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A couple of days ago I was in the grocery store. I wasn’t sure what I wanted, so basically I was just wandering around looking at everything. At one point, while going over to the freezer that held the shrimp, I noticed something just off the side of the cheese table that caught my eye.


I stared at it, wondering if it was cheese or some other thing. It was a very dark brown, very solid, and even trying to read the sticker on it was problematic because it had worn out. What was strange is that the description all of the packages there had worn off.

This woman came by with two children, and noticed I was having difficulties reading. She probably thought it was because I had my glasses on top of my head (that’s how some of us read things as we get older) so she offered to help. She read off the stuff I could see. I told her my problem was trying to figure out what it was because none of them had listed what they were.

She then said “I’d put it down and just walk away.”

I did. 🙂

In my own way I’d gotten caught up in the moment. This was a mystery that I was trying to solve, to the exclusion of anything else I had to do. This lady stepped in, did her thing, and was not only able to walk away but to get me to do what was necessary so I could walk away.

It was a brilliant piece of leadership. She wasn’t mean or critical. She observed, thought about it, and gave me a solution. I was smart enough to take it.

Back in 2008 I wrote an article titled Sometimes Leaders Have To Take A Step Back, where I talked about the fine line Barack Obama had taken just days after being elected as the next president of the United States. He’d been asked some pointed questions about how he’d change things the current president was doing.

At that point he knew it wasn’t the proper thing to do and so he deferred. He understood that politics is politics but leadership is leadership and President Bush was going through a tough time. It wouldn’t have benefited anyone had he said something that could have shown him up.

Back in the day when I was the director of a department, I reported to the chief financial officer, or whatever the title happened to be wherever I was. It meant that person oversaw what I did; I could live with that.

What often happened is that person had to listen to me telling them what was going on and having my making almost all the decisions for what we were going to do. That happened because the person in charge didn’t know the job or any of the jobs that people who reported to me did, so they knew they had to step back and let me do what I had to do.

I would often take things to them because I didn’t want to overstep my authority just to see what their opinion might be. Instead, most of the time they asked me what I thought should be done. I’d offer it, then wait for them to decide. Most of the time it was in my favor, but not always. That’s because sometimes my solution was going to cost money or time, and since that’s the area they were over they’d have to make a tough decision based on that.

I’ve been on the other side as well. As corporate compliance officer, I had a lot of authority to get things done as it pertained to audits of departments. Yet there were times where I had to step back and let someone with more knowledge about something take the floor and help guide us through the process. In those moments it’s not about being right as much as getting the right thing done.

Real leaders realize they don’t know it all. Either they have to train others to be leaders of themselves or work with others who have skills and knowledge they don’t have. They need to let these people do their work without being obstructed while still supervising it all.

Are you a confident leader who understands this principle?

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I eat out often. If I say so myself, I’m a pretty good tipper. I tip well because I usually get pretty good service. I usually get pretty good service because I try to be as nice and engaging as possible with the person who’s taking my order and bringing me my food.

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I believe that restaurants probably have the best customer service of any industry. It might be because, at least in the United States, the wait staff gets paid less than minimum wage, and to make sure they get paid the hourly wage they’re hoping for they work harder than everyone else so that they can get tips.

They’ve probably learned over time that being nice to the customers result in bigger tips. They’ve also probably been schooled by the restaurant managers or owners in how to take care of their clientele because leadership knows that if customer service isn’t up to snuff then no matter how good the food is those patrons won’t be coming back.

I like to think of this as a three-way street. I don’t even know if there is such a thing, but I think that looking at it this way can make a great impact on how we see customer service organizationally.

The first street is the person or people who are either the first contacts or those directly responsible for how the customer is treated. This goes beyond restaurants. The first person a customer talks to on the phone is the beginning of the customer service process. The first employee a consumer encounters when they enter a business is the beginning of the customer service process. These are the people who actually make or break businesses.

The second street is leadership. Leadership is very important in the customer service process because leadership sets the tone for how the organization treats their customers. It’s up to leadership to define who their customers are, which means they need to determine whether they’re going to treat their employees as customers along with everybody else. The companies who include the best customer service processes and include their employees usually stand out above other companies in their industry.

The third street is the customer; that one’s the wild card. When customers come to partake of our services or products, they will either be in a good mood or a bad mood. This puts those on first and second streets at a disadvantage. It would be nice if all consumers recognized that you teach people how to treat you by treating people better, but it’s not always the reality we deal with.

