What Makes an employee a high-potential employee (HIPO)?
High-potential employees (HiPos) are those who demonstrate the ability to excel in their current roles and show promise for growth in leadership or more advanced positions. Here are 10 signs that indicate an employee has high potential:
Strong Performance: They consistently perform well in their current role, exceeding expectations and demonstrating a high level of competency.
Adaptability: HiPos can handle change well, whether it’s adapting to new technologies, shifting team dynamics, or changes in the business environment.
Proactive and Self-Motivated: They don’t wait for instructions; they take initiative and show a strong drive to improve processes or solve problems.
Continuous Learning: They actively seek new knowledge, skills, or experiences, whether through formal training, seeking feedback, or learning on their own.
Leadership Potential: They demonstrate natural leadership qualities, such as the ability to inspire, motivate, and guide colleagues, even without holding a leadership position.
Problem-Solving Abilities: High-potential employees are skilled at identifying problems and quickly devising creative solutions. They approach challenges with a positive mindset.
Emotional Intelligence: They possess high emotional intelligence, meaning they can manage their emotions, build strong relationships, and navigate social complexities with ease.
Resilience: They can handle setbacks or failures without losing momentum and demonstrate persistence in overcoming obstacles.
Effective Communication: HiPos communicate clearly and effectively, whether it's in one-on-one conversations, team meetings, or presentations. They are able to express their ideas and listen well to others.
Commitment to Company Values: They align with the organization’s values and goals, and they demonstrate a strong sense of loyalty and commitment to the company's mission and vision.
These qualities can indicate someone with the potential to advance in their career and contribute significantly to the organization's success in the future.
High-potential employees (HiPos) also often demonstrate the ability to address toxic behaviors in a constructive and professional manner. Here’s how they typically handle toxic environments or negative behaviors in the workplace:
Lead by Example: Instead of engaging in toxic behavior themselves, they model positive behaviors like respect, collaboration, and professionalism, which can help create a healthier work environment.
Conflict Resolution: HiPos are skilled at addressing conflicts in a calm, objective, and solution-focused way. They may mediate between colleagues, listening to all parties involved and working toward a resolution that benefits everyone.
Giving Constructive Feedback: If they notice toxic behaviors, high-potential employees can provide feedback to their peers in a way that is both respectful and helpful. They focus on the behavior, not the person, which can reduce defensiveness.
Escalating Issues Appropriately: If the toxic behavior is persistent or harmful, HiPos are likely to escalate the issue to the right authority—whether it’s HR, a manager, or a team leader—while maintaining professionalism.
Encouraging Open Communication: They foster a culture of transparency and open dialogue, making it easier for others to speak up about toxic behaviors or concerns without fear of retribution.
Empathy: Rather than reacting negatively to toxic behaviors, high-potential employees try to understand the root cause of the issue, whether it’s personal stress, miscommunication, or other external factors.
Promoting Inclusivity and Respect: They actively encourage inclusivity and ensure everyone feels valued, often counteracting toxic behaviors like exclusion, bullying, or discrimination by promoting a respectful atmosphere.
Addressing Gossip and Negative Talk: HiPos typically avoid engaging in or spreading gossip. They either address issues directly with the person involved or encourage others to do the same in a respectful manner.
Influencing Change: Instead of just tolerating toxic environments, high-potential employees will often suggest and lead initiatives aimed at improving workplace culture, whether it's through team-building activities, wellness programs, or leadership training.
Maintaining Professionalism: In the face of toxicity, they are able to remain calm and maintain professionalism, not allowing negativity to affect their own performance or attitude.
In essence, high-potential employees don’t just avoid toxic behaviors themselves; they actively contribute to creating a positive, collaborative, and healthy work environment by addressing negativity in a proactive and constructive way.
References:
Arnold, Grace C. The Effect of HiPo and NoPo Status and Feedback Purpose on Feedback Acceptance, Leadership Outcomes, and Self-efficacy. Diss. The George Washington University, 2024.
Deller, Carolyn. "Beyond performance: Does assessed potential matter to employees’ voluntary departure decisions?." Journal of Accounting Research 61.4 (2023): 981-1024.
Kehoe, Rebecca R., David G. Collings, and Wayne F. Cascio. "Simply the best? Star performers and high‐potential employees: Critical reflections and a path forward for research and practice." Personnel Psychology 76.2 (2023): 585-615.
How To Protect Yourself From Rumors and Lies in the Workplace
What do you do when someone is lying about you or twisting the facts of events in the workplace? How do you protect yourself? What do you do if these lies result in disciplinary action?
Being lied about at work can be challenging, and how you respond depends on the situation. Here are a few steps you can consider:
1. Stay Calm and Professional
Feeling upset or defensive is natural, but try to keep your emotions in check. Reacting impulsively can escalate the situation or make it harder to resolve.
2. Clarify the Facts
If possible, calmly gather evidence or documentation supporting your side of the story. This could be emails, messages, records of meetings, or witness accounts. The more concrete your evidence, the easier it will be to refute the lies.
3. Address the Person Directly (If Appropriate)
If you feel comfortable doing so, have a private conversation with the person who is spreading the false information. Politely but firmly state that you are aware of what has been said, and ask for clarification. Sometimes, a direct conversation can clear up misunderstandings or force the person to back off.
4. Talk to a Manager or HR
If the situation is affecting your reputation or work environment, escalate the issue to your manager or HR. Share the details of the false information and provide evidence if you have it. They should take the situation seriously, investigate, and take appropriate action.
5. Remain Professional in Your Work
Keep doing your job to the best of your ability. The more you focus on your work and maintain a high standard, the harder it will be for others to believe the lies.
6. Protect Your Reputation
If the rumors are spreading in the workplace, you might want to proactively address them. This could involve sending a clear, professional email to your team or having a meeting with your supervisor to make sure everyone is on the same page about the facts.
7. Consider the Bigger Picture
Ask yourself if the issue is something you want to escalate or if it's something you can let go. In some cases, ignoring the lie and continuing to perform well can make the person who spread it look bad instead.
8. Know Your Rights
If the situation is more severe, such as slander or workplace defamation, research your rights or consult with a legal professional about your options.
