an item was not bar coded nor sticker transferred in order to capture a device or procedure. Finding where a process can be fixed or automated is GOOD–it is not a negative reflection on the staff nor its immediate management.
2. Communicate explicitly that roles will likely NOT change if the hospital optimizes a process.
Ironically, the staff who do an incredible job attempting to catch misses in billing/documenting device use and procedures performed are often the most threatened when a part of the process of capturing the front-end data can be automated and made more accurate. Encourage the reviewers/coders/patient finance staff supporting these areas that automating tools will help them do their jobs more effectively. It will help them better defend higher level (complexity) procedures and more accurately capture ALL devices used on behalf of the hospital.
3. Department Directors get to be the HERO, not the scapegoat!
As an Administrator/Executive, you do not have to micromanage an internal review, but it helps greatly if you have a short, live conversation assuring a direct report (or their reports) that the hospital is NOT looking for reasons why current process is, but how a hospital department can go from good to great in capturing revenue. Ironically, some of the highest cost (and most valued) clinical staff (Directors, Managers), spend a shocking amount of time personally reviewing the most basic of data related to documentation and billing. Automating steps frees them to do less doing and more managing/leading, while at the same time increasing the fullness and accuracy of the data.
4. Administrators/Executives: Stay atop (at least via emails) progress (or lack thereof) in any process review.
Hospital professionals have a great deal to do, but in many cases, requesting (or if an owner of data, providing) data isn’t time consuming. Often a request for status keeps the data flowing and participants communicating.
5. Don’t forget the Doctors!
Current estimates are that MD time spent documenting (queries) to support ICD-10 may increase as much as 50%. This comes at a time when current systems for recording what an operating physician did for a procedure aren’t exactly fast nor easy to use. Identifying time spent remediating often simple, missed devices or procedures helps reduce the shock of this coming new demand on doctors. How/where can capture/collection be simplified or automated to free physician time? Tools to help automate what the doctor is doing/using helps save time all the way through the chain of staff in billing (techs, reviewers, patient finance analysts, coders).
As leaders, if you can keep involved, demonstrably show you truly support your staff, and request results, you might be pleasantly surprised at what you find—financially and staff satisfaction-wise.