If you have customers who are in bad moods, there are usually two things can help them feel better and make everything pleasant across the board. The first thing is to be professional. It helps if you can be professional and friendly, but every once in a while friendly just isn’t an option at the moment. The second thing is to take care of the customers issue. That’s where being a true professional comes into play.

I believe that an overwhelmingly number of all customer complaints are solved and people leave feeling pretty good. Unfortunately, sometimes a consumer’s complaint can’t be solved to their satisfaction for whatever reason because business is business and life is just like that.

When that happens, it’s more important for customer service personnel to be professional rather than friendly because as we all know when we’re being told something that we may not like we get even more upset when the person giving us this news seems to be inordinately cheerful.

It’s at times like this where leadership’s role in customer service is most important. Well trained staff should be given a green light to try to help customers by being able to offer them something when things go wrong and there is no true solution.

Since businesses are diverse I can’t make suggestions on what types of things should be offered, whether it’s discounts, free services or products, but allowing the first street customer service employees latitude to make decisions they’ve been trained to know that can help consumers feel better is probably one of the best gifts that leadership can do for them.

This doesn’t negate those times when leadership needs to step in to take care of the problem. Sometimes they might need to be the only authority who can pull it off, especially if there’s a large monetary component.

No matter the business (well, maybe not independent businesses like mine), there’s always a convergence of these three streets. It would be nice if all three streets led the way out of a situation, but for the most part it’s going to be up to the first and second street to get the job done.

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I don’t really have any nicknames, which suits me fine. My grandfather called me something different, which was great because he was my grandfather and the only one who ever used it. My mother and father had a name they called me; parents do that. And there was this group of ladies in college who made up another nickname that I had to live with… for a year at least. No, I’m not telling you any of those nicknames! lol

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I have one friend that I’ve known for almost 35 years who has a nickname for me that I will share however. Five years after we met he started calling me “guru”. This was way before the days when everyone started calling themselves this so there wasn’t any consternation in accepting the appellation at the time, and he’s still the only one who calls me that.

He has a reason for calling me that. He says that out of all the people he’s ever known, I’m the only one who can listen to someone describe an issue, take some time to think about it, and then not offer just advice but options, usually at least 3, that a person can decide to take and what the possible outcomes of each option might be. He’s told me that after all these years I’ve never been wrong, and that it took a few years for him to realize that the best option should have always been the one he should have selected.

I’ve always appreciated his words. I used to wonder why none of his other friends seemed capable of the same thing. Over time I realized why, and it leads to two major failings of leadership.

The first one is the art of listening. Many times leaders are ready to solve issues without fully listening to what the problem is. Sometimes the people telling leaders what’s going on don’t tell everything, and that makes it hard to define what needs to be done. Every once in a while they might need to ask follow up questions to get closer to the truth, but that can’t happen if they’re not listening as well.

The second one is the art of seeing problems from multiple points of view once there’s a good grasp of what’s going on. Most people think of problems as black and white, which means doing either one thing or the other. I’ve found in life and business that there’s often layers of answers, and that sometimes it’s smarter to take the route of a layer than either the best or worst idea.

An example of doing something like this was when I was a director at a hospital during the Y2K time. Our computer system was being discontinued at the end of the year and we learned just before conversion that there wouldn’t be enough time for the people installing the new system to write a program that could merge our current data into the new system.

I'm listening
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Two other things were complicating our efforts. One, a contract with one of the major insurance companies hadn’t been signed yet, which meant there was a possibility that we might or might not get payment information posted before the end of the year. If that wasn’t enough, I also had to merge two different hospital business offices together while trying to find a way to get almost everyone trained to use the new system, since only 3 people had been trained on it.

I realized I had to get more people into the thought process instead of just myself. I held an all day meeting with my 3 supervisors, having each of them bring one person who reported to them, and also had one person who’d already learned the new system but hadn’t had a chance to work on it in real time. On a whiteboard I laid out what I thought were all the issues that I could think of as a starting point for us to have a serious brainstorming day. I also told each person in the room that not only did I expect everyone to contribute with their opinions, but I was buying lunch; couldn’t have people being hungry could I?

Over the course of 7 hours we talked about every issue we could think of and the list grew beyond what I had started with. Then we started looking at what we could either remove or push to the side for the short term. After we got down to 7 specific things that we knew were going to be crucial, we worked down even further until we got to the place where we knew we could only tackle those things we had control of. That left us 4 things to deal with, pushing the insurance issue to the side for the moment since that was the great unknown.