Navigating workplace conflicts, especially when it involves being lied about, is tough. Just remember to keep your composure and look at the situation from a solution-oriented perspective.
If the person lying about you gets you fired, that’s a very difficult and stressful situation. However, there are steps you can take to address the issue and protect your rights:
1. Stay Calm and Reflect
It’s natural to feel angry, upset, or even defeated, but try to stay calm. Emotional reactions, while understandable, might not help in the long run. Take some time to assess the situation and think about the next steps.
2. Request a Clear Explanation
If you haven’t already, ask your employer for a clear, specific explanation for why you were fired. In many cases, companies provide a reason in writing or during an exit meeting. If the termination was based on false information or lies, this will be an important piece of the puzzle.
3. Document Everything
Gather as much evidence as you can regarding the false claims and your termination. This could include Emails, texts, or any written communication that supports your version of events. Witness statements from colleagues who can confirm your side of the story. Any records of positive performance reviews or feedback you received during your time at the company.
4. Contact Human Resources (HR)
If you feel the termination was unjust and based on false information, contact HR. Share your evidence, explain your side of the story, and ask for a re-investigation. HR departments are supposed to address issues related to unfair treatment or wrongful termination.
5. Consider Legal Action
If HR is unresponsive or your appeal to them doesn’t lead to a resolution, it might be time to consult with an employment attorney. If the termination was based on slander, defamation, or discrimination, a lawyer can advise you on how to proceed. Depending on the situation, you might have a case for wrongful termination or defamation.
6. File a Complaint
If you believe you were wrongfully terminated, you can file a complaint with government agencies that handle employment disputes. In the U.S., for example, you can contact the Equal Employment Opportunity Commission (EEOC) or your state’s labor department if discrimination or harassment was involved. If you’re in another country, there are usually similar organizations to contact.
7. Review Your Employment Contract
If you had an employment contract or were part of a union, review the terms for wrongful termination or dispute resolution. If your contract outlines specific steps for disputing a termination, follow those procedures. If you’re part of a union, they may be able to assist you in challenging the firing.
8. Consider Your Next Steps
Job Search: Start looking for new job opportunities. While the situation may feel overwhelming, focusing on your next role can help you move forward. If you’re asked about why you left your last job, you can explain the situation professionally, focusing on what you learned from it.
Reputation Management: If the false information could affect your reputation, think about how to address it with potential future employers. In some cases, you may want to get a reference from colleagues who know the truth or work with HR to clear up any misunderstandings.
9. Emotional Support
Being fired, especially under these circumstances, can take an emotional toll. Lean on friends, family, or a counselor for support during this difficult time. It’s important to process your feelings so you can move forward healthily.
10. Keep Your Network Strong
Even if you’ve been wronged, maintaining strong relationships with former colleagues or industry professionals can be helpful. Having people in your network who know the truth and can vouch for your character and work ethic can go a long way in the future.
Final Thought
It’s incredibly tough when someone’s false claims negatively impact your career, but there are avenues to challenge wrongful actions, clear your name, and move forward. Seek the support and resources available to you, and take each step at your own pace. Most importantly, always document every event in detail and send the documentation, by email, to your supervisor, HR, and anyone else that you feel should know what is happening. If possible, ask for a meeting with HR and the person doing the lying, bring all your documentation to the meeting, and ask for an explanation. Doing so in front of others, like those in HR and your supervisor, can help alleviate the stress, but also, in the event you get terminated, you have that as evidence. You can always record the meeting with various apps on a laptop or phone for further proof and documentation. Do whatever you need to do to protect yourself.
Sources:
Grover, Steven L. "The truth, the whole truth, and nothing but the truth: The causes and management of workplace lying." Academy of Management Perspectives 19.2 (2005): 148-157.
Shulman, David. From hire to liar: The role of deception in the workplace. Cornell University Press, 2007.
Goman, Carol Kinsey. The truth about lies in the workplace: How to spot liars and what to do about them. Berrett-Koehler Publishers, 2013.
Clarke, John. Working with monsters: How to identify and protect yourself from the workplace psychopath. ReadHowYouWant. com, 2009.
Using an itemized billing model in audiology
Using an Itemized billing model in audiology can help generate much-needed revenue for the clinic. Many believe that audiology must bill a bundled model, but this is not true as itemized billing allows for greater transparency for the insurance companies and patients to see exactly what you are billing. Key points for itemized billing in audiology are:
Breakdown of services:
Each component of the hearing aid process, like initial evaluation, real-ear measurements, hearing aid selection, programming, and follow-up appointments, is listed on the bill with its specific code and price.
Patient understanding:
This model can help patients understand the value of each service the audiologist provides, as they can see exactly what they are being charged for.
Insurance considerations:
Some insurance plans may require itemized billing to determine coverage for different aspects of hearing aid care accurately.
Potential for higher revenue:
By itemizing services, audiologists can charge more for complex or time-intensive procedures, which could increase overall practice revenue.
Transparency:
Patients can see the exact costs associated with each service, leading to better-informed decision-making.
Flexibility:
Depending on the patient's needs, the audiologist can adjust the services included in the billing based on their specific situation.
Demonstrating value:
By itemizing services, audiologists can showcase the expertise and time involved in each step of the hearing aid process.
Payer policies:
Check with each insurance provider to understand their specific rules regarding itemized billing and which codes can be used for each service.
Coding accuracy:
Properly applying the correct billing codes for each service is crucial to ensure accurate reimbursement.
Patient communication:
Clearly explain the itemized billing structure to patients to avoid confusion and ensure they understand the cost breakdown.
2025 Significant changes for healthcare insurance billing
In 2025, several significant changes are being implemented in healthcare insurance billing, particularly concerning Medicare and related services. Key updates include:
Medicare Physician Fee Schedule (PFS) Adjustments:
Payment Reduction: The Centers for Medicare & Medicaid Services (CMS) has finalized a 2.83% decrease in the Medicare PFS conversion factor for Calendar Year (CY) 2025, lowering it from $33.29 to $32.35. This reduction is expected to impact physician reimbursement rates.
Caregiver Training Services: CMS is introducing new coding and payment structures for caregiver training services, including those provided via telehealth. These services encompass training in areas such as wound care and infection control.
