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A few weeks ago I was talking to someone on Twitter, a writer. We were both lamenting the need to think about hiring others to do some of the more mundane things we have to do, being self employed, that could possibly leave us more time to work on our craft.

photo (19)

I said that one of my goals was to get to the point where I could hire someone to clean my house once a week. She said that she couldn’t imagine anyone else cleaning her house and that if she actually did hire someone she’d feel compelled to clean the house first so that whoever showed up didn’t think bad about her house being messy.

I thought that was pretty funny because that’s exactly the same type of thing my wife says all the time. The one time she allowed someone to come to the house to help clean was when we were going to throw a large holiday party the day after I spent the night in a sleep lab, and she felt she needed some help with last minute cleaning. Even then, the areas she asked the person to clean were areas that she’d cleaned days before so that those areas wouldn’t be what she considered “nasty” to have someone else working on.

I have no such qualms. Many years ago when I was single I had someone come in to clean my apartment every couple of weeks. I’m not super messy but I do tend to accumulate a lot of clutter. I also felt overwhelmed because I was driving an hour each way to work, sometimes coming home late and every once in a while going back into the office on the weekend. Add in that I was in two bowling leagues a week and, when I wasn’t working late, bowled 2 other nights if someone called needing a substitute.

I’ve never met a single male who’s had any worries about having someone come into their space to clean up, and some of those guys were pretty nasty; just sayin’… Yet, I’ve met a lot of women, way more than 70%, who couldn’t conceive of someone coming into the house to clean, no matter how much stress it would relieve, let alone the reality that they could afford it.

Suffice it to say that, in general, men and women think and act differently about a lot of things. The same type of thing applies to leadership as well. Over the years, I’ve worked mainly with women employees. I’ve had maybe 6 or 7 men who’ve worked for me over the course of 30 years as compared to at least 250 or so women. I’m not going to say I’m an expert in working with women, but I can easily say that once I found my groove I was certainly skilled enough to know how to work well with women and enjoyed it immensely.

When it came to leadership positions I’d have to say the ratio was around 65-35% men to women. They were mainly peers, but I did have occasion to report to female leaders. What I’ve encountered has almost always been different than working with men; I’m not saying better, just different.

I’m not an idiot, so the last thing I’m going to do is try to illuminate the differences in women and men as leaders. Instead, I’m going to relate how, because of working with so many women, I communicated differently with women leaders and how they communicated with me. I tend to believe that the way I communicate is what’s actually shaped me into the person I am now, falling into a place I don’t believe I’d have ever reached if I’d only interacted with men or mainly men. Let’s take a look at it.

Raquel & Me

First, I’m not as direct with women leaders as I can be with men. That’s because I’ve never had a woman leader think that I might be weak in the way I’m talking to her. I’ve had some men here and there who made the mistake of thinking that kindness is weakness.

Second, I’ve learned to have a lot more specifics ready to address when working with women leaders as opposed to working with men. The reason is that women are generally more apt to want to understand an issue than many men are. I’m only talking about leaders here and not all employees. Many times I’ve found that male leaders will either stay quiet and walk out of a meeting not understanding what’s going on or act like they know what’s going on and put their foot in their mouths. Every once in a while that happens with women leaders, but not as often.

Third, I’ve found that my own behavior allows me into the inner circle than it does most men when it comes to the sorority of women leaders. I’ve had more business lunches with women than men, and it’s not because I’m hitting on them or condescending to them. It has more to do with talking to women as equals, which I don’t see as often with other male leaders. I like to think I’ve been able to inspire a level of trust with women that doesn’t happen as often with men at work. This is a small thing, but I can tell a woman leader if she’s got something hanging off something she’s wearing without her thinking that I’m being lascivious in any way whatsoever.

Fourth, I’ve learned to listen better and to be prepared for a lengthy story. In a way, it’s reminiscent of learning the listening skills of the Navajo, who have a roundabout way of getting to a point by telling a story. The conversations can be nuanced such that something could be missed if I’m not listening properly. Trust me, I’ve made that mistake enough times to know better because often questions need to be asked to get the information that’s really needed to push forward.