In the end, we had a plan that had added things I hadn’t considered and also didn’t leave us with only one thing we could look at. This wasn’t close to a black and white issue; it was more like the colors of a prism, where each color was important but we could only concentrate on specific colors. All of them worked towards a goal that we couldn’t fully complete because of the unknowns, but they would get us closer to where we needed to be.

Without being a good listener, I’m not sure I could have facilitated that meeting properly. Without all of us coming up with options and then working out the importance of each, I’m sure that it would have all gone awry. We were communicating well with each other as equals, even though I knew at all times that the outcome would be on my head. This was one of those times where there was no one perfect answer, and had I gone with just my original ideas I’m not sure I’d have been able to pull off what we eventually got to.

This was a very complicated case, yet I tend to believe that using my leadership skills I not only helped guide us to the proper conclusion but a lot of other people had a hand in it, which was important because it brought a lot of people together during a very tense time. The way I saw it, everyone else could take credit for where we ended up; I was just the person who helped pull it all together.

Listening is an essential part of leadership. Maybe these listening tips can help those of you who might determine this isn’t your strong suit to get it right, although I’m sure that if you read this blog you already know these things. 🙂

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In my first post about what a revenue cycle consultant does a few weeks ago I introduced the 4 major areas of the revenue cycle of medical entities. This time around I’m going into a bit more depth which I know will not only educate those outside of health care but inside as well… though many of them won’t willingly admit it. 🙂

Before I get into that, I want to mention two things.

Day 34/365
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First, this article isn’t a comprehensive description of everything I’m talking about. That would take way too long and only a few people would benefit from it. This is definitely enough to give a high level of information that almost everyone should be able to understand. Also, remember that this is from an outline for a live presentation I thought I was going to be delivering to a group, so the answers below fall in step with that.

Second, not all medical entities get this deep into the process. For instance, collections is often handled by outside companies so this might not be as important to them. Some physicians and physician’s groups also hire outside companies to handle their billing. Still, every one of these is a part of the overall revenue cycle of each of them, whether they specifically do it or not.

Health Care & The Revenue Cycle Process

A. Admissions/Registration

1. This begins the entire process

Except for some emergency room services, no medical procedures are done without giving up a lot of information to the registration or admissions areas. Some facilities only ask a few demographic questions while others get really intense with the types of information they want.

2. If done properly, bills will go out automatically

There’s little “billing” done by the billing office these days, which is why the name morphs so often. If all the upfront demographic information is captured properly (not necessarily correctly) and the charge capture process and medical records gets diagnosis codes on the patients services properly then bills will automatically go out, which saves a lot of processing time and, hopefully, everyone gets paid quicker.

3. Gathers all demographic information

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Let’s start with name, address, birth date, social security number, and then move into the insurance information. People are asked for driver’s licenses, insurance cards, and sometimes social security cards. In physician’s offices and either inpatient or surgical admissions, a lot more information will be asked regarding medical condition and previous services. Not only is this information crucial to physicians but it also affects how diagnosis codes are determined, since there could be many different reasons in describing why a patient has presented for services.

Of course it’s not just getting all this information. When there’s time all insurance information needs to be verified for coverage, such as making sure it’s still valid, that the patient is actually covered under the insurance information that was given (insurance fraud is a big deal), and in some cases if an authorization was supposed to be obtained before services are provided.

a. Ties in to charge capture

The ancillary departments (some of you might have to read the first article for some of the definitions in this one) need all the previous information to make sure charges go onto the correct patient’s accounts.

b. Ties in to medical records

Medical records can’t code properly without some of the demographic information and the charges matching up. For instance, if the registration folk put in a birth date that makes a woman 75 years old and the patient came in to determine pregnancy, medical records hopefully will catch it first and send the file back for corrective action.

B. Charge Capture

1. Ancillary departments are those that capture revenue

Radiology, lab, surgery, diabetic education… if a service is provided it’s considered an ancillary, or revenue generating department. Pharmacy and materials management (supply) aren’t usually considered in the same way because most of what each of these departments do is send items to other departments, who are supposed to capture the revenue when they provide services… if it’s proper to do so. For instance, over the counter drugs aren’t billable so even if pharmacy sends these to the emergency room area, they can only be used for immediate treatment but aren’t allowed to be billed to patients.