Advanced Primary Care Management (APCM) Services: New coding and payment models are being established for APCM services, aiming to reduce administrative burdens by bundling elements of existing care management and communication technology-based services.
Medicare Advantage and Part D Updates:
Payment Increase: Payments to Medicare Advantage (MA) plans are projected to rise by an average of 3.7%, equating to over $16 billion, as per the CY 2025 Rate Announcement.
Prescription Drug Cost Cap: A significant revision in Medicare prescription-drug benefits is set for 2025, offering a lower out-of-pocket cost cap and options to spread medication expenses throughout the year. Enrollees must stay informed to fully benefit during the open-enrollment period from October 15 to December 7, 2024.
Hospital Outpatient Services:
Rate Update: CMS has finalized a 2.9% rate increase for hospital outpatient departments and ambulatory surgery centers, resulting in an additional $2.2 billion in funding for 2025. Despite this increase, hospital associations have expressed concerns that the update may not sufficiently address rising operational costs.
Potential Overhaul of Medicare Billing Codes:
Proposed Changes: Robert F. Kennedy Jr., appointed by President Donald Trump as the head of the U.S. Department of Health and Human Services, is considering significant changes to the Medicare billing system. Kennedy plans to remove the American Medical Association's (AMA) control over Medicare billing codes, a system that has been in place since the 1980s. This move could disrupt the existing Medicare billing process and threaten the AMA's primary revenue source, as the organization currently maintains these codes.
These developments reflect ongoing efforts to adjust healthcare insurance billing practices in response to economic factors and the evolving needs of patients and providers.
Sources:
https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2025-medicare-physician-fee-schedule-final-rule?utm_source
https://www.cms.gov/files/document/mm13887-medicare-physician-fee-schedule-final-rule-summary-cy-2025.pdf?utm_source
https://www.cms.gov/files/document/mm13887-medicare-physician-fee-schedule-final-rule-summary-cy-2025.pdf?utm_source
https://public3.pagefreezer.com/browse/HHS.gov/02-01-2025T05:49/https://www.hhs.gov/about/news/2024/04/01/cms-finalizes-payment-updates-2025-medicare-advantage-medicare-part-d-programs.html?utm_source
Be Known As A Winner in the Healthcare Industry
Winners Are Not People Who Never Fail, But People Who Never Quit
Success is often romanticized as a smooth, uninterrupted ascent to the top. However, the reality is far from this idealized image. Behind every victory lies a story of setbacks, struggles, and moments of doubt. Winners are not those who evade failure entirely; rather, they are individuals who persist despite their failures, embodying resilience, determination, and an unwavering commitment to their goals.
Failure as a Stepping Stone
Failure is an inevitable part of life. It is often the precursor to significant growth and learning. When Thomas Edison was asked about the thousands of failed attempts he made before successfully inventing the light bulb, he famously replied, "I have not failed. I've just found 10,000 ways that won't work." His perseverance turned countless failures into a groundbreaking achievement.
Failures serve as invaluable lessons, offering insights into what doesn’t work and providing opportunities to refine strategies. The key difference between those who succeed and those who don’t is the ability to view failure not as an endpoint, but as a stepping stone on the journey to success.
The Power of Persistence
Persistence is the hallmark of winners. Life is rarely a straight road, and obstacles are bound to emerge. Those who succeed are the ones who refuse to quit, no matter how challenging the journey becomes. They adapt, innovate, and keep pushing forward, fueled by their belief in the possibility of achieving their dreams.
Consider J.K. Rowling, the author of the Harry Potter series. Before achieving worldwide success, she faced rejection from numerous publishers and endured personal hardships, including poverty and depression. What set her apart was her resilience. She continued to write and refine her work, eventually becoming one of the most celebrated authors of our time.
The Mindset of Winners
Winners embrace a growth mindset, a term popularized by psychologist Carol Dweck. They view abilities and intelligence as qualities that can be developed through effort and perseverance. Instead of being deterred by failure, they see it as an opportunity to improve and evolve. This mindset fosters a tenacity that enables individuals to overcome obstacles and stay the course, even when the odds seem insurmountable.
Moreover, winners are not afraid to seek help, learn from others, and adapt to changing circumstances. They understand that setbacks are temporary and that perseverance, combined with a willingness to learn, is the ultimate formula for success.
Overcoming the Fear of Failure
Fear of failure often holds people back from pursuing their goals. However, accepting failure as a natural part of the journey can be liberating. When individuals no longer view failure as a reflection of their worth but rather as a necessary step in the process, they become empowered to take risks and persist.
One of the most effective ways to overcome the fear of failure is to focus on the larger picture. By keeping their eyes on their long-term goals, individuals can maintain the motivation needed to navigate through short-term setbacks.
Conclusion
Winners are not extraordinary beings who have never tasted failure. They are ordinary individuals who have made the extraordinary decision to never give up. Their journeys are marked by resilience, perseverance, and an unshakeable belief in their ability to succeed.
Failure does not define us—our response to it does. The willingness to persist in the face of adversity is what separates those who achieve greatness from those who fall short. Remember, success is not about never failing; it is about never quitting.
References:
Ghaleb, Belal Dahiam Saif. "The importance of organizational culture for business success." Jurnal Riset Multidisiplin Dan Inovasi Teknologi 2.03 (2024): 727-735.
Gumelar, M. S. SUCCESS UNLEASHED: A Guide for Beginners and Seasoned Business Professionals. An1mage, 2024.
Busch, Timo, et al. "Moving beyond “the” business case: How to make corporate sustainability work." Business Strategy and the Environment 33.2 (2024): 776-787.
Helping patients understand insurance billing:
Explaining why the amount billed to insurance is higher than what patients expect can be a sensitive conversation, but it's crucial for helping them understand the complex process behind medical billing. Here’s a guide on how to approach this:
1. Clarify the Process of Billing vs. Insurance Contracts:
Explain Charges vs. Contracted Rates: Start by clarifying that the amount billed is often the full cost of the service (also called the “chargemaster rate” or “gross charge”). However, insurance companies negotiate lower, contracted rates for services. The billed amount is not what the patient or insurance actually pays.
Use Layman’s Terms: Avoid jargon. Explain that healthcare providers charge a standard rate for services, but insurance companies typically pay a reduced, pre-negotiated amount.
