8 Health Care Business Office Specifics

I often think hospital billing offices make the general process way too hard to figure out. There are some things that can be put into place or enacted upon pretty easily that will help them long term.

Ben Mautner via Compfight

The thing is, not all of them are directly related to medical billing; that's the easy part. A lot of it has to do with leadership and working with other leaders within the hospital.

Other than the first thing on this list, which is specific to medical billing, the rest of these principles will work for all businesses... so y'all need to read this as well. 🙂

A. Alpha split versus insurance specific

Although I said this one is specific to hospital medical billing, I have a feeling there are other industries where this type of thing might be prevalent.

As it regards hospitals, I've always believed in the rule of numbers based on staffing. If you have a small staff, which means less than 10 people, it makes more sense to set up your office based on the letters of the alphabet than on specific insurance types. There aren't all that many insurance types, and it's known that some insurance types, such as no fault, are going to have fewer claims than others, such as Medicare. It also helps to have more people who know how to handle every type of claim so that the department isn't overwhelmed if someone is out sick or on vacation, or if staff is short for some other reason.

When you have a larger staff, you have a lot more choices on what you might want to do. Alpha split within the teams you set up is still the smart way to go for a proper distribution of work, but you can create teams based on the amount of work or the type of work, such as inpatient versus outpatient.

B. Division of work; how much is too much or too little?

This is a much different issue than the one above. This one makes you be more managerial in determining the strengths of your employees, their individual talents, and who can actually handle the workload you might have to impart on them.

It's not all about numbers when you get to this level. You might have some really talented people who can handle things that are a bit more complicated, rather than those people who can produce great output if you lay everything out perfectly for them.

thetaxhaven via Compfight

C. How much do your employees need to know, and what do you trust them to do?

I've never been one of those leaders who was worried that someone working for me might know more than I did. What I figured out at a certain point was that I would know more about strategy and procedures but the employees would know more about processes and what was actually going on with the system, since they did the work.

Because of that, I was always willing to share whatever I could with them. However, I know in many businesses that leaders either won't or can't do the same thing... most of the time "won't". This leaves employees doing things the best they can without all the knowledge they might wish they had, but knowing that the rules say they do their part in the process while someone else is responsible for another part, like certain types of factory work.

D. Is it best to go to other directors or employees in their department?

This is a tough one that depends on the type of business you're in and the kind of trust you've built up. I was lucky in that I was allowed to talk to anyone based on the type of work I did, and I was fortunate that everyone would talk to me because they all knew I treated everyone fairly, no matter what work they did.

This is important for more than one reason. Sometimes other directors don't want you to ever talk to their employees. Sometimes you know you need to talk to the employees because they're actually doing the work that impacts your department. Thus, it behooves you to have a great working relationship with your peers so that you can easily move between everyone when you have to make sure you're getting the proper information you need.

E. The patient isn’t always right, but they’re always the patient

I'm using patient because I started out talking about health care, but everyone else can use "customer".

Sometimes you have to disagree with the people who you're really working for who aren't your employers, while at other times you might have to tell them something you know they don't want to hear.

No matter how they take it, you have to work hard to remain professional instead of losing your cool or being sarcastic towards them. This doesn't mean you have to suffer abuse that's unwarranted. I once hung up on a patient three times because he began each conversation by calling me a profane name without knowing me.

The fourth time he called he asked me if I was going to hang up on him, to which I replied "Not if you don't call me names and give me a chance to help you." Five minutes later we were best buddies because I'd taken care of his problem.

All most people want is a bit of respect and some attention to the reason they're calling you. Without these people you might not have a job; how much does it take to treat them with some respect?

F. What does upper management know about what you do?

If I've learned anything about upper management in all my years, it's that they really don't know what most of their department directors do. I'm not saying that to indicate that these aren't intelligent people; it's just that many of them have people who report to them that do things they've never seen or done.

In health care it comes down to a lot of the technical work. The departments that report to CFOs all do work that almost no CFO has ever done and probably hasn't seen. Most of the departments that report to either the COO or Nursing VP do work that those folks have probably never done or seen.

Outside of health care... well, we know that the CEO of Wells Fargo just resigned because many of the employees were creating false accounts and basically stealing money from many of their clients to do it. He said he never knew it was going on, even though a letter showed up telling him that there was a possibility it was going to happen.

If you look at his background, you'll see that he spent the overwhelming majority of his career in leadership positions all over the country, sometimes overseeing multiple departments at once. When you're that kind of leader, it's strongly possible that you don't fully understand the type of work that others are doing to know whether or not it should be allowed.

From my perspective, I vacillated between how much I wanted to tell my CFOs. I needed them to know the good and bad things that were going on and how effective I was, but I didn't have the time, nor did they, to go into the nitty gritty of the daily work unless it affected budgets and cash. Still, I had to make sure they knew what was going on since that's how I was going to be evaluated on a yearly basis.

G. What are your language skills like? Are your employee problems derived from you?

I'm big on communication when it comes to talking to employees. I had to learn the hard way that sometimes terminology we get used to using in our profession isn't always fully understood by the people who work for us.

When we don't take the time to find out what our employees know and how they interpret what we're saying to them, or if they don't fully understand department goals, we're setting them and ourselves up for failure. You can't be too erudite nor condescending when you talk to people whose work your livelihood depends on. You also can't be too secretive. If employees don't understand what's going on, trust me, it's your fault if you're the leader.

H. Conflicts are inevitable; what’s the best way to manage them?

This is a tough one for most people, but it doesn't have to be. Although I always wanted to get to the truth, you'll usually find that the truth is different when you have two people disagreeing about something.

In these instances I saw myself as a mediator. My first goal was to diffuse the tension; nothing could push forward until that took place.

My second goal was to get it resolved to MY satisfaction; the workplace isn't always a democracy. If one person was wrong, I'd tell them so. If it was just a difference of opinion, I'd work with those who were involved to get to a resolution that was acceptable enough to get them back to work with expedience.

I don't believe that most people working with each other have to be friends, but they certainly need to be coworkers and work towards a common goal if they're working for me. Usually, by talking things out, the worst of tensions would be taken care of and there wouldn't be any long term animosity. I'd like to think I did a good job because in all my years in leadership I had few people leave because of how I handled something... though it did happen here and there.

There you are, 8 specific things that might help you do your job better if you're leading others. Please feel free to add to the discussion.