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11/15/2016
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Developing your Talent in RCMBy
Franklin SmithCRCE-I
Make a case for developing home grown talent.
Establish a baseline method for team members to successfully learn.
Utilize bottom-up approach.
Front line staff leading projects
All staff levels provided coaching opportunities
Use delegation as a method to improve staff competencies.
Costs effective ways to develop your team.
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Cash Collections
Denials Management
Staff Development
Registration Accuracy
Bad Debt Reduction
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Multiplicity of specialties and their billing rules
Difficulty of understanding the specificity of billing operations for various lines of business
Diversity of people involved in revenue cycle
Information technology used to managed processes throughout cycle.
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• Multiple Reimbursement Models
• Consumerism, Patient Experience
• Presidential Election ResultsStrategic Alignment
• Health System Consolidation
• Diversity of Billing Knowledge for Several Provider Types
• Matrix Managed Organizations
Community Healthcare Alliances
• Impact of Meaningful Use on the Adoption of New EHR Systems
• Need for Super Users, Emergence of New Leaders, Recognition of Hidden Talent
RCM Technology Advances
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Putting out today’s fires
Non-actionable succession planning
Self-indulgence
No time or budget developed
Fear of losing influence
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Educated staff prevent fires
High achievers want knowledge
People need to feel you care about their improvement
Training builds loyalty, increases productivity
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Align Training Goals with KPI
• POS Collections
• Denial Deductions
Monitor Track Trends for Coaching
Opportunities
• Establish expectations
• Fine tune action items
Determine Bottom-line Impact with
Results
• Share ROI!
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Cash Collections
Denials Management
Staff Development
Registration Accuracy
Bad Debt Reduction
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What’s best for my team?
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The Nebraska Department of Education delayed the release of the writing test results until Friday after some districts raised questions about ...
It seems like the public school system is getting worse and worse. ... need to be reward systems in place for the best teachers to encourage good performance.
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What are SLOs?
Student Learning Objectives drive educational paths
SLO’s are aligned with jobs assigned, levels of authority and existing understanding of topic
Establishing a baseline for each employee provides data points to judge progress
Data collected on the student or staff provide clues on what needs refining
Training is created to meet the needs of the organization based on the SLO development
Kathy Samuels, a teacher from Rhode Island explains the changing use of data when teaching people.
What do my students already know?
Data used to validate lessons learned.
How do I know they are getting the SLO?
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Graphic provided by Oregon Health and Science University
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Pre-Visit
•Front end related denials
•Calculating estimates
•Medical necessity tracking
During/Post Visit
•Customer service ratings for Registration, Financial Counseling
•UR, coding related denials analyzed along with billing edits
•Upfront cashier balancing issues
Leadership Data Points
•Succession planning strategy
•KPI tracking for revenue leakages and improvement
•Staff turnover by department
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Experience
Reflection
Conception
Evaluate
Retention
KNOWLEDGE
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•Motivating or not
•Can I obtain the skills for job
•Career advancement
•Apply learning to job performance
•How will I apply this to my day-to-day
• Job Shadowing
• Buddy System
• Volunteering
• How can this experience help me
• How do I use this opportunity to improve my team
Evaluate Experience
ReflectionConception
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Staff Opportunities to Lead RCM Projects
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5 Major Issues for Hospital Revenue Cycle Teams, Written by Bob Herman | June 26, 2012
Competing High Priorities
Lack of skilled resources in several disciplines
Narrowing margins with escalating costs
Significant changes in market
Optimization of Revenue Cycle Processes
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Daily/month-end balanceMonth-end reporting
Open issues tracking
Key metric tracking
Non-collectible adjustments
Ad-hoc reporting analysis
Root cause analysis
Pre-
ClaimPre-Visit Visit
Claim
Submission
Inbound
Processing
Month-End
Closing
Performance
Management
Account Receivables
Management
Quality
ManagementCompliance
Information
Technology
Contract Negotiations
Eligibility Verification
EDI/ERA Enrollment
Fee Schedule
Scheduling/Registration
BankingSet-up
Patient Check-in
Mail Processing
Claim StatusPatient
Statements
Provider
Credentialing
Appointment Reminders
Co-pay and deductible
collection
Patient
Payment
Arrangements
Encounter Documentation
Coding and
Charge
Capture
Scanning/Indexing
Bank Deposit
EFT,ERA Processing
Payment Posting
Revenue Allocation
Pre-Adjudication
Claim Submission
EDI Management
Request for Information
Denial Analysis
Appeals and Resolution
Inbound and Outbound
Calls
Collection Letters
Patient Refunds
Conveyance,
Small Balance
Write-Off
Transition to Collections
No-show rate
Charge Entry
Claim Scrubbing
Analytics
Cash collected
Revenue Cycle Management Support
Regulation monitoring
Coding and chart audits
Non-collectible adjustments