Example: “We bill insurance the full amount for the service, but your insurance company has negotiated to pay a lower, agreed-upon amount, which is what you’ll be responsible for after any deductible, co-pay, or co-insurance.”
2. Discuss the Complexity of Healthcare Pricing:
Explain Pricing Factors: Healthcare pricing is influenced by various factors, including the cost of specialized equipment, highly trained personnel, and administrative expenses. The prices reflect these costs, but insurance companies help offset what the patient ultimately has to pay.
Mention Regional and Provider Differences: Prices can vary across hospitals, regions, or even providers within the same practice. This is because of differing operational costs, technology investments, and more.
Example: “The cost of providing healthcare includes many things, like the staff, equipment, and even administrative work. That’s why the listed prices are high, but insurance reduces the amount you’re responsible for.”
3. Discuss the Role of Insurance and Patient Responsibility:
Outline Deductibles, Co-pays, and Co-insurance: Explain that the patient is responsible for their deductible, co-pay, and co-insurance amounts, regardless of what is billed. Make sure they understand how these contribute to their out-of-pocket costs.
Emphasize Insurance’s Role in Reducing Out-of-Pocket Costs: Highlight that insurance typically reduces the total amount owed by the patient, but they may still need to cover a portion based on their plan’s structure.
Example: “Even though we bill the full amount, your insurance reduces the actual payment. You’re only responsible for the deductible, co-pays, or co-insurance based on your plan.”
4. Explain Legal and Regulatory Compliance:
Justify the Billed Amounts as Necessary for Compliance: Hospitals and healthcare providers are required to bill the full chargemaster amount to insurance in order to comply with federal or state regulations. This helps standardize billing practices.
Focus on Transparency: Explain that healthcare providers are legally obligated to be transparent about their pricing, which is why they provide the full charges upfront to the insurance company.
Example: “By law, we must bill the full price to insurance, even though they’ll likely pay less. This ensures fairness and transparency across all patients and insurers.”
5. Offer to Review or Explain Their Insurance Plan:
Break Down Their Bill: Walk the patient through their bill, explaining each item and showing how much the insurance company has paid vs. their responsibility.
Offer Resources: Provide them with resources or contacts for further information about their insurance benefits or to help them better understand their plan.
Example: “If you’d like, I can walk you through the bill to explain how your insurance processed the claim and what’s left for you to pay.”
6. Be Empathetic and Understanding:
Acknowledge Their Concerns: Show empathy toward their concerns about costs. Let them know that you understand medical bills can be confusing and potentially higher than anticipated.
Reinforce Availability for Help: Offer to help them resolve any issues with their insurance or answer any additional questions they might have.
Example: “I completely understand that medical bills can be overwhelming. We’re here to help you understand them and work through any concerns.”
This approach emphasizes clarity, empathy, and a focus on patient education, which can help demystify the billing process and ease frustrations.
References:
Gottlieb, Joshua D., Adam Hale Shapiro, and Abe Dunn. "The complexity of billing and paying for physician care." Health Affairs 37.4 (2018): 619-626.
Napier, Rebecca H., et al. "Insurance billing and coding." Dental Clinics of North America 52.3 (2008): 507-527.
How to manage all the coding changes for healthcare billing
Managing coding changes in healthcare billing involves several critical steps to ensure compliance, accuracy, and efficiency. Healthcare billing is complex due to the frequent updates in coding standards like ICD-10, CPT, and HCPCS, as well as changes in payer requirements. Here’s a guide to managing these changes effectively:
1. Stay Updated on Coding Standards
Regular Training: Ensure that your billing and coding staff are regularly trained on the latest updates to ICD-10, CPT, and HCPCS codes.
Professional Associations: Stay connected with professional coding associations (e.g., AAPC, AHIMA) for the latest coding changes, guidelines, and updates.
Software Updates: Ensure that your billing software is updated regularly to incorporate new coding standards.
2. Implement a Change Management Process
Documentation: Create a process for documenting changes to coding practices and billing procedures. This documentation should include who made the change, why it was made, and how it was communicated to the team.
Testing: Before implementing coding changes, test them in a controlled environment to identify any potential issues.
Review and Approval: Establish a review and approval process for coding changes to ensure accuracy and compliance.
3. Effective Communication
Team Meetings: Regularly hold team meetings to discuss upcoming coding changes and their impact on billing processes.
Internal Memos/Updates: Send out regular updates via email or an internal communication platform to inform all relevant staff about changes.
Training Sessions: Offer focused training sessions on specific coding changes, especially if they are significant.
4. Monitor Compliance and Accuracy
Audits: Conduct regular internal audits to ensure that coding changes are being applied correctly and that billing is accurate.
Compliance Checks: Monitor compliance with payer guidelines and regulations to avoid potential penalties.
Feedback Loops: Implement feedback loops where billing staff can report issues or difficulties with new coding changes.
5. Utilize Technology
Automated Alerts: Use software that provides automated alerts for coding changes and updates.
Data Analytics: Utilize data analytics to monitor trends and identify any discrepancies that may arise due to coding changes.
EHR/EMR Integration: Ensure your Electronic Health Record (EHR) or Electronic Medical Record (EMR) system is integrated with your billing software for seamless updates.
6. Collaborate with Payers
Payer Guidelines: Regularly review payer guidelines for any changes in coding or billing requirements.
Direct Communication: Maintain open communication with payers to clarify any doubts about coding changes and their impact on billing.
Negotiations: Be prepared to negotiate with payers if coding changes lead to disputes in billing or reimbursement.
7. Continuous Education and Improvement
Ongoing Education: Encourage continuous education and certification for your coding and billing staff.
Process Improvement: Regularly review and improve your coding and billing processes to adapt to changes and improve efficiency.
By following these steps, you can effectively manage coding changes in healthcare billing, ensuring that your practice or organization remains compliant, accurate, and efficient in its billing processes.
References:
Apathy, Nate C., et al. "Early changes in billing and notes after evaluation and management guideline change." Annals of internal medicine 175.4 (2022): 499-504.
Burks, Kristie, et al. "A systematic review of outpatient billing practices." SAGE Open Medicine 10 (2022): 20503121221099021.
Peters, Steve G. "New billing rules for outpatient office visit codes." Chest 158.1 (2020): 298-302.