"It's not like it's rocket surgery."
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2. Departments capture charges pre-coded and priced via a charge master

Almost all procedures, billable pharmaceuticals and billable supply charges are coded up front so that all ancillary departments have to do is select the services provided and enter them into the computer system. There’s a bit more information on all of this below.

a. Charge Masters are the data system for procedures, supplies & pharmaceuticals

This is more than just a listing of all charges. Overall, you’ll have:

charge description;
procedure code;
revenue code;

Some charge masters add a lot more information, but for billing purposes these categories are the most important. Depending on the size of a hospital there could be as few as 2,500 charges and as many as 75,000 or even more (gasp!). This is why it’s smart to have everything coded up front.

b. They also contain general ledger codes to track department revenue

This is a major determinant in evaluating how profitable different ancillary departments (sometimes referred to as cost centers) are… or aren’t. It’s an important way for health care entities to determine where changes in revenue are occurring, to see if something is wrong or what’s going right, and hopefully make the proper decisions to address issues that show up.

3. Charges are captured either by sheets or computer access

Physicians offices and clinics are very big on charge sheets because they’re often seeing a lot of patients and it’s the easiest way to capture charges, along with adding diagnosis codes and other quick notes as needed. Some hospital departments will also use charge sheets but some departments will allow the technician who’s doing the service to enter it directly into the computer without sheets… although they still have to document what they did in some kind of record.

4. Verified by medical records; charges must match up with diagnosis codes

You wouldn’t believe how often what was performed on a patient and what they were charged doesn’t match up. Medical records is the auditor of sorts who’s supposed to catch these anomalies and get them to the proper areas to be fixed. In some hospitals medical records never sees the charges, which is when errors can occur.

Unfortunately, unless these hospitals have what’s known as claim scrubbers that look for things like this that don’t match up properly, if everyone did what they were supposed to as far as processes go, even if they got something wrong, bills will go out and need to be fixed on the back end… sometimes weeks later.

Please Pay Here 3-14-09 19
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C. Billing/Patient Accounting/Business Office

1. Billing is kind of a misnomer; almost no billing takes place anymore

As mentioned above, very little billing takes place in the billing area anymore since the overwhelming majority of claims go out electronically, which is why they’re often referred to as patient accounting or patient representatives.

2. Basic job is following up on unpaid claims

Even the best run area will have errors, like mentioned above. If a hospital has at least a 96% success rate in getting claims paid the first time out then they’re probably doing pretty well. Still, large facilities with an error rate of 4% can amass a large number of claims that need to be worked for all types of errors that aren’t always necessarily internal (as in, it’s not always the medical providers fault).

3. Intermediary between all the other departments

Why is this job so hard to do? One reason is training; there’s a lot to learn. Another reason is because there are literally a few hundred reasons why claims might not get paid, and insurance companies don’t always give enough information to know what they’re trying to tell you.

It’s worse when dealing with one’s internal departments though… or trying to figure out if it’s an internal problem or not. Sometimes the demographic information is incorrect and someone has to contact the registration area. Sometimes charges aren’t captured properly; sometimes medical records hasn’t coded properly. Sometimes it’s a combination of two departments; it’s not pretty.

These are the folks that every medical organization in the world is most dependent upon because they’re bringing in the money. It’s the reason why I always say that the last group of people you want to downsize is the area that brings in the money. Deciding that you can get the same production as it concerns your money with fewer people is a desperate move that I’ve never seen a single hospital ever benefit from… never! Sometimes it’s overstaffed, but it takes a real good evaluation to make that determination, and I’ve rarely seen it dome properly; if you have questions about this one, go ahead and ask me why.

4. Deal with most customer calls/complaints

When patients have problems with their bills they’re going to call this department because their phone number is on the bill. Some facilities have certain people who take these calls, while others have the phones rotate so everyone gets a turn.

Not all calls are easy to answer without doing some research, thus the most important thing to teach is that if the person taking the call doesn’t know the answer with conviction, get as much information about the concern as possible and either take the time to research it or go to a supervisor or director for assistance. Customer service should always be a priority.

3D Shackled Debt
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D. Collections

1. Last line of revenue “defense”

The patient accounting area is the toughest because of processes. Collections is the toughest because at least half the people who call them, or who they have to call, aren’t going to be all that nice. That’s because these are folk who owe out of pocket money… and sometimes they don’t know it beforehand. If it’s taken a long time to get a final determination or payment from the insurance company, or the insurance company hasn’t send a statement of paid/denied benefits to the household… or even if they have, people are either going to be mad or upset.

2. Tries to get payments after the fact for remaining patient balances

Health care is the only business where you try to get money out of people after they’ve had services… and they often don’t know up front how much those services cost (though they should). This means it’s an adversarial relationship from the beginning. Luckily, sometimes it ends well.

