Articles taken from "The VOICE" February 1999

The VOICE
February 1999

Four Ways To Reward Employees Without Spending Any Money

Cash bonuses can be great, but they are certainly not the only way to reward employees. In fact, other methods can be even more effective. Here are four ways good managers can recognize employees without dipping into the budget:

1. Let then set their own schedules.Once a worker shows that she or he is a consistent contributor, relax some of the supervisory structure. Let stellar employees use their own judgement about when they take breaks, how long lunch should be, and so on.
   
2. Find advancement opportunities for them-even out side your department, if necessary. Obviously, it would be better to keep good workers in your own department. But, if there are no opportunities for them there, actively seek out promotional possibilities in other departments. Sure, you'll lose some good workers this way, but that will be offset by the image of goodwill you project. Your employees will realize that you care about their future as much as you care about yours.
   
3. Give them plum assignments. When possible, find special assignments for exceptional workers-assignments that offer them a welcome change of pace. Sitting on a special task force, for example, or working on a new project launch.
   
4. Praise them in front of their peers. The human being has not yet been born who doesn't relish public praise. Remember, though, to reserve this powerful weapon for exceptional performance. Otherwise, you risk weakening its potential power.

   -Adapted from The Supervisorís Big Book of Lists, by George T. Fuller, Prentice Hall

   State of Wisconsin

   Share your experiences!
   A wedding?
   A significant Anniversary
   A job change?
   An unusual vacation?
   A new baby?
   An unusual experience?
   A promotion?
   Commentary!

   Are any of these events going on in your life or of anyone we know?

   Call Bud Brauer at (414) 964-6000 or fax Bud at (414) 964-6040
    

   Happy New Year!
   The number of times that this familiar phrase has been repeated to us or by us in the past month is countless. Often times. too often perhaps, it is uttered (or muttered) without much thought or meaning. It is much like the "How are you?" followed by the required "Fine, thank you!" And then there's my favorite and perhaps yours too, "Have a nice day!"

   Our lives are, of course, just too fast paced as we push headlong into the next millennium. Most communications it seems are reduced to some type of electronic utterance. A click, a beep, a fax, an e-mail, a recorded message. (If I were in, I would be answering this call and asking how are you. If you are fine, press one, not feeling well, press two) .

   And, of course, we can all justify our actions and attitudes since we are all in a hurry. Corporate roll-ups, acquisitions, mergers, down-sizing, right sizing, re-organizing, improving the bottom line are all very very important. Although to whom and for how long has never been answered to my satisfaction. (Contrary to popular belief, we are not going to live forever. We are all indispensable). So how about we all make one giant New Year's resolution. When we ask "how are you?"?mean it and wait for the answer. If the response is the expected 'fine," listen for a hint that things might not be "fine." When the C store clerk says "have a nice day," resolve not to go back there. And when you say "Happy New Year", mean it! I do!

   Moving On
   WMCAers rumored to be in transit include Dave McCormick, Tim Brown, and Dick Knospe. Dennis McMillan is reported to be working for Associated Collectors in Janesville. "And finally, yours truly is undertaking a new venture, namely The Phoenix Company of Wisconsin, LLC. What is it? Another collection agency! What else? The company officially began operations February 1st."

   Not rumored, but confirmed is the retirement of CUI's Paul Schmidt. Paul follows his two long time partners Lee Blavat and Bill Cherek into retirement. Paul was CUI's second employee when he joined Lee in 1975. When CUI was sold to Asset Management Outsourcing last year, the company had grown to four offices with 150 employees. Paul's retirement plans include just relaxing.

   Sick List
   Steve Baseley continues doing his part to bolster the OR revenue for his employer Agnesian Healthcare, Fond du Lac. Ask Steve how he is the next time you see him. If his answer is "fine," ask him again.

   A Higher Calling
   Mark Herder, Assured Communications Corp., long time WMCA member and past president, r spent the last week of January in Puerto Rico. Mark joined fellow Evangelical Lutheran Church members buildings homes for recent hurricane disaster victims.