Empathy in Patient Billing
Do you struggle with collecting patient payments? Do your patients struggle to understand why they owe you the money if insurance pays something? Many times practices leave money on the table. They want to avoid confrontations with patients because they feel they are at risk of losing patients if they require them to pay their bills. This is a real struggle for many small healthcare offices; however, understanding that patient billing requires empathy can make this task a whole lot easier for your office.
Empathy in healthcare extends beyond patient care; it should also be present in every aspect, including billing. Understanding and compassionately addressing patients' financial concerns can alleviate stress and foster a more trusting and supportive relationship. Fostering empathy in healthcare patient billing involves several key strategies:
Training and Education: Provide regular training for billing staff on empathy, active listening, and effective communication. Teach them to understand the emotional and financial stress patients might be experiencing.
Clear Communication: Use simple, clear language in all billing communications. Avoid medical jargon and complex terms to ensure patients understand their bills.
Patient-Centered Approach: Treat each patient as an individual with unique circumstances. Personalize interactions and be attentive to their specific needs and concerns.
Transparent Processes: Be upfront about costs and billing procedures. Provide detailed explanations of charges and what patients can expect to pay, helping to eliminate confusion and build trust.
Flexible Payment Options: Offer flexible payment plans and financial assistance programs. This shows a willingness to work with patients to find manageable solutions for their financial responsibilities.
Supportive Environment: Create a supportive and non-judgmental atmosphere where patients feel comfortable discussing their financial issues. Ensure staff are approachable and willing to help.
Feedback Mechanisms: Implement systems for patients to provide feedback on their billing experience. Use this feedback to make continuous improvements and address any areas where empathy may be lacking.
Collaboration with Clinical Staff: Encourage collaboration between billing and clinical staff to ensure a holistic approach to patient care. When clinical staff are aware of a patient’s financial concerns, they can better support the patient’s overall experience.
Technology Utilization: Use technology to provide easy access to billing information, allowing patients to view and understand their bills online. Implementing user-friendly interfaces can reduce frustration and improve the overall experience.
Follow-Up Communication: After the billing process, follow up with patients to ensure they understand their bills and to address any remaining concerns or questions.
By integrating these strategies, healthcare organizations can create a more empathetic and patient-friendly billing process, ultimately enhancing the overall patient experience.
The Importance of Consulting Services in Identifying Gaps in Business Revenue Cycle Departments
In today's fast-paced and highly competitive business environment, ensuring optimal performance in every aspect of an organization is crucial for success. One area that often requires keen attention is the revenue cycle. The revenue cycle encompasses all the administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue. Consulting services play a vital role in identifying gaps and inefficiencies within this cycle, offering expert insights and solutions to enhance overall performance and profitability.
Understanding the Revenue Cycle
Before delving into the importance of consulting services, it is essential to understand what the revenue cycle entails. The revenue cycle typically includes:
Patient Registration and Scheduling: Gathering patient information and scheduling appointments.
Insurance Verification and Authorization: Ensuring coverage and obtaining necessary authorizations.
Charge Capture: Recording services provided and translating them into billable charges.
Coding and Billing: Assigning appropriate medical codes and generating bills.
Claims Submission: Sending claims to insurance companies for reimbursement.
Payment Posting: Recording payments received from patients and insurance companies.
Denial Management: Addressing denied claims and resubmitting them for payment.
Patient Collections: Collecting payments from patients for out-of-pocket expenses.
Each of these steps is critical in ensuring that a business receives timely and accurate reimbursement for services rendered. However, inefficiencies or gaps in any of these areas can lead to revenue leakage, increased costs, and reduced profitability.
Identifying Gaps with Consulting Services
Consulting services offer specialized expertise and an objective perspective that can be invaluable in identifying gaps within the revenue cycle. Here are several ways consulting services can benefit a business:
Objective Assessment: Consultants provide an unbiased evaluation of current processes, identifying inefficiencies and areas for improvement. Their external perspective can reveal issues that internal teams may overlook due to familiarity or ingrained habits.
Expertise and Best Practices: With extensive experience across various industries and organizations, consultants bring a wealth of knowledge and best practices. They can benchmark a company's performance against industry standards and recommend proven strategies to enhance efficiency.
Process Optimization: By analyzing each step of the revenue cycle, consultants can identify bottlenecks, redundant processes, and areas prone to errors. They can then design streamlined workflows that reduce administrative burdens and accelerate revenue generation.
Technology Integration: Consultants can assess the current use of technology and recommend advanced solutions that integrate seamlessly with existing systems. This includes electronic health records (EHRs), practice management software, and billing systems that can automate processes and improve accuracy.
Training and Development: Identifying gaps is only part of the solution. Consultants also provide training and development programs to equip staff with the necessary skills and knowledge to implement changes effectively. This ensures that improvements are sustainable and continuously yield benefits.
Financial Analysis and Reporting: Consultants can enhance financial reporting capabilities, providing more detailed and accurate insights into revenue cycle performance. This enables businesses to make data-driven decisions and proactively address issues before they escalate.
Case Study: Consulting Services in Action
Consider a healthcare organization struggling with high rates of claim denials and slow payment collections. By engaging a consulting firm, they underwent a comprehensive revenue cycle assessment. The consultants identified that outdated coding practices and lack of staff training were major contributors to the problem. They implemented updated coding standards, provided targeted training sessions, and introduced an automated denial management system. As a result, the organization saw a significant reduction in claim denials, faster payment processing, and an overall improvement in cash flow.
Conclusion
In an era where margins are continually squeezed, optimizing the revenue cycle cannot be overstated. Consulting services provide the expertise, objectivity, and innovative solutions necessary to identify and address gaps in the revenue cycle. By leveraging these services, businesses can enhance efficiency, reduce revenue leakage, and ultimately improve their bottom line. Investing in consulting services is not just a cost—it's a strategic move towards sustainable growth and long-term success.
References:
Chandawarkar, Rajiv, et al. "Revenue Cycle Management: The Art and the Science." Plastic and Reconstructive Surgery–Global Open 12.7 (2024): e5756.