3. Must follow federal regulations

It would be nice if all anyone had to do was send a bill to patients, and if it isn’t paid within a week to 10 days you sent it to a collection agency and got on with life. Because of Medicare, most medical providers are actually stuck with following their guideline of at least 90 to 120 days of trying “in good faith” to get payment from patients before sending outstanding claims to agencies. In some states like New York, if it turns out that patient had Medicaid, or if you thought up front that the patient had Medicaid but you didn’t verify the information while they were in your facility, you can’t charge them at all… and almost all of these patients know that rule.

4. Area that helps set up payment arrangements or Charity Care

Actually, if this can be done before patients have services provided everything works better, but most of the time neither registration or patients are paying attention to their own signs, which are supposed to be displayed in prominent places, talking about setting up payment arrangements or applying for charity care. This means the collections department has to walk a fine line in trying to negotiate monthly payment arrangements or bringing up the possibility of seeing whether patients quality for discounted services or Medicaid.

Even without talking to patients, this is the department that ends up making the final determination as to what gets written off to bad debt early or goes to a collection agency to determine, after even more time goes by, what should be considered as bad debt. For instance, hospitals might determine that it’s not in their best interest to send accounts under $25 to collection agencies, which aren’t going to give it their best effort (no matter what they say) because there’s too many small dollar claims to deal with. They might have one patient who owes hundreds of dollars because they never pay any of their deductibles or copays and thus will send those claims to an agency because the dollars have compiled into an account worth pursuing. In any case, it’s important to have a consistent written policy for dealing with things such as this so that decisions aren’t arbitrarily made and to keep everyone honest.

As high level as all of this was, it’s still a pretty long article to get through. Would you believe there’s still a lot more to cover, based on my original outline? We’ll get to it after a couple more weeks. Any questions or comments, please go ahead and ask. Just another reason why bringing a revenue cycle consultant in to help look at processes could be the best decision your facility makes.

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We don’t have to argue with anybody. We don’t have to curse and go around acting bad with our words. We don’t need any bricks and bottles. We don’t need any Molotov cocktails. We just need to go around to these stores, and to these massive industries in our country, and say, “God sent us by here, to say to you that you’re not treating his children right. And we’ve come by here to ask you to make the first item on your agenda fair treatment, where God’s children are concerned. Now, if you are not prepared to do that, we do have an agenda that we must follow. And our agenda calls for withdrawing economic support from you.” – Dr. Martin Luther King Jr

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Today is the 48th anniversary of the assassination of Dr. Martin Luther King Jr., and because of that I’ve co-opted the Monday spot usually relegated to my other blog for the second time this year. I felt it was important to do so because of the day and because I have something to say. Some won’t like it, some will, but in this heated political year it’s important that we come to grips with some reality.

Last year I wrote an article specifically for LinkedIn titled How Does Dr. King’s “Dream” Speech Translate In Health Care?. The article was well received… kind of. It got 162 views and it was probably the most commented article I had there. A couple of the comments weren’t quite negative, but instead of talking about the article itself the comments were made by people who had their own agenda against the Affordable Care Act and against President Obama… neither of which was even in the article. At this point it seems those few people must have had a change of heart because those comments are gone now.

A few days after that article went live I had someone else reach out to me and ask if they could feature the article on their website. It was a business website, and I took a look at it before deciding to allow it. I was given a password if I wanted to respond to any comments the article got… and it turned out to be useless.

The article did indeed get comments… almost all of them negative. Almost none of them talking about health care. Almost all of them talking about “another black person starting trouble that doesn’t exist”. I responded once to each person, stayed nice because it wasn’t my space, and decided at that point I was done, lost the password and forgot the site and never went back.

Notice I said “almost” above. That’s because there was one guy, one white gentleman, who not only liked the article but basically got into battles with the other people on my behalf. That was interesting and it felt pretty good on the surface, but in the long run even that depressed me.

A few weeks ago I was asked to be part of a local news story about the lack of diversity in booking music acts for a new amphitheater that just opened in September. While the list was impressive, it contained not only no people of color but no women. After we finished the official talk, I said to her “You know the kind of responses that are coming don’t you?” She said “Yes, but I don’t care. This is 2016 after all.”

When I was informed the article was live I went to check it out. I thought my position was represented well, and I went out of my way to make sure I didn’t call anyone “racist” or “bigoted” because I didn’t believe that was the case. However, I did say these three things:

“The truth is people are scared to talk about diversity,” he said. “Most people don’t think about it until someone brings it up. But good leadership is inclusive. Good leadership always thinks about diversity.”

“Whether it’s picking music, picking Oscars or working in business, people are always going to go with people they identify with,” Mitchell said. “One voice can help change things, but if there’s no one voice, they won’t think about it.”