    

    

    

    
   What To Ask In An Interview

   Ask these questions in an interview to find out how well candidates will:

• Handle a sudden change in plans. "How would you respond if you spent a long time planning a project and your supervisor told you      to drop it and start a new project?"
• Relate to others. "What would you say to a co-worker who suggests a way to improve the work process that you know won't work?"
• Communicate orally. "How did you prepare for the most successful presentation you ever gave?"
• Handle writing tasks. "What do you think was the best business writing you ever did, and why do you think
• Work on a team. "How would you handle the problem of a team member not doing his or her share of the work?"
• Be open to learning. "If you could take a class or attend a seminar, would you do so, and what topic would you choose?"
• Think creatively. "How would you react if you tried an innovative solution to a problem and it failed?"

  Source: Staffing the New Work place: Selecting and Promoting, by Ronald B. Morgan and Jack Smith, ASQC Quality Press, 611 E. Wisconsin Ave., Milwaukee Wl 53201.

   

   

   

  JCAHO Standards Admitting/Business Office (Part II) By Joan Carr

  In this article, we will explore the remaining direct patient functions: assessment and Care of Patient as they relate to business office and admitting processes. We will also look at A/R viability for performance improvement. Effective practices at these levels will support organizational goals not only in the context of a JCAHO survey, but also with respect to overall financial mandates. Again, the purpose of this article is to give you workable information, which can help you achieve your goals.

   
  EXCERPT OF JCAHO ACTION PLAN (Part 2)

  Outline: This plan outline is organized around the JCAHO Accreditation Decision Grid and matrixed by the Continuum of Care (CC1-2, JCAHO Manual).

  Direct Patient Functions?Continued

  Assessment of Patients: "Determine what kind of care is required to meet a patient's initial needs as well as his or her needs as the change in response to care." JCAHO, PE-1). Goal: To have information collected by qualified (proficient & knowledge-based) individuals who will assist the clinicians & the patient in analyzing this information - enabling the patient to make an informed decision with regard to treatment.

  Initial & Subsequent Assessments:

  Pre-Admission:

  Patient outcomes are improved when they interact with a qualified individual in regard to future services.

1. Pre-Registration/Admission personnel are trained & proficient in the following: ADT processes, computer usage, medical terminology, interviewing skills, telephone skills, insurance plans, pre-cert/referral processes, etc. (see competencies list, attached)
2. Employees are given the tools to do their jobs well

   a) Reference library is implemented & maintained
   b) Insurance Plan Matrices are developed & used
   c) Computers are available

   Admission / In-Hospital / Pre-Discharge; Patient outcomes are improved when they interact with a qualified individual in regard to immediate services, as stated.

3. Cross training allows each work group to understand the functions of the other workgroups, and therefore, the "bigger picture".
   
   
4. If point-of-service mods are used, the Pre-Registration / Pre Cert / Pre-Adm. work groups act as a resource for training & information.
   
   
5. On occasion, the hospital hosts seminars for various insurers, medical ~ user groups, as     needed to support educational efforts.
   
   
6. Standard Office Procedure Manual is developed by the work groups for everyone's use. This provides a structure for consistency in work processes and supports compliance.
   
   
7. Work groups are a resource for clinicians, other hospitals, and other staff in the delivery of care.
   
   
8. Work groups assist patient counselors (both clinical & financial) with the procurement of information as needed.
   
   
9. Employee awareness is heightened to the extent that patient / family needs are met before those needs are expressed or assistance is requested ( i.e. asking a visitor if they need help. or giving assistance to a visitor in the lobby who "looks" lost.)
10. Special services provided to meet special needs: (specific requests for no entry into visitor book or no calls to a room, wheel chair assistance to a visitor, escort to a room, etc.) ADA compliance.