Coding support for billing process
Practice management system
EMR integration
Other application integration
Interfaces/data exchange
Hosting and support
Process measures and audits
Employee performance audits
External audits
Front End Back EndTransaction Processing
Life of a claim
Total days in AR
Payers denial rates
Rejection analysis
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Front-end ManagersPatient Access
SupervisorsPatient Access Team
LeadsCall Center Leaders and
staff
Patient Access staff
Financial Counselors
Billing Specialists
Billing Leadership
Pre-
ClaimPre-Visit Visit
Claim
Submission
Inbound
Processing
Pre-Visit At- Visit
Account Receivables
Management
Post
DischargeDuring Visit Discharge
Analytics
Interpret Data
RCM Banking
Elements
Negotiator
People Skills
Accountability
Presentation Skills
Vendor Management
Interpret Data
CustomerService
Physician
Relations
Sales/Marketing
Sales/Marketing
Negotiator
Data Entry/Computer
Skills
ICD-10, CPT
and HCPCS
Coding
Strategic Thinking
Reconciliation
837/835 Elements
Balancing
Revenue Allocation
Payer Specific
Education
Spreadsheet Development
Analytics
HIPAA
Root Cause Analytics
Clinical clarity
Difficult
Conversations
Writing/Speaking
Math
Computations
VendorManagement
Inter-facility
Communicati
on
Delivery System
Date Entry/Computer
Skills
RCM Process
Flow
Analytics
Data Gathering
Revenue Cycle Management Bottom Up Learning Opportunities
Billing Leadership
Patient Access Leadership
All Team Leads
Patient Access and Financial
Counseling
Discharge Clerks
Admission Staff
Financial Counselors
Cashiers
Back-end Leadership
Business Office Staff
Denials Team, Clinicians
Front End Back EndTransaction Processing
Educating Staff to Survive the Life of a Claim
RCM Formulas
Data to Knowledge
Rejection analysis
FinancialCounseling
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Frontline Individuals
Most Interactive
with Customers
Most in Touch with Consumer
NeedBiggest
Influence on Performance
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People Learn When People Do!
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TEACH LEADERS TO OVERCOME BARRIERS
Staff cannot do the job managers can
Less time to do work than it is to train someone else
Limited belief in employee’s motivation and commitment to excellence
Self preservation
Plain ole I like to do it myself mentality
Retention of staff due to current workload
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DELEGATE THESE TASK NOT THESE
Staff development
Recruitment of certain teams
Specific short and long term projects
Day to day repetitive activities
Competency building and stretching
Leadership team building
Crisis Management
Delivering praise
Disciplining employees
Secession Training
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Face-to-Face Meetings
Confirm Understanding
Clearly Define Authority
Continual Coaching to Control Outcome
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Revenue Cycle Offers People
Building Opportunities
• Leading daily team meetings to reinforce daily goals
• Tracking performance versus goals
• Researching and reporting on payer contracts and modifications
• Training new staff on task related duties
• Event management, special engagements and visit types, insurance maintenance
• Customer service training specific by revenue department and related payer requirements
• Dictionary maintenance and building for systems converting EHRs
• Production of team newsletter to communicate with internal and external customers
• Call center, IT management and training
• Scripting and form letter development
• Provider specialty services and practice liaison
• Secession training and planning
• Denials team participation, expansion of network
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Director
• Invoicing and Payment
• Budget Preparation
• Production of KPI Reporting
Manager
• Time and Attendance
• Project Management
• Standard Meetings
Supervisor
• Daily Staff Meetings
• On-boarding Staff
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Director
• Explore New Technologies for Possible Implementation
• Create Denials Teams for Specific Problem Areas
Manager
• Production of KPI Reporting
• Budget Preparation
• Invoicing and Payment
Supervisor
• Standard Meetings
• Project Management
• On-boarding Staff
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The Investment will be Well Worth It!
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Job Shadowing
Big Brother Big Sister Partnering/Mentorships
Online Education
Trade Organizational Programs
Guest Speakers
Development Goals Established during Performance Reviews
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AAHAM Certifications
Hospital Association Specialty Classes
Professional Education Software
Web based Training Exercises
Higher Education
Public Speaking Societies
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Employee Retention Now a Big Issue: Why the Tide has TurnedPublished on August 16, 2013Featured in: Recruiting & Hiring
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Bersin, Josh. “Employee Retention Now a Big Issue: Why the Tide has Turned.” www.linedin.com. Web. 16 Aug. 2013. Nov. 2016.
Lipman, Victor. “Why Employee Development Is Important, Neglected and Can Cost You Talent.” www.forbes.com. 28 Jan. 2013. Web. 10 Oct. 2016.
McLeod, Saul. “Kolb – Learning Styles.” www.simplypsychology.org. Web. published 2010, updated 2013. Oct. 2016.
Rhode Island Department of Education & National Center for the Improvement of Education Assessment, Inc. “Using Baseline Data and Information to Set SLO Targets.” www.ride.ri.gov. Web. Oct. 2016
Veliz, Mynor. www.slideshare.net. Web. Nov. 2016.
Thompson, Molly. “How to Calculate ROI for Training.” www.chron.com. Web. Nov. 2016.
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Mr. Franklin Smith, Jr.,
Director, Patient Financial Services
Calvert Memorial Hospital
Phone 410.535.8259
Email: [email protected]
Twitter: @flsnupe
Website: www.calverthospital.org