“If you mention it to them, they’re going to make excuse after excuse,” he said. “That’s what the Oscar people did. People get defensive, even if you’re just telling the truth. People are scared to be called racists or bigots.”

After I read the article, I read some of the early comments. They were exactly on line with what I was expecting. A lot of hateful stuff, a lot of complaints about people writing about the lack of diversity… blah blah blah… I decided to stop reading them before someone decided to come after me personally because I know myself fairly well; I don’t play that game fairly… not as all.

For 8 years I’ve been reading all this negative stuff about President Obama, and a lot of it has been racial. People have tried to defend their actions saying it had nothing to do with race, but calling him a Muslim and starting this birther movement were definitely about race… possibly religion but I’m sticking with race.

Why? Because if those people were white and Muslim this wouldn’t even be a discussion to begin with. The overwhelming number of the followers of Islam are brown skinned people, and thus it makes it easy for these folks who hate with animus and agreement. The politicians running for office in one particular party are using it to their great advantage, preying on the fears of those who think their world is being taken over by “those people”, which has led to beatings, threats, name calling and all sorts of other things.

Then this mess started about something called “black privilege”, where many white males are saying that blacks get all the breaks and get to do and say things they can’t because they’d be called racists. Many have even started saying there should be a White History Month; sigh… Obviously they didn’t see or read this post of mine; not that they’d have understood it in the first place.

Maybe some of them would understand this by Jane Elliott:

That puts the issue in an entirely different light doesn’t it? Kind of tosses that black privilege belief out the window I’d say. For that matter it throws out the privilege issue for any minority group in the nation; we’re all in the same place.

I’ve written about diversity via newsletters and on my blogs for just over 13 years. Most of the time I don’t get any responses on those articles; hey, that’s just the way it goes. I will continue writing about it, and talking about it as I did during two live presentations in February locally.

What I have decided I’m not going to do anymore, unless I’m personally pulled into the fray, is engage stupidity as it applies to race. Frankly, like politics and religion, even telling and showing people facts about race doesn’t change their minds nor gets them to accept the truth. I don’t know how many times CNN has debunked the claims of both of the leading Republican candidates that the majority of Syrian refugees are NOT Muslim; hey, why let facts get in the way of a good talking point that’s getting voters?

Overall, I believe race relations is on its last breath. Things aren’t going to start changing until the majority is close to becoming the minority and when that happens, things are going to get worse. Do I have to point out South Africa before Mandela became president? What about Rhodesia, whose record was so horrific that they ended up changing the name of the country to try to bury the shame?

I’m not worried about the people I know in person. I’m used to being the token presence and voice in most of my interactions, and after 56 years I play the game well. But when, after 14 years of having this website up, there’s still conversation every once in a while about whether or not my picture being on my bio page might be keeping me from getting more business, it shows me that it might not be a daily thing, but it’s always in the subconscious of others, which is why it’s always in the consciousness of my mind.

People will believe what they want to believe; I have no problems with that unless it impacts me, directly or indirectly. I just lament that 53 years after “I Have A Dream” and 48 years after his assassination that this country seems not to have moved much on Dr. King’s words or actions. It’s better, but not by much… not based on what I see or hear.

If you believe in the dream, please let me know; I could use the inspiration, and I know I’m not alone.

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As an independent consultant, I usually have two “speeds” I get to work with as it pertains to doing business in general; slow and fast. Moving slow means I’m working on a contract or with a client, which usually means I don’t get to market because I’m not always sure how long a project might be. Moving fast means I’m marketing, marketing in multiple ways, and trying to gain both an audience for my long term goals and a new client for present goals.

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When I came home in November 2014 after 18 months in Memphis, I took a few weeks off to relax, then started up slowly in my marketing efforts since December is a month where almost no one ever wants to think about new business or even someone who might be able to help their business be better. So, even though this was the “fast” period, I was pretty much on cruise control rather than pedal to the metal, taking things as they went along.

Out of the blue a friend of mine told me about the ability to post articles on LinkedIn. She said she’d been doing it for a few weeks and that she was getting great visibility and how it might work well for me because of how much I write.

I figured why not, but I first wanted to look to see what it was all about. It looked pretty cool so I wrote an original article and posted it there, along with an image to see what would happen.

That first article, which went live on January 5th, 2015 and was titled Hospitals Must Change From “Cut Staff” Mentality To Maximizing Revenue, ended up getting over 300 views and had 55 likes. My eyes lit up seeing that kind of performance, and the game was on.