    Discharge:

11. Patient outcomes are improved by a timely and efficable reassessment of their insurance / billing status.
    
    
12. Work groups coordinate with patient financial counselors and education counselors to ensure information for services beyond discharge is available when the decision process for those services is initiated.
    
13. All members alert director when there are reimbursement issues, which might impact patient outcomes.

    Care of Patient: "To provide individualized care in settings which are responsive to specific patient needs throughout treatment processes." JCAHO,Tx-l). Goal: To provide continuous reimbursement and specialized information to patients and clinicians which supports in formed decision making at all levels.

     

     Pre-Admission thru Discharge:

    Patient outcomes are maximized when coordination between clinical and business processes support efficable treatment throughout the encounter.

14. Matrix staff into specialties so they can provide liaison services for other hospital departments as well as be a resource for patients and physicians on various issues with carriers, intermediaries, state agencies and commercial insurers.
15. Train & develop staff to be proficient in the above, supplying them with the tools needed to be successful.
16. Encourage interaction & partnering with other hospital departments so common understanding of the "big picture" can take place.
17. Provide a forum for problem solving & discussion for all interested parties on insurance / reimbursement issues as they appear.
18. Work closely with Clinical Quality Staff to ensure JCAHO Compliance at all levels in an ongoing manner.

    NOTE: Develop specific functions as needed for your organization or department (i.e. ASC, ER, UC, etc. )

    The goal of all direct patient functions (Clinical & non-clinical) is to ensure each patient has a Positive Outcome - defined as the patient's ability to make an informed treatment decision based on timely / accurate information.

    We cannot alter the situation where a terminally ill patient must decide whether to continue chemotherapy- knowing her children will pay for it with her grandchilds 'College fund' money. In this case we CAN ensure this patient has had accurate information about her insurance benefits all along.

    Remember: Today we help patients. To morrow we ARE these patients.

    Departmental Functions
    Improving Organization Performance: "To continuously improve patient health (& related financial) outcomes. JCAHO, PI 1). Goal: Establish the integrity, accuracy, and viability of the A/R through an operational audit, which includes an "All-Ac count Trend Analysis" report.

    Planning:

19. Systematic review of total A/R quarterly.
20. Reports designed to capture deficiencies to global work process.
    
21. Weekly meeting with work groups to monitor progress & problem solve.
    
22. Standard Office Procedures & manual developed.
    
23. Training & staff development.

    Designing:

24. Insurance matrices are designed as tools for billing coordinators to use to monitor bills and reimbursement trends.
25. Order entry function process is redesigned to ensure Medicare compliance - including a mechanism to resolve late charge entry by clinical departments.
26. System module function training is designed to maximize efficient use of the computer as a tool.
27. Internal audit system & quality program are designed around TQM & CQI principals - including recognition for excellence in job performance.
28. Financial evaluation process is designed which correctly identifies those truly deserving financial aid as well as those individuals who need to go to collection.
29. A co-pay / deductible process to focus in payment at time of service.

    Measuring:

30. A/R days in-house, unbilled, billed, denied, etc.
    
31. Collection agency performance.
    
32. Quality(error reduction)
    
33. In-house collection goals.
    
34. Reimbursement goals.

    Assessing:

35. Benchmark with VHA and other similar entities.
    
36. Determine major trends for each quarter as a focus to TQM "zero-defect goals.
    
37. Determine critical trends (key impact factors) to be resolved immediately.

    Improving:

38. Develop action plans for all of the above, as needed.
    
39. Document trends, milestones, adjustments, & revisions.
    
40. Share results with other areas to support their efforts.

    Joan Carr is President of J Carr, Ltd. health coverage & reimbursements specialists. She holds an MBA and has 20years in both the clinical and financial aspects of health care. She is a national member of the Medical Group Management Association and a member of the Wisconsin Medical Credit Association.

     

    Terms You Should Know: Is It Fraud or Abuse?