Aidana, Baitemirova, and Sarsembaeva Gulnara. "DEVELOPMENT MANAGEMENT CONSULTING SERVICES BASED ON LIFE CYCLE OF COMPANY." The Kazakh-American Free University Academic Journal (2017): 92.
Erdmann, Tashi P., Manon de Groot, and Ronald JMM Does. "Quality quandaries: Improving the invoicing process of a consulting company." Quality Engineering 22.3 (2010): 214-221.
Sun, Xinyan. "Research on the whole life cycle of the PPP Project Consulting Business Process Reengineering of Cost Engineering Consultation Company." (2017).
Challenges Facing Medical Billing in the HEalthcare Revenue Cycle
Medical billing in the healthcare revenue cycle faces numerous challenges, which can significantly impact the efficiency and financial stability of healthcare providers. Some of the biggest challenges include:
Complex Regulatory Environment:
Compliance with Regulations: Healthcare providers must adhere to various federal and state regulations, including HIPAA, Medicare, Medicaid, and the Affordable Care Act. Keeping up with frequent changes and ensuring compliance can be daunting.
Coding Standards: The transition to ICD-10 and maintaining accuracy in coding for procedures and diagnoses requires continuous training and updates.
Insurance Verification and Claims Management:
Verification of Patient Eligibility: Ensuring that patients have active coverage and understanding the extent of their benefits can be time-consuming and prone to errors.
Denials and Rejections: Managing denied or rejected claims, which often occur due to incorrect or incomplete information, coding errors, or lack of prior authorization, requires significant effort and resources to resolve.
Technology Integration and Data Management:
Electronic Health Records (EHR) Systems: Integrating EHR systems with billing software can be complex, and discrepancies between systems can lead to billing errors.
Data Security: Protecting patient data from breaches and ensuring secure transmission of billing information is critical and challenging.
Patient Payment Collection:
High Deductibles and Out-of-Pocket Costs: With increasing patient financial responsibility, collecting payments from patients can be difficult.
Payment Plans and Financial Assistance: Implementing and managing payment plans or financial assistance programs for patients requires additional administrative efforts.
Staff Training and Retention:
Continuous Education: Billing staff need ongoing education to stay current with coding changes, regulatory updates, and new billing practices.
Turnover: High turnover rates in billing departments can disrupt the revenue cycle and lead to inefficiencies.
Revenue Cycle Management (RCM) Efficiency:
Workflow Optimization: Streamlining processes to minimize delays and errors in the revenue cycle is a constant challenge.
Performance Metrics: Monitoring and improving key performance indicators (KPIs) such as days in accounts receivable (AR), collection rates, and claim denial rates is essential for maintaining financial health.
Patient Experience and Communication:
Clear Communication: Ensuring that patients understand their bills, charges, and payment responsibilities can reduce confusion and improve payment rates.
Patient Engagement: Engaging patients through portals, reminders, and clear billing practices can enhance the overall experience and encourage timely payments.
Addressing these challenges requires a combination of technology, process improvements, staff training, and effective communication strategies. Healthcare providers often seek assistance from specialized billing services or invest in advanced RCM solutions to manage these complexities efficiently.
Outsourcing medical billing can be an effective strategy to address many of the challenges in the healthcare revenue cycle. Here’s how outsourcing can help solve some of these challenges:
Complex Regulatory Environment:
Compliance with Regulations: Outsourcing companies specialize in staying up-to-date with the latest regulations and compliance requirements, reducing the burden on healthcare providers.
Coding Standards: Professional billing companies often employ certified coders who are proficient in ICD-10 and other coding standards, ensuring accuracy and compliance.
Insurance Verification and Claims Management:
Verification of Patient Eligibility: Outsourcing firms typically have dedicated teams for verifying patient insurance coverage, ensuring that claims are submitted correctly and promptly.
Denials and Rejections: Experienced billing companies have processes in place to manage and appeal denied or rejected claims efficiently, often resulting in higher recovery rates.
Technology Integration and Data Management:
Electronic Health Records (EHR) Systems: Outsourcing providers usually have experience integrating with various EHR systems, which can streamline the billing process and reduce errors.
Data Security: Reputable outsourcing firms implement robust data security measures to protect patient information and comply with HIPAA and other regulations.
Patient Payment Collection:
High Deductibles and Out-of-Pocket Costs: Outsourcing companies often have more effective strategies and tools for collecting payments from patients, including payment plans and financial counseling.
Payment Plans and Financial Assistance: Outsourced billing services can manage payment plans and financial assistance programs, relieving healthcare providers of this administrative burden.
Staff Training and Retention:
Continuous Education: Billing companies invest in ongoing training for their staff, ensuring that they are knowledgeable about the latest industry changes.
Turnover: Outsourcing can reduce the impact of internal staff turnover, as the billing company is responsible for maintaining a stable workforce.
Revenue Cycle Management (RCM) Efficiency:
Workflow Optimization: Outsourcing firms specialize in optimizing billing workflows and processes, leading to quicker turnaround times and fewer errors.
Performance Metrics: Professional billing companies track and improve key performance indicators (KPIs) such as days in accounts receivable (AR), collection rates, and claim denial rates, helping to maintain financial health.
Patient Experience and Communication:
Clear Communication: Outsourced billing companies often have better communication strategies in place, ensuring that patients understand their bills and payment responsibilities.
Patient Engagement: These firms can enhance patient engagement through portals, reminders, and clear billing practices, encouraging timely payments.
By outsourcing medical billing, healthcare providers can focus more on patient care while leveraging the expertise and efficiency of specialized billing companies to manage the complexities of the revenue cycle. However, it’s important to choose a reputable outsourcing partner with a proven track record, strong security measures, and a commitment to compliance and quality.
We understand the complexities of medical billing and the impact it can have on your practice. By partnering with JB Consultant Group, you can focus more on patient care while we handle the intricacies of your revenue cycle management.
I would love the opportunity to discuss how we can tailor our services to meet your specific needs. Please let me know a convenient time for a call or meeting.
Thank you for considering JB Consultant Group. I look forward to the possibility of working together to streamline your medical billing processes and improve your financial health.
sources:
Odeyemi, Olubusola. "Integrating accounting fintech innovations in the US healthcare sector: opportunities, challenges, and impacts on financial management and patient care." (2024).