I was in fast mode, and I was feeling pretty good. I was sharing those articles on all other social media spaces, and sometimes I was linking to them in my blogs. It looked like I was finally showing a lot of traction across the board, which was pretty cool because LinkedIn had always been a tough nut to crack. I started posting in more groups as well, offering my opinion and tips on things and every once in a while sharing there also. It all seemed to be appreciated; I’d be lying if I didn’t say it was pretty heady stuff.

Over the course of the next few months I posted a good amount of articles, some very successful and some a bit less, but all had more than 100 views. I started having a lot of people following me because of those articles, and at some point along the way I went over 1,000 people and felt thrilled to get there. On March 31st I had my most seen article ever, where almost 1,300 people saw an article titled Five Ways To Push Forward When You’re Stuck. It had 82 likes also; I thought it could go on forever because I always had something to say.

After that, things started dwindling a bit. I still had some articles that got some good viewing numbers, but likes started dropping and soon the numbers of people viewing were dwindling. By May I was starting to have fewer than 60 people seeing most of the articles, and by July it had gotten to fewer than 35 people seeing them. After May 26th I only had one other article reach 100 views.

As I got close to hitting my 100th article, I decided that if my last few articles didn’t have even 40 people view them that it was time to stop and move on. My last 3 article got 27, 23 and 28 views; I decided not to even try to add the 101st article as an experiment to see if LinkedIn might start showing my articles to more people, so the last one I put up was on December 21st.

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I had no idea what had happened to reduce the visibility of my posts. I wondered whether it was me putting up too many articles, whether LinkedIn didn’t think my articles were still relevant, or whether people had decided that I had nothing new to offer and stopped wanting to view them anymore. It’s something that long time bloggers often have happen to them, where there are people who visit and comment all the time, then suddenly you don’t see them anymore, you suffer a lull, and another group comes in and it starts over again.

Of course, LinkedIn was making some changes as well. They changed how groups worked and suddenly conversations dropped and all the groups I was participating in were taken over by marketers. They also made all the groups private, which means people who weren’t in those groups would no longer see anything that came from there. I have no real idea how that is working for them now because the last time I tried posting something to a group to see if I could generate a conversation I got what my wife called “crickets in 3-part harmony”.

At this point I’m sure this article looks like a bashing of LinkedIn but it’s not. As strange as it might seem, it’s actually an allegory that ties in with how the process of leadership goes, sometimes good, sometimes bad.

For instance, as leaders we try to find ways to make the process for those who report to us work better and make them better at the same time. Every once in a while we come across a formula that not only works but works great. Everyone’s happy, we’re sharing chocolate cake every day and life is sweet.

We might notice at some point that things are wavering some, so we as the leader has a choice to make. We either tweak the process a little bit or we decide to continue on the path we’ve chosen, thinking that things will improve and get back to where we were, without a clue as to what the metrics are telling us. In essence, we’re guessing; guessing rarely succeeds for long.

Now we notice that performance is falling, and we start taking a look at both the process and the people. Hopefully we don’t find anything wrong with the team; if it were that easy life would be sweet. Instead, it’s usually the process, whether the initial results were a freak or some outside stimulus has insinuated its way into things and made it difficult for us to have the same success we had before.

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Now we’re in “fish or cut bait” mode, and the only one who can make this decision is the person in charge. A determination needs to be made whether to continue on the path or get off and try something else. It’s never an easy decision because life is too complicated for simplicity most of the time.

Deciding to go forward and just tinker with the process is probably the easiest and worst decision most of the time. We’ve seen massive failures on corporate America because companies adopted that strategy while other companies were innovating. Even if it’s easier it doesn’t mean it doesn’t take a lot of work; however, most of the time extra work isn’t what happens, and problems just don’t go away on their own.

Deciding to drop a process is scary and sometimes dangerous. It’s also hard because it forces leadership to come up with something new and give it another try, with no guarantee that it’s going to work. However, it supports the reality that change is always inevitable, even if some of the change might involve some of the old techniques need to be revisited. Every once in a while what’s new is actually old, but if it’s not it’s still a great place to lay a foundation whenever you’re looking to find ways to improve.

For me, making a decision to stop putting new articles on LinkedIn was a leadership decision; after all, officially and by law I’m the president & CEO of my corporation. Allocating time to a losing strategy that I had no control over didn’t make sense. It was time to think of a new strategy; time to drop the old one.

Whether your company or department is large or small, if you’re in a leadership position you need to learn how to evaluate, initiate, track and modify and, if need be, stop a process, figure something new out and start again. If you know why something isn’t working and you can determine it’s an aberration that’s one thing. If you can’t, that’s another.