    Fraud: Fraud is an intentional misrepresentation of fact designed to induce reliance by another person. The most common form of healthcare fraud is billing a third-party payer for services not rendered. Other examples include misrepresenting the nature of the services provided, the identity of the person providing the services or the cost of the services.

    Abuse: Instances of abuse do not necessarily involve intentional misrepresentations of fact, but they do create a significant risk to the integrity of the healthcare system. As such, they are punishable under various criminal and civil statutes. Source: Effective Corporate Compliance Programs for Health Care Organizations. Ernst ~ Young LLP,1996.

     

     

     
    New Federal Budget Favorable To Healthcare Providers

    Medicare Interim System, User Fees, False Claims, and Rural Health Addressed by New Bill

    The new $500 billion budget deal constructed by the White House and Congress in October offers hope to healthcare providers who feared the worst. The following are provisions of the new budget:

     

    Medicareís Interim Payment System:
    Although congressional sources concede that this is only a short-term fix, the budget includes additional funding for home health agencies and a one year delay for
    proposed across-the-board 15% reduction in Medicare home-health payments. Providers had been concerned that the proposed reduction would endanger low-profit home-health agencies.

    Medicare User Fees:
    Presidents Clinton had proposed user fees for Medicare providers to offset spending in other areas. Although strong protests from the healthcare industry helped defeat the proposal, it is expected to be raised again next year.

    False Claims Act Enforcement:
    The budget is expected to include a requirement that the General Accounting Office monitor the Justice Department's implementation of False Claims enforcement guidelines.

    Rural Health:
    The budget will include funding for the Medicare Rural Hospital Flexibility Program. This program is designed to help financially struggling rural hospitals slay open and also to assist states to develop rural health care plans.

    Reprinted with permission of State Collection Service, Inc, Madison, W7 "Pulse".

     

     

     

    How To Identify Major Problems In Accounts Receivable

    Three ways to examine your A/R

    If it sometimes seems you've been spending all of your time firefighting óó solving one problem after another-it might be time for a closer look. Too often, patient account managers don't know problems exist in their own departments. Here are tips on how to locate major obstacles to fast-cash turnaround.

    1. Analyze revenue by source of payment. Don't determine your revenue source by assigning revenue codes at time of admission, you'll get, a distorted picture. It's more accurate to track your revenue source when the bill is paid. This will take into account all self-pay deductibles, copay insurance rejections, etc. Too many hospitals and clinics still think their self-pay is less then 10 percent of total revenue because they track it at the wrong point. Tracking revenue sources at time of payment is the only true picture. Analysis of these figures can help you plan collection strategies because you'll know where the total revenue is coming from.

    2. Analyze your points of collection. Look at all the major areas within your department where collection takes place:

    Pre admission and admission. What percent of admissions are preadmitted? Do you    collect deposits? If so, how much?
    In-house collections. Do you prorate? Do you ask patients to make financial arrangements while hospitalized? Does anyone talk to the       spouse, relatives, or family about payment?
    Cashiers. Do you ask patients to stop at the cashier area at discharge? Do you know how much the cashiers collect at that time? I)o you      track how   much they could have collected compared to how much they could have collected?
    Backlog. Do you have weekly reports showing these problem areas?
    Billing delays. Do you get reports showing all the points where bills are held up? Are these reports by financial class, dollars, amount      of accounts, by employee, by department, etc.?
    Collection after discharge. Do you know who is collecting what? Do you track collections by financial class, by employee?

