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.

Wether you are an office manager or the billing/collections manager, proper revenue management begins with understanding the way your practice flows. It's very important to know what each one of your key positions do on a daily basis. If you're managing your practice's revenue from your position's point of view, you may not be identifying certain potholes in your practice's flow that are in turn, affecting the practice's revenue.

COMMON POTHOLES IN A MEDICAL

1. The registration process

Careful analysis of your practice's registration process is the most important step in identifying possible potholes that could affect your revenue down the line. There are several key steps taken at this stage.

A. Collecting patient data:
     Once the patient completes the registration paperwork, is this information being reviewed by your check in staff member and confirmed with the patient? Ilegible apartment numbers, zip codes, street names, etc., these are all things that many times are disregarded and thought of as irrelevant, but if the patient needs to be billed for a coinsurance charge, deductible, etc., you will not be able to accomplish this due the invalid information collected and entered.

B. Recording patient insurance policy:
     Taking a photocopy of the patients's  insurance card is a vital step that can not be missed. Any questions about claims mailing addresses, group numbers and so on, can be confirmed later on in the collections process if needed. Additionally, making sure that the correct insurance profile is selected in your billing program is also key. Many carriers have several mailing addresses depending on the policy and ensuring that the correct address is recorded is crucial. In a day where almost if not all claims are going electronically, the address isn't needed for the intial claims submission for any future appeals or medical records that may need to submitted.

C. Proper Insurance Verification:
     Checking for a copay is pretty simple to verify and many online services like Emdeon and Availity will provide this quickly. However, when we enter the world of a PPO, POS, EPO and anyother type of non HMO policies, you now many need to verify the patient's deductible and/or coinsurance. Too often practices think that you verified and collected the patient's copay, so everything is fine. Unfortunately, many individual policies nowadays have very limited benefits. From a flat allowed amount paid (vs a percentage) to a high individual deductible, these are areas that catch medical practices by surprise. Instead of receiving a payment for an office visit of $65.00 because you've already collected the copay, you find that you only received a payment for $42.00 and need to bill the balance to the patient because they have a 60/40 policy. This type of error made one time seems irrevelant, but when done many times a month it adds up. Making sure that Check-In understands medical policies and its components (deductible, limitations, coinsurance, etc.) is imperative to ensuring that as much money is collected upfront to avoid delay in payment in the future.

Observing your Check-In staff member for a couple of days to see what their process is could serve as an eye opener. Maybe you had no idea that he/she had no knowledge of a very vital step that needed to be taken. Communicating to him/her how important their role is in the practice's revenue process can also help them feel as though they are part of something bigger. That what they do has a large impact in the entire process.

Stay tuned for other potholes and processes that will be discussed:

Authorizations
Customer Service
Effective Communications
Check Out
Scheduling/Appointments
Care Coordination
Referrals

....And many more