Never be afraid to change if your intention is to try to make things better. For that matter, when things are working well, always be looking for ways to keep growing instead of waiting for the fall. Waiting always brings on the fall, and you might not be able to recover all the time.

Thanks for going along LinkedIn; as always, you’ve provided a nice lesson to learn from… whether you intended to or not.

Digiprove sealCopyright protected by Digiprove © 2016 Mitch  Mitchell
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In February I gave a talk to students at Syracuse University that was hosted by one of their sororities titled “Health Care Diversity And It’s Affects On The Minority Community”. Although that talk went very well and was well received, the funny thing was that’s not the original presentation I put together for it.

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When I was initially contacted, I was asked to put together a presentation on what a revenue cycle consultant does. I created that presentation, set it up so that it could be as long as 2 hours, then worked on whittling it down to around 30 minutes. That’s how I work on speaking projects; I always put together a long outline, rehearse, then start cutting what’s not really needed or adding more if I’m supposed to talk longer.

Anyway, I had this pretty good presentation that I put together that I didn’t get to do. I also realized that in all the years I’ve had this blog I’ve never addressed that specific topic; talk about a bad business move, especially since I always tell people that’s what I do (unless I’m not talking to people in health care, because… they don’t care).

Back in December I wrote a two part series on the basics of being a CDM consultant, but I talked almost exclusively about charge master consulting rather than revenue cycle consulting as a general topic. However, I used my best opening line when talking about charge masters in that article… and I was slightly wrong; let me explain.

In that article I said that the charge master was the respiratory system of a hospital, physician, clinic… any medical entity that needed a quick way to capture charges that are already priced and coded so bills can go out quicker. Only, it’s kind of a misstatement.

Truth be told, revenue cycle is actually the respiratory system of medical providers, with the circulatory system being the most critical as it includes doctors, nurses and other clinical providers. The charge master is actually the respiratory system of revenue cycle; whew, glad I fixed that.

Back to the original question; what is a revenue cycle consultant? To answer that, I now have to tell you what the revenue cycle consists of:

1. Admissions/Registration

Anyone who’s ever been anywhere to get medical services has had to give information to someone before they can be seen. These are the front end people, and what they do is critical because if they get all the information up front correct it can help speed up the billing process if everything else along the line is done properly. Admissions is usually the term used for inpatients, while registration is for everyone else.

2. Charge Capture/Ancillary Departments

Ancillary departments are those that generate revenue such as radiology and lab. Pharmacy is technically an ancillary department while supply isn’t, since they supply the ancillary departments with those supplies. The charge master is most crucial to this stage of the process because the people capturing the charges rely on it being correct and set up properly throughout the computer system.

3. Billing/Patient Accounting/Business Office

Everyone knows what this is… at least they think they do. These days, there’s very little billing done in the billing department because most claims go out electronically and, unless there are major errors, probably 95% of medical claims are never seen by anyone in billing… or any of the names you see above. Once again, the charge master is crucial here because of the pricing and specific codes that have to go on the electronic claims in order to get paid.

4. Collections

Luckily most patients don’t have to deal with these folks, who in my opinion have the hardest job because they’re the ones who have to chase people down after they’ve gone back home and either feel better or worse and had moved on from remembering that they might owe any money to those who either treated them or performed some kind of procedure on them.

Now that you know what the revenue cycle is, you pretty much know the duties of a revenue cycle consultant. The best consultants know every piece of the revenue cycle process, with the possible exception of charge master. I’ve found few revenue cycle consultants who have a good understanding of the process or coding; that one thing helps to set me apart from the majority.

What we do is either fix or help improve these systems and processes when there are issues. For instance, if admissions/registration has problems with accuracy or speed in getting people into the system, a revenue cycle consultant can address that.

If charge capture is an issue, same thing.

If accounts receivables start to climb and cash is falling, or there are a very high number of denials, having someone on the outside come in to help can be very beneficial.

Collections is all about process and identifying the best claims to work on, and sometimes an outsider with a lot of experience in dealing with such things can bring new ideas to help rectify the situation.

Over the next few months, I’ll be integrating more articles about this process into my articles here, along with my normal leadership, diversity and motivational items. After all, what I’ve just noted here is only a small section of the presentation I put together. Who knows, maybe these articles will help someone that needs it, like when I wrote my article giving 10 revenue cycle tips last November.

Or maybe it’ll just help me; I have no shame. 🙂

Digiprove sealCopyright protected by Digiprove © 2016 Mitch  Mitchell