Now is the time big clinics, little clinics, one provider practices.  The often heard mantra is “if it’s not broken, don’t fix it”.  I challenge that with “break everything”.  Now don’t shy away, keep reading! So often we are so enmeshed in the “status quo” in our healthcare business office that change is not only a dirty word, but a rarely used one.  Our current health care culture almost demands that we change the way we do business; not just as an exercise, but as a way of creating a template within which our business offices can flourish and quickly respond to this changing business environment. Business as usual will simply not meet the demands of physicians, staff and most importantly patients.
So where do you start?

1. Analyze everything– document what you are doing now, in detail.  I’m betting this exercise will reveal things you actually weren’t totally aware of. By everything I mean everything in the revenue cycle process.  Start with the practice management system.  How is it set up? Why were the decisions to set up made? Has anything changed that you may want to re-think the options available? Are there options you are not now using that somehow got lost in the shuffle?  Analyze check-in and registration process. Does it work? (Meaning of course do you have minimal denials) Analyze how charges get into system, analyze how charges are processed, what the turn-around time is on that process.  Analyze the coding process. How often to you send charged to clearing house? Who works clearing house denial reports? How are payments posted? How is balancing accomplished? (and please do not tell me you do not balance charges and payments daily) Who and how are denials worked? Who works credit balances? How is aging of accounts handled? what about the secondary process? What is automated? What isn’t and why? Analyze policies and procedures (make sure they are current and “real”) Analyze training, analyze outcome of training. Analyze positions, who’s on first? Look at the CBO staff to physician ratio. Analyze hardware needs. Am thinking you get the picture.  This process will take some time to accomplish, but will render a wealth of information that will become your blueprint for change.
2. Make a commitment to change – This is a long term commitment that requires every provider, management and staff. And this is a leadership mandate.  The management leaders must indeed manage this process to get to a win win outcome. Talk about it…..create a slogan for it….make it a fun project…….get everyone on board.  Talk about it some more.
3. Create the change plan – This too will take time.  Whatever you decide to change, make sure that the over-all goal in the change is to either cut costs or improve revenue.  I went to college where the founders motto was “plan your work, work your plan”.  You will be able to accomplish only what you have planned to accomplish!  Write out the plan with a time-line and let everyone see it.  Now, as you are in process, things may need to be tweaked as reality of changes settles in.  Be flexible, be open to suggestions from staff, be creative, think so far out-side the box that you can’t even see the box any longer. Look at MGMA stats for best practices, use those stats as goals.
4. Begin at the beginning – This may sound obvious, but you would be surprised at how many want to start at the end and work backwards…….never works. What’s the beginning? Patient encounter with a practice is the beginning. All other processes should be built around how that encounter happens and how registration takes place.  Get that one process right and many other things will fall into place. Be logical in your approach and don’t mandate.  There often seems to be a war between front end and back end offices; that needs to be changed to a collaboration of people and processes. Educate, listen and work together for the patients best experience.  Keep in  mind that patients getting a timely and accurate bill is just as important as satisfaction with provider services.
5. Details, Details, Details – The complexities of billings are extensive.  Pay attention to the details!! It’s the details that are so often lost in processes that may be creating a problem or preventing you from solving one. As a manager, you hope that you have really good detail people to manage the day to day processes and people; however, even that needs to be analyzed and changed if not working.  Take time to understand the billing system and options available to you.  Automate where practical. This effort may be painful at first, but will reap great cost savings if managed appropriately. It may also mean you need to get your software rep in house for a few days to make sure you understand all ramifications of change and automation. Ask questions, make sure they give you real answers!
6. Provide Feedback often – hold regular and open meetings with staff to talk about progress and encourage them when things seem slow and complex. Re-engineering is an awesome task, but keep everyone on track and on task. Listen, encourage, don’t take “but” as an option.  I used to tell staff, “don’t tell me what you can’t do”.  Raise the bar for them and for yourself…….you will be amazed at how staff will respond to your trust in their ability to affirmatively answer that call. Get rid of nay-sayers and people who inhibit progress.  Regardless of what job they do, or how competent they are; do not allow negative people to sabotage what you know needs to be accomplished. Keep providers in the loop as well with updates and progress milestones.
7. Analyze outcomes – with every change you should have a way of analyzing the outcome of that change. Does it indeed expedite a process?  Is there a cost savings? Is revenue enhanced? This should be an on-going process; indeed even if you do not fully re-engineer but see ways to improve processes you should be able to report on the quality and quantity of those changes.  Management will be particularly interested in this analysis.
8. Take a deep breath –  Change is hard!!  It will at the same time create stress and generate excitement. Don’t rush the process! Change takes time, and everyone needs to understand your timeline and goals for change.  Keep a steady eye on goals and trust the process you have gone through to create change. Be a leader, people respond to strong and confident leaders and will follow change when you “sell” it well.
9. Work hands-on with key change areas – You cannot effectively manage change at a distance. Be closely connected to those people and processes that will be most affected by change.  Listen to them, work with them, and show them the plan for change.  People work best when they understand what’s going on and why.  Ask them for regular feedback.  A well laid out plan with milestones will give you and staff confidence that the change plan is working to your expectations.  Tweak when you must, but most of all stick to the plan.
10. Give credit where credit is due –  change does not happen by magic.  It happens because good analysis has been done, a well thought out plan has been documented, on-going analysis demonstrates success and the bottom line reflects accomplishments.  Even as everyone must be a part of the process, those who work diligently, effectively and smart to implement plan should be rewarded and credited. This does not have to be a monetary reward, can be recognition in front of staff, a dinner coupon, a paid day off. But success should always be recognized and credit given to those who made it work.  Be as creative with this as you have been throughout the process.

Now, get started with that analysis and let me know how it’s going.