Owolabi, Oluwaseyi Rita, et al. "Reviewing healthcare financial management: Strategies for cost-effective care." World Journal of Advanced Research and Reviews 21.2 (2024): 958-966.
Chore, Mrunali, et al. "HEALTH CARE SERVICE AUTOMATION."
Importance of A Revenue Cycle Process Review
The revenue cycle review is a critical process in healthcare that involves the management of financial transactions resulting from medical services provided to patients. This cycle encompasses the entire spectrum of activities from patient registration and appointment scheduling to final payment of the services. Here are several key reasons why revenue cycle review is essential in healthcare:
1. Financial Stability
Accurate Revenue Capture: By thoroughly reviewing the revenue cycle, healthcare organizations ensure they capture all possible revenue, avoiding missed billing opportunities and underpayments.
Cash Flow Management: Regular reviews help in maintaining a steady cash flow, which is crucial for the day-to-day operations of healthcare facilities. Timely payments from insurers and patients are essential for financial stability.
2. Regulatory Compliance
Adherence to Regulations: The healthcare industry is heavily regulated. A comprehensive revenue cycle review ensures compliance with federal, state, and local regulations, including those related to billing and coding standards (e.g., ICD-10, CPT).
Avoidance of Penalties: Non-compliance can result in significant fines and legal issues. Regular reviews help to identify and correct compliance issues before they become problematic.
3. Improved Patient Experience
Transparent Billing: Clear and accurate billing practices enhance patient trust and satisfaction. Patients are more likely to return and recommend services when they understand their bills and do not encounter unexpected charges.
Reduced Administrative Burden: Efficient revenue cycle management reduces administrative hassles for patients, such as resolving billing disputes and correcting errors.
4. Operational Efficiency
Streamlined Processes: Reviewing the revenue cycle helps identify inefficiencies in the billing and collection processes. Streamlining these processes can reduce administrative costs and improve overall efficiency.
Error Reduction: Regular audits and reviews can pinpoint common errors, allowing for corrective measures that minimize future mistakes.
5. Enhanced Financial Performance
Increased Revenue: Effective revenue cycle management maximizes revenue by ensuring proper coding, timely claim submissions, and efficient follow-up on unpaid claims.
Cost Reduction: Identifying areas where costs can be reduced, such as administrative overhead, contributes to better financial health.
6. Strategic Planning
Data-Driven Decisions: Revenue cycle reviews provide valuable data and insights that can inform strategic decisions, such as investments in new technology, hiring additional staff, or expanding services.
Benchmarking: Comparing performance metrics against industry standards helps healthcare organizations understand their position in the market and strive for continuous improvement.
7. Risk Management
Early Detection of Issues: Regular reviews can uncover potential problems early, such as fraud, coding errors, or billing discrepancies, allowing for timely corrective action.
Enhanced Accountability: Establishing a routine review process creates a culture of accountability, where staff are aware that their work will be regularly checked and validated.
Conclusion
A thorough and continuous revenue cycle review is indispensable for healthcare organizations. It not only ensures financial health and compliance but also contributes to operational efficiency, patient satisfaction, and strategic planning. By investing in robust revenue cycle management practices, healthcare providers can achieve sustainable growth and deliver high-quality care.
References:
Atluri, Haritha, and Bala Siva Prakash Thummisetti. "Optimizing Revenue Cycle Management in Healthcare: A Comprehensive Analysis of the Charge Navigator System." International Numeric Journal of Machine Learning and Robots 7.7 (2023): 1-13.
Cleverley, William O., James O. Cleverley, and Ashley V. Parks. Essentials of health care finance. Jones & Bartlett Learning, 2023.
Thakur, Vinita, Olatunji Anthony Akerele, and Edward Randell. "Lean and Six Sigma as continuous quality improvement frameworks in the clinical diagnostic laboratory." Critical Reviews in Clinical Laboratory Sciences 60.1 (2023): 63-81.
Maximizing Reimbursement For Audiology Services
Audiologists face significant challenges in today's healthcare environment, including limited reimbursement rates and the prevalence of low-paying third-party administrators (TPAs) managing hearing aid benefits. Despite these challenges, audiologists can employ several strategies to sustain and grow their practices while effectively serving patients with hearing loss. Here are some key approaches:
Diversification of Services
Diagnostic Services: Audiologists can offer comprehensive diagnostic evaluations for hearing and balance disorders. These evaluations are often reimbursed at higher rates compared to hearing aid sales.
Hearing Conservation Programs: Providing services such as hearing conservation programs for industries can be a lucrative niche.
Vestibular and Balance Testing: Expanding into vestibular assessment and treatment can attract a broader patient base and potentially higher reimbursements.
Value-Added Services
Hearing Aid Maintenance and Repairs: Offering maintenance, repairs, and adjustments for hearing aids can generate additional revenue and build customer loyalty.
Assistive Listening Devices: Selling and supporting a range of assistive listening devices, such as FM systems or amplified telephones, can complement traditional hearing aid sales.
Private Pay Options
Bundled Service Packages: Audiologists can create bundled service packages that include the hearing aid, follow-up visits, adjustments, and maintenance for a set price. This approach provides a clear value proposition for patients, offering comprehensive care in a single package.
Tiered Pricing Models: Implementing tiered pricing models for different levels of service and technology allows patients to choose a package that fits their budget while still receiving necessary care.
Enhancing Patient Experience
Telehealth Services: Offering telehealth services for follow-up appointments and consultations can improve accessibility and convenience for patients, potentially increasing patient retention and satisfaction.
Patient Education and Support: Providing thorough patient education on hearing loss management and the use of hearing aids can improve outcomes and patient loyalty. Establishing support groups or informational sessions can also enhance patient engagement.
Efficient Practice Management
Effective Use of TPAs: While TPAs often offer lower reimbursement rates, efficiently managing relationships with these entities and negotiating better terms can help. Streamlining administrative processes to reduce overhead costs associated with TPA interactions is also crucial.
Optimizing Insurance Billing: Ensuring accurate and timely billing for diagnostic services and treatments can maximize reimbursements. Employing experienced billing staff or outsourcing to specialized medical billing services can reduce claim denials and delays. Using an itemized approach can help generate revenue upwards of $250 per hour per audiologist, in the state of Wisconsin if it is done correctly and you understand what you are billing for and why. To find out if this option is best for you, click this link.
