Are your employees venting about having too much work and not enough time? Are they expressing that they never having enough time to finish all of their work? Is the office paying too much overtime because your employees are having to stay late or come in early?

Many medical practice employees find themselves playing catch up on a daily basis. We as managers have tried several times to help. We have scheduled training sessions, thinking that maybe the employee is simply just not adequately trained to do the job. We have reorganized their desks, created daily tasks lists and taught them how to manage their day, only to find that they are still not able to complete their work. This is where the hard part comes in. Is it time to consider terminating the employee? Can you honestly say that the employee has been given all the resources to perform his/her job and is still not able to do so?

Here is an exercise that I have done in my office that has been an eye opener several times: I will observe my employee all day long. There, that simple. Now, what do I look for? Is the employee being interrupted numerous times? Is he/she properly supplied with the correct resources (computer, office supplies, information) Is he/she taking unnecessary steps or doing another employee's work? You'd be surprised how much information you didn't have before by performing this simple task.

It is imperative that all office roles are identified, but you have to be realistic about it, simply saying these are the responsibilities for this position isn't going to do it. Understanding what that person does already and what areas are suffering due to he/she not having enough time do it is very important in reorganizing your office roles. It not only is unfair to the employee since you are really just setting them up for failure but it could potentially create revenue leakage in your practice. I know you are probably cringing at the thought of hiring more people, but have you looked at the overtime you're already paying. If one employee is working 10-20 hours of overtime every 2 weeks (lets say she gets paid $14.00/hour) thats equivalent to $210-$420 at $21.00/hour, again for for only 10-20 hours. How about you hire a part timer to work those 10-20 hours at $12/hour? That's only $120-$240 for the same amount of hours of work. This person can come in to work on the small tasks that are taking time away from that full time employee. For example, maybe your front desk is spending a lot of time calling patients to remind them of their appointments or answering phones. If your office has a high volume of patients on a daily basis, having someone performing these two simple tasks can really help your front desk provide better service, be more thorough about checking benefits, and so on.

Do these simple tasks to determine what if any roles in your office need to be revised: Observe the employee; analysize your office's overtime and how this can translate into a part timer being hired. You'll find that you can run a more efficient office when you do this. Many times overworked employees are unhappy employees. This results in low office morale, bad customer service and a bad experience for your patients.

Having an airtight authorization process is extremely important in ensuring reimbursement for services provided in the office. Too often an in office procedure is done with out the correct verification and the services are denied for no authorization on file. However, understanding the patients' policy is also important. One important piece of advise I give  is, if your not sure if needs an authorization, just call and ask. At times, those online verification services are too vague when it comes down to services like injections, DME, fracture care, in office procedures, etc. Call the patient's healthplan and verify this. If you are told that an authorization is NOT needed, document a reference number and name. You may need this for an appeal if services are denied when the claim is processed. Other advise I give is:

VERIFY MEDICAL NECESSITY
This is often a step missed in the decision making process of an in procedure. Now, I don't expect the physician to stop what he's doing to verify if the services are medically necessary. However, someone in the office has to take this very important step. I can not stress this one enough. I small step can save your office a lot of trouble and money.

All insurance have their own guidelines for medical necessity. Take the time to explore the websites of all insurances accepted in your practice and located the policies of your most common services. Put these together in a clear and concise spreadsheet so it can be used as a reference. Too often this is not done and a practice finds themselves with a denial and no idea why. Only to find out after the fact that the diagnosis used does not support medical necessity.

VERIFY THE DEDUCTIBLE
Many times a patient's policy will have different deductibles. Today medical policies are so complex that it is very difficult to obtain all of these deductibles at the initial verification. One verifying whethere or not an authorization is needed you should also be asking if the patient has a deductible for these types of services.

COLLECT UP FRONT
Its unfortunate, but true, if you do not collect from the patient at the time of service, it is very likely that you will have a very difficult time after the fact. Collect an approximate out of pocket for the patient. If the procedure has an allowable of $214.00, and the patient has a deductible of $125.00 remaining, collect the $125.00. It's always better to give a refund than to have to chase a patient or pay a collection agency for their service.