    Analyze all your influences. Make a list of all the things that influence your cash     turnaround. Here's a list of examples:

    All insurance carriers. Analyze the problems with your major carriers and the effect it has on your turnaround. Then, find out what       you can do to solve those problems and improve turnaround.
    Medicare. Know what's happening with Medicare now and what's likely to be happening in 6 to 24 months. Find out how Medicare       affects your procedures and how changes are likely to alter those effects.
    Employers in your area. Which are the biggest employers admitting the most patients to your facilities? Are those patients being       treated for some illnesses or injuries more than others? What are the common problems you have with the payers carried by those       employers?
    Physicians. Who do patients see the most? Who has the highest revenue? Who has the highest bad-debt percent age? Who's on your       side? Who's against you?
    Administration. Do they support you? And, do you get support from all of the administration staff or just some of them? Do you       have a credibility gap with them. What do they think of you and your department? How do they view your department's performance?
    Board of directors. Is it gaining power? Do they support you?
    Your management skill level. Are your management skills what they should be? Are you doing anything to improve them?
    Motivation. Are you self-motivated these days? Is your staff motivated to give you a maximum performance? Will they support your       changes? If your answer is no, what are you doing about it?
    Technology. Is your software system keeping up with your needs? Do you have electronic billing, collection, admission and medical       records? How well does your staff operate the system? Are there frequent errors in your system? If you're working with more than one       program, are they compatible?  After this kind of intense analysis, you'll be ready to take the next big step developing a plan of action.

    Reprinted with permission of
    Aspen Publishers, Inc.
    Gaithersburg, MD with
    Midwest Office in Brookfield, WI "Health Care Collector".
    
    
    

    Don't Stop Working To Collect From Out-Of-Work Debtors

    Being unemployed is scary. People who are newly unemployed are often not aware of the many forms to be filled out and procedures they must go through to collect unemployment compensation . They may be embarrassed and not want others to know of their situation. It is important for you to remember that the debtor may still be able to pay despite her current circumstances. Eventually, she will probably return to work. Especially if she had been making payments, you must do all that is within your capacity as a collector to keep her in the habit of making those payments-even if they are only token payments-until she's employed again. She must keep in contact with you and continue to make payments, otherwise she is not likely to pay when she starts working again. One of the first things you must do is to determine why the debtor is out of work. Is it because of a layoff or that the company she works for is moving? Many times large businesses have financial assistance or retraining available. Is she on strike? Her union may have financial aid or loans she can use. Is she ill or did she suffer a work-related injury? Again, financial assistance may be available. Once the reason for her unemployment has been determined, you may wish to ask questions such as the following:

    1. Where was the debtor employed?
    2. How long has she been out of work?
    3. Where has she looked for work?
    4. Is the debtor receiving unemployment benefits? If so, how much and for how long?
    5. Are her husband/children working? If he/they are, can some of this money be used to pay off the debt?
    6. Does she have any back pay coming?
    7. How is she paying for her rent, food, clothing, medical expenses, etc.?
    8. Are there any other sources of income? Can relatives and friends assist her in making payments?
    9. What are her prospects for future employment?
    10. What is she doing to find new employment? Has she registered with any employment agencies?
    11. Is the debtor on welfare?

    Just because a debtor is unemployed, don't write her off as uncollectible. Keep in contact with her and, if at all possible keep her in the habit of making regular payments, even if they are small.

    Reprinted with permission of American Collectors Association, Inc. "Collector"

     

     

    Never Say These Things

    If you want to be considered a "star" performer, consider this list of "Nevers." Never say:

    "They didn't get back to me." Or, "They are getting back to me." Both are equally disastrous. Expecting someone to get back to you   stops the action. Take the initiative.

    "I thought someone else was taking care of that" Excuses indicate a roadblock to action. Always ask questions to keep thing moving.

    "No one ever told me." Let a supervisor hear you talk this way very often and you will have made a very clear statement about the way you work. You operate in a tunnel, oblivious to everything that is going on around you.

    "I didn't have time." And don't bother with "I was too busy," either. If you find yourself saying things like this, you are writing your employment obituary.

    "I didn't think to ask about that." An inability to see down the road may indicated that you lack the ability to understand and grasp relationships.

    The message in business today is clear. The only measure for success is performance. What ever the roadblocks, it's your job to remove them. If not, you'll be perceived as one of them.

    Source: John R Graham, president, Graham Communications, 40 Oval Road, Quincy, MA 02170.
    
    
    
    

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