Women leaders don’t get to the point as often as men do, and often that’s a good thing because if one listens, you’ll get almost everything you need in more ways than one, which helps to alter the solutions because of the different layers. It gives me a chance to get it right the first time instead of having to go through lots of starts and stops.

As I said earlier, I treat men and women leaders and peers the same; for that matter, I treat all employees the same. Because of the lessons I learned from working with so many women, I’ve been able to use skills I’ve developed to better use when working with all leaders. I do recognize that my skills are better suited to working with women leaders though, at least initially.

With men, I’m either given carte blanche or having to give information on a more regular schedule that impedes the work I’m trying to do. Frankly, I love the carte blanche thing much more; who wouldn’t? But the other end… ugh.

Like I said, different, not better or worse. This is based on what I’ve seen and observed; what are your thoughts and realities on this subject?

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My most viewed YouTube video is a review I did comparing Verizon FiOS to Time Warner Cable, with over 17,000 views. My second most watched video is also about Verizon FiOS with over 6,600 views, where I talked about trying to get my 2nd phone line in and all the issues we were having at the time. It literally took a month for me to get everything into the house that I was supposed to have.


Months later I realized I had an issue with the second line. I have a fake name in the phone book for my main number, which helps me to eliminate anyone who calls asking for that person and just hang up the phone after telling them no one with that name lives at the house. We set that up about a month after moving into the house in 2000 and it’s worked very well for us. What we discovered is that the second line, which we both use for business purposes, was using that same name, and helped explain why certain potential business contacts might not be picking up the phone.

I called Verizon and asked if we could change the name that went out on that second line but were told that both lines had to show the same name. That couldn’t continue, but it took me 9 months to finally decide to change things over.

I went to the Time Warner office because I still have an alarm system through them and asked if they would claim the second phone number and move it back to them so I could have the phone back in the name I wanted it to show. The customer service guy gave me the box, told me to hook it up to the phone in a few days, and all would work just fine, and the cost would be the same as what I was paying Verizon; that sounded pretty sweet.

The day comes, I hook up the modem, and… nothing. No dial tone whatsoever. Then I remembered that the guy said I might have to call to have the service activated, so I picked up the other line and called them. I wanted to talk to a technician so I hit “0” and actually got to talk to someone.

He asked me if I’d hooked the modem to the phone and I said yes. He asked me if I’d hooked the modem to the cable and I said “Uhhh, I have Verizon FiOS. I mentioned that to the guy at the office when he gave me the modem.”

He said “Oh. The modem won’t work unless it’s connected to cable. We can’t connect it to the Verizon service either which means we’re going to have to send a technician out to you.”

This means I’m without a business line for 3 days since I have to wait until Friday for the technician to come. Truthfully, the calls I’ve been getting lately haven’t been all that great so I’m not upset by what I might be missing. However, I am upset a little bit by not getting the proper information up front. Turns out I could have had my phone line last week if I’d known about the cable issue.


Three weeks ago I wrote a post talking about leadership and customer service and the week before that I wrote another post about the importance of listening so one can respond to questions and issues properly. I wrote about those two things based not only on what I’ve seen as a consumer but also what I tried to address with my team members, where a bit part of the work they did was talking to customers. I used to say that it’s hard to properly answer customer questions if you’re already talking or doing something else before they finish telling you what their probably is. We can’t always assume that every person we talk to has the same issue that the person before them had unless we caused the problem.

I thought back to the day I was in the office in front of this guy. I remembered that what he told me was a 2-minute process ended up taking 10 minutes, and that he seemed confused a couple of times as I stood there waiting for him to get things done. I think his issue must have been that I wasn’t the typical Time Warner customer since I didn’t have their cable or internet, which might have been something they weren’t set up for or expecting.

