Here's as true a statement as you'll ever need to know about patient accounting directors; if you bring in the money, as much as
possible, on a consistent basis, you'll be virtually untouchable. As long as you're not breaking any rules or laws, CFOs and VP's
of Finance will totally leave you alone because no one wants to mess with cash flow.
I mention this because, even though it seems that every director should know this already, I find that they really don't. Oh, no one
tells me that directly, but I see many directors doing this or that, concentrating on the wrong things, when there are so many other
things that could be more important to long term cash flow.
First, I want to highlight some things I've seen that have impeded cash, in my opinion. Many years ago in New York State, there were
some changes put into place concerning how worker's compensation claims were going to be paid. I learned that many patient accounting
directors were holding their claims until they could figure out how the new payment methodologies were going to work out.
At my hospital, I decided to continue sending out the claims as if nothing had changed at all. My reasoning was twofold. One, there
was, and never has been, a requirement that compensation claims had to go out with the amount hospitals expected to be paid. Two, if
I withheld those claims, it would throw off my cash flow, and I wasn't in the mood to explain to the CFO that our cash had dropped
because I wasn't sending out bills.
So, for a few months, I was hearing reports that other hospitals were seeing reduced cash because of holding their bills, whereas my
hospital not only didn't lose money, but the new payment algorithms actually increased payment rates, so we showed an increase.
Sure, the other hospitals caught up eventually, but why take any chances with hospital cash flow to begin with?
At another hospital, I had to counter the wishes of another consultant who wanted me to make some changes to the charge master that
I kept telling him weren't valid, in an attempt to get Medicaid claims paid. He had been given responsibility for the Medicaid
billing team, but it wasn't his specialty, and he was listening to his staff telling him that whenever they received denials, they
just changed certain codes and Medicaid would eventually pay those claims.
Finally, after he brought it up in a meeting with other directors and VP's, I went to his office and had him sit there while I called
someone who worked for the state office, and had him tell her what the hospital was doing. In no uncertain terms, she told him that
could be considered fraud because what he was looking to have done wasn't what the issue was, and, when we finally took a look at the
denials (which I'd been asking him to do for weeks), it turned out that the issue had been addressed on the Medicaid website two years
previously, and had someone thought to take a look they'd have known the answer and how to fix the problem.
I made a recommendation to him that he have his staff rebill as many claims as possible, because, it also turns out, if the claims
had been submitted properly that the hospital would have been reimbursed more than they were being paid based on how the claims went
out. That never happened, and that was one time were I let it go, since it wasn't my area of responsibility, but hoped that the
hospital would start doing things correctly, increasing their cash flow.
My final tale concerns seeing directors more worried about maintaining a sense of power than worrying about getting the job done;
my interpretation anyway. One of the billing personnel came into my office to ask me a specific question. After answering it, she
was telling me some of the issues she was having with one particular insurance company. I asked her why she hadn't called the
insurance company, and she said she wasn't allowed to call insurance companies. When I asked why, she said no one was allowed to
call insurance companies, and that everything had to go through supervisors or the director.
I thought that was odd, so later on I went to one of the supervisors to ask about this issue, in my own way, and she said that
the word had come down from the director, and that was policy. So, being me, I went to the director to ask her about this. She
told me she set that policy up because she felt that the employees didn't have the knowledge or qualifications to properly ask
insurance companies any questions, and that if "they" allowed employees to handle things on their own, management would never know
what problems were going on within the department. I asked her how her and her supervisory personnel were able to keep up with the
sheer volume of questions and the issues billing personnel had to be bringing them, and she said the number really wasn't all
that high.
She was right, because I came to realize, from talking to other staff members (people sometimes just talk to me) that they had
stopped taking their problems to management because they knew no one would ever get back to them with their issues, so they just
ignored certain claims and moved on. The hospital wasn't tracking denials anyway, and no one was being held accountable for any
part of outstanding accounts receivables, so why should they bother? This isn't a new or rare mentality, by the way. If their
concerns aren't addressed and brought back to them, employees often will give up, or do things their way.
Of course this didn't sit well with me, so even though it was outside of my purview, I did take it to one of the vice presidents,
something that a consultant can get away with, and he tried to enact a culture change to allow employees the ability to try to
solve some of their own issues. That partially worked, as what happened is more employees were allowed to come to me for
assistance, something that, once I'd started asking questions, management had tried to stop. But in the long run, management knew
that I, and other consultants, wouldn't be there forever, so they didn't follow the suggestions of the vice president, who was also
a consultant, and things stagnated. Of course, because I was able to help revenue jump drastically, cash jumped drastically along
with it, so no one at the time was even paying attention to lost cash. However, that same hospital is now laying off hundreds of
employees, and a part of me wonders, had they taken care of their cash flow issues when I brought it to their attention, if it might
have taken care of some of those employees who have now lost their jobs.
As a patient accounting director, supervisor, or whatever, always remember that if you're taking care of cash, and your days in
receivables are low, you'll always be viewed as a hero. Anything else and you're always on the hot seat. How would you rather
have your days go?