January 31, 2023

Healthcare isn’t really the place to learn how to think outside the box. For the technical professions, it becomes critical to make sure everyone knows the process and procedures as accurately as possible in order to not make mistakes, which can be costly. For the caring side, being able to follow the same exact process with each patient helps to maintain efficiency.

In patient accounting, following procedures helps to make sure there are no errors also. It helps everyone to keep receivables steady, cash flowing, patients registered properly, etc. Or does it?

The entire patient accounting process is at a disadvantage when it comes to staying the same. You’re at the whim of all the other departments combined as it pertains to each months revenue and productivity numbers. If in one month revenue is high, it usually means there are more accounts to deal with, which puts more pressure on your billing staff. If one month there were significantly more surgeries than usual, there was extreme pressure on the registration staff that handles them. If the count went the other direction and you had less activity than normal, chances are that at least some people throughout the process may have had less work to do, which means they weren’t being as efficient with their time as they could have been. The ups and downs of the numbers flows into secondary billing, self pay accounts, and collections.

What I’m saying here is patient accounting can’t really ever afford to stay put and hope the current processes will always work. We all know already that it doesn’t. At one facility, I inherited a billing staff where the days in receivables were over 130. We got it down to below 70, but then they started going up again. No change in personnel, and I knew they were all trained, yet something had happened that was outside my jurisdiction, so to speak, and I hadn’t anticipated how the change would affect my department, nor had anything in place to make sure my numbers didn’t fall apart when that change occurred.

So we need to learn quicker than anyone else in the hospital how to think outside the box, sooner and more consistently. We have to think of ways to address billing backlogs way in advance. We have to think of ways to collect some kind of payment from patients who owe sooner. We have to be prepared to handle the times when the workload is higher, and the times when it’s lower. Let’s do some practice sessions in thinking outside the box. If you already have some of these things in place, good for you.

Why not a float? If you have a small department, I hope you’re already alpha-split, which means everyone has been taught how to bill and collect everything. That’s the only way you can make sure you’re covered when someone goes on vacation, or you have a shortage of staff. If you have a large staff, your issues are obviously more complex, but your teams can probably absorb a missing person easier.

In both cases, though, why take the chance? Why not have a float person, someone who’s at least familiar with every type of bill, who can fill in when you have emergencies? You as the manager are expected to know it all, regardless of whether your billing personnel do or not, so why not have one other person who at least has the practical knowledge of being able to sit at a computer and do some cursory work on claims? This person could be someone who already works in billing if you’re a large facility. It could be a registration clerk who does some backup work when things are slow. You could arrange with another department to show one of their personnel a few things they could do for your department when their workload is low. We’re not talking fully complex things here. We don’t want floats doing heavy research, and in most cases you don’t want a float handling the phone calls either. But we all know there’s plenty of maintenance computer work that could be handled by someone other than your billing personnel, and if that part can be given to someone else it eases the load on the folks you have doing that work on a full time basis.

2. Cross train. This one is done often enough, but not to the nth degree, if you will. There are still many facilities in this country who feel that registration people and billing people should be paid differently because the jobs they do are so much different. Not the case at all if you ask me, but even if you feel this way, cross training some of them into billing, as well as some of your billing personnel into registration, can help to even the playing field.

The benefits here are many. As before, if you only train people to do some of the cursory work, which could be as simple as giving them a list of financial classes to change, it affords you the opportunity to let people you’ve trained in one respect to concentrate on other things. But this goes both ways. At one facility I worked at, we had the billing personnel trained to handle registration at times when the crush of registrations might have been a bit heavy. Our lab handled an amazing number of outside samples, and they had to be processed through the system in a short time period. If no one in registration was free, it was no problem for us to send a billing person to help input some of these specimens. A couple of hours each way, as it concerned billing, wasn’t going to make or break the department. I also had a deal where we cross trained hospital runners, as well as some volunteers, on how to handle small paperwork and filing projects. Even in today’s paperless systems, there does seem to be a lot of paper, doesn’t there? Also, because of our size, we had at least two ward clerks trained on how to register direct admits so it didn’t impact patient care (nurses stated they couldn’t order pharmacy items or blood draws unless the patient had been registered first), and then we would have someone follow up with the patient or family later for more specific demographic information. There are many patient accounting folks who balk at having anyone outside their department having any access to our systems, especially in today’s HIPAA environment. The truth is that every hospital employee has already signed confidentiality forms, and as long as access is restricted only to the specific duties you need them to perform all should be fine.

3. Can you move your office someplace else? Maybe not the entire physical body, but some parts of it? Centralized billing is a wonderful thing because you know where everyone is, and if there are questions to be answered there’s always someone available. Some facilities are seeing some benefits, however, to having a specialist of some kind, maybe a cashier or a billing person, dedicated to certain areas of a facility, such as the emergency room or outpatient surgery centers. At one health center I know of, they have a billing person in the dental department because that type of billing is different than traditional healthcare billing, and it gives them an insurance expert to rely on instead of just the person answering the phones and taking appointments. At one of my facilities I had the billing person in the attached nursing home rather than in the general billing office because that gave her the opportunity to talk to the family members of those who were in the nursing home without it having to be a separate trip.

These are just a few ideas; you probably have way more, if you decide to take the time to think of whether you need them or not. The main point is that you need to always be ready to change and come up with something that might work better, because, as I said, you’re working in the most flexible, ever changing department in your entire facility.