I’ve wondered if maybe he’d been listening and actually heard me mention FiOS that he would have realized that I couldn’t perform this installation on my own. I’ve also wondered if this was a true leadership fail, not because there was obviously a failure but because it’s hard to think of everything that could possibly happen when it seems a bit inconceivable.

In the end I believe that even if the Time Warner guy I was talking to wasn’t totally listening, he wasn’t really at fault in this case. Although I doubt I’m the first person who’s ever asked for just a Time Warner phone, based on his confusion the day I was in front of him I do believe it might have been his first time dealing with this issue. In that case, if it’s a rare enough issue that this was his first time dealing with it (I’ve been going there for years to pay my monthly bill but he’s been there maybe the last 6 months) then it’s hard to blame leadership for this one at the same time.

Sometimes it’s not anyone’s fault when things don’t work out. I think this is one of those times where everyone gets a pass; how often does that happen? Am I being too nice? Do you agree with me? Let me know your thoughts.

Digiprove sealCopyright protected by Digiprove © 2016 Mitch  Mitchell
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“Life is about success not perfection” – Alan Weiss

A few years ago I wrote an article titled Is It Bad Reaching For Perfection where I talked about the reasons why going for perfection aren’t bad, but that it doesn’t take perfection for one to be successful.

Leo Reynolds via Compfight

Almost 6 years ago I wrote another post talking about a friend of mine, her drive for perfection, and how it was going to hold her back from being successful. Unfortunately that one turned out to be true in more ways than one.

I’ve always known that I wasn’t perfect, but that didn’t stop me from going for it. I have this belief that to attain perfection would be the ultimate thing to do, even if in the end there would probably be little benefit to it.

In another month I’ll have been self employed for 15 years. That’s not bad since an overwhelming number of people don’t make it 5 years. I’m not patting myself on the back for that one because it hasn’t always been a smooth ride.

I haven’t always made it easy for myself because for years I was trying to find the perfect way of marketing my primary business to an industry that doesn’t work like other industries, that being health care. Because of that lack of success I kept trying to find new ways, modify some of the old ways, hoping there was a perfect solution that would lead me to great success.

I finally found my solution, though it’s not perfect, but it’s definitely out of the box. I decided to stop marketing to my primary industry because those folks don’t want to talk to me. For that matter, most of them probably don’t even understand what I do; I’m good with that.

Instead, I work in concert with other organizations who do the grunt work and then contact me to see if I’m interested. For the most part that’s been the business model I’ve had success with for most of my 15 years in that area. I figure why keep banging my head against the wall, so I’ve decided to give myself a break on that front. It’s not a perfect solution but it’s a workable one that’s been pretty beneficial; I can live with it.

Once I decided to let that one go, I found that I brought a bit more peace of mind into my life. It’s allowed me to market my other services, maybe not with great success but at least I now have people talking to me. It’s allowing me to work on my 4th book, this time on motivation. It’s allowed me to get paid a lot more than I previously was for writing articles. Best of all, it’s allowing me to stay closer to home, which is imperative as my mother’s health declines.

All of our lives are built upon our successes, large or small. Mine range from helping a hospital increase its revenue $730 million in a year to finishing my second book on leadership to doing seminars and speaking engagements across the country. I know I’m not close to perfect, but I’ve done some things others never will, just as people have done some things I’ll never consider doing (like climbing mountains or jumping out of planes; ugh!).

I’m looking for more successes, and I’ll take what I can get. What about you?

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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?

Digiprove sealCopyright protected by Digiprove © 2016 Mitch  Mitchell
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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.

American Waitress
Thomas Hawk via Compfight

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

Listen to your kids
Bindaas Madhavi via Compfight

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
Melvin Gaal via Compfight

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. 🙂

Digiprove sealCopyright protected by Digiprove © 2016 Mitch  Mitchell
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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
Creative Commons License Ole Kristian Losvik / LOS365 via Compfight

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

Phill MV via Compfight

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."
Nathan Proudlove via Compfight

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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