Billing: Keep Your Eye on the Ball!
By Joe Sansone  Last month, I recounted a story of the discovery
of a file cabinet with over $800,000 worth of unsubmitted claims.
What follows is an account of what we did to make sure something
like this never happens again.
Many of us have learned the hard way that billing nightmares can
sneak up on you, but it is difficult to proactively know when
trouble is looming. Here is what we did to solve our problems:
Take Ownership: As CEO, I took my insurance
billing department for granted. I assumed my role was that of
growing the business and "playing" owner. I had tight controls over
the Sales, Operations, Fabrication, and other departments but had
never taken the time to learn the intricacies of the daily
functions of the Insurance Department. The first step to ensure
billing problems did not recur was taking ownership of this
department.
Establish Policies and Procedures: The reason
why claims were being left pending initially was because we did not
have policies and procedures in place for our employees to follow.
Simply put, they did not know how to carry out their day-to-day
duties. Our employees inherently wanted to do a good job, but they
needed a set of rules to work by. Armed with knowledge, they could
do their jobs correctly.
Unfortunately, we left it to the employees' discretion when
deciding how to handle many situations, and since management had
not dictated policy, employees did the best they could. Upon this
realization, we decided to enact policies and procedures stating
exactly how to carry out every aspect of the insurance billing
process. Our intention was that once this policy and procedure
manual was written, persons with very little experience could be
trained on how to do their jobs.
Observe and Work with Your Personnel: Within
weeks of supposedly solving our problems, we began noticing pending
claims were once again piling up. We were devastated. How could
this happen after we had enacted policies and procedures to make
sure this problem never recurred?
When we looked further, we discovered that our personnel did not
feel comfortable with the newly instituted policies and
procedures.
We soon discovered the idiocies of our protocols. The mistake we
made was developing policies and procedures without knowing what
was going on in the department. It was very easy for us to sit
behind a manager's desk and establish our protocols. But when it
came to following the guidelines set forth in these policies on a
day-to-day basis, we struck out.
We did not observe the employees as they carried out their
day-to-day tasks to ensure that our policies made sense. We learned
the hard way that if a company's policies and procedures do not
make sense, employees will become confused and disheartened. Once
again, they will find another filing cabinet to start hiding
questionable claims.
After we observed our employees at work, our two-page
impractical protocol soon grew to 15 pages, and it is now over 20.
It is simply not effective for management to sit behind a desk and
dictate to employees how to do their job. We must work with the
employees to verify that policies and procedures make sense, both
on the drawing board and in the field.
Quantify Results: We realized that management
would never be able to plan for all unforeseen events. Therefore,
it became important for us to quantify the productivity of our
staff to ensure that claims were not being held. Initially, we
decided to tabulate the total number of claims mailed on a daily
basis.
The results were disastrous. It was impossible for us to
ascertain why one day we would mail out 100 claims and the next day
mail out 30. When we went back to the individuals, they pointed
fingers at each other, hiding in the confusion and safety of their
numbers.
We sat at the drawing board again and decided to quantify daily
results by each employee. For example, we wanted to know what an
intake specialist was doing on a daily basis. Her job was to: 1)
Enter data, 2) Pre-certify and verify benefits, 3) Enter charges,
and 4) Forward to billing. We began tabulating the numbers of each
of these tasks performed each day.
Employee Feedback: I was soon overwhelmed with
a two-page legal-sized table with more information than I knew what
to do with. We were able to simplify the data by breaking it down
and producing graphs for each employee. Now we look at them on a
weekly basis for each employee and for the department.
This allows us to see exactly what each employee is
accomplishing on a weekly basis. Now, if a particular employee has
low productivity numbers one week, we can communicate with this
employee in order to determine what happened. An employee loses the
ability to say, "I did not get claims out this week, because I was
doing data entry or pre-certing," because these tasks are logged
also. Now there is no room for argument.
Every week employees' numbers speak for themselves, and there is
no room for excuses. If a particular biller averages 200 claims a
week, and one week bills 110, then we will ask the employee what
happened.
Graph Crazy: Now our employees accuse
management of going "graph crazy." Anytime there is a recurring
problem, the mere threat of graphing compliance immediately solves
it. We have graphed things such as percentage of clean claims,
percentage of returned claims, percentage of accuracy of data
entry, and number of braces fabricated on a daily basis.
The graphs have been invaluable in solving many compliance
issues that we have had with our employees. For example, the error
ratio found by our auditor from the intake department has decreased
from about 27 percent to less than 5 percent. Also, we have been
able to show employees that some weeks they are literally two and
sometimes three times more productive than other weeks. We are able
to let employees know that if they can consistently reach this
level of productivity, they will be rewarded financially upon their
next evaluation.
What are the results of the changes we made? We have increased
our collection percentage by 17 percent in just one year, and now
we have learned to proactively try to find holes in our billing
system, so that we can solve these problems and become even more
profitable. Accomplishing all of this allows management to focus on
why we got into this business to begin withto serve the patient's
needs. Joe Sansone is CEO of TMC Orthopedic, 
Table Of Contents - November 2002
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