Expanding Market Reach
Community Outreach: Conducting community outreach programs and partnering with local organizations to raise awareness about hearing health can attract new patients. Free hearing screenings at community events can also drive patient volume.
Online Presence and Marketing: Building a robust online presence through a professional website, social media, and online advertising can attract a broader audience. Online reviews and patient testimonials can also enhance credibility and attract new patients.
Business Innovations
Hearing Aid Lease Programs: Offering lease programs for hearing aids can make the technology more accessible to patients who may not afford upfront costs, providing a steady revenue stream.
Subscription Models: Implementing subscription-based models where patients pay a monthly or annual fee for ongoing services and support can create predictable revenue and enhance patient loyalty.
By diversifying services, enhancing patient experience, and implementing innovative business models, audiologists can navigate the challenges of limited reimbursement rates and low-paying TPAs, ensuring they remain financially viable while providing essential care to those with hearing loss.
References:
Fifer, R. (2016). Health care economics: the real source of reimbursement problems. CCC-A American Speech-Language-Hearing Association (ASHA).
Fifer, R. (2006). Documentation Requirements Related to Reimbursement for Audiology Services. The ASHA leader, 11(12), 6-31.
D'Onofrio, K. L., & Zeng, F. G. (2022). Tele-audiology: Current state and future directions. Frontiers in Digital Health, 3, 788103.
Hall, M. W., Prentiss, S. M., Coto, J., Zwolan, T. A., & Holcomb, M. A. (2022). Decoding billing practices in cochlear implant programs. Ear and hearing, 43(2), 477-486.
Warren, S., & Swanson, N. (2020). 2021 Medicare Fee Proposal Decreases Payments: Increases to primary care physician fees translate to cuts for audiologists, SLPs, and other providers. ASHA Leader, 25(7), 26-28
Hudson, M. W., & DeRuiter, M. (2023). Professional issues in speech-language pathology and audiology. Plural Publishing.
Overcoming the Change Healthcare Challenge
The Change Healthcare/Optum Payment Disruption (CHOPD) has caused many challenges for providers, specifically small to medium practices, regarding submitting claims, obtaining patient benefits, getting insurance remits, and receiving and even getting payments for the services rendered. So, what can these providers do to ensure that they are still able to practice and get paid and not have to shut their doors due to the issues caused by CHOPD.
Use a different clearing house. There are many great clearing house entities out there and some of the best ones with low cost and ease of using are——Availity, Claim MD, and Practice Fusion.
Use CMS’s CHOPD accelerated/advanced payments to help offset the loss of revenue due to the Change outage. Click this link to see how to enroll and obtain these payments.
Submit your claims on your new EDI/Clearing house daily and follow up to ensure those claims were not rejected or pushed back for corrections prior to the close of business.
Understand that if you switch to a different claims submission/EDI application, you will need to know what insurances use Change to receive those claims, and either fax paper claims to those insurance companies or submit those claims directly on those insurances portals. This is the fastest way to get your claims paid, avoid timely filing denials, and get the money to your practice.
Use insurance company portals to check on the status of claims and track payments so that you can see when those payments were made and when to expect them into your bank account.
Look at outsourcing your claims as billers are aware of all the ins and outs that come with billing and turning around the billing into revenue in a very quick fashion. These companies are also aware of the Change issues and how to work around them to ensure that your payments are not delayed.
No matter what you decide to do, you need to do what is best for your practice, patients, and revenue cycle for your organization. It is important to research your options and then do not look back. Change has had many issues over the years and while they are the largest system across the United States regarding insurance companies, revenue cycle operations and applications, and EDI/Clearing House it is important not to feel pressured to remain with Change as your business “goes down in flames” due to their issues and problems.
Do errors in Patient REgistration, Matter?
I did my doctoral thesis on this very topic and the results were astounding. There is not a lot of research out there on the correlation of errors made during the time the patient is being registered for care and mistakes that happen during their care. My research, supported by more than 350 peer reviewed journal articles and research papers, found that the errors made during patient registration can in fact lead to sentinel events during a patients care at the facility.
From an incorrect name spelling to multiple charts the care mistakes that can happen due to those simple errors in registration can have catastrophic effects on the patient and at times can be life altering or life ending. It is vital that more research is conducted on this topic and solutions are found to avoid the “simple” and “non-important” errors that are happening during the patient registration process.
Join me for the next several weeks, as I post sections of my dissertation on this very topic. I am hoping that this brings awareness to this issue and that those in these departments begin to realize that not only does their position matter in patient care, but it sets the tone for correct care to be given the entire time the patient is within the facility.
Can a healthcare leadership consultant help your practice?
2022 brought to light the trend of "quiet quitting", "quiet firing", and "fast quitting". 2024 is bringing to light "quiet hiring". Quiet quitting is when an employee does only the minimum requirements of their job--nothing more, nothing less--and puts in no effort or enthusiasm than absolutely necessary. Quiet firing is when managers either do not train employees properly or create non-ideal work environments that cause employees to quit. Fast quitting is the employee leaving a position before they have been in that position for at least a year, often leaving after only a few weeks on the job.
Quiet hiring is when an organization recognizes they have a role or roles to fill but do not want to hire full-time employees for one reason or another. One major reason for quiet hiring is that employers want to fill roles for a short period of time or they do not want to take on all the costs associated with hiring a new team member whether full-time or part-time.
There are two ways to conduct quiet hiring. First, use current employees in different roles for a short time or give them new tasks to do within their current roles. The other way is to higher consultants to fill the gaps. Consultants are experts in their field and often can do the work of several people reducing the cost to the organization are contracted so no benefits are paid out and no time spent by other employees training the consultant. This leads to the question, 'Can a healthcare leadership consultant help your practice?'
There are six main reasons why hiring a leadership consultant is right for your organization. First, let's discuss what a leadership consultant is. A healthcare leadership consultant is someone who provides medical-related organizations with expert-level advice and knowledge. They are specialists in their field and use their background and training in healthcare policies to identify challenges, gaps, and opportunities for organizations and make recommendations on overcoming the identified issues. The leadership aspect of the consultant's title reflects the fact that the consultant looks for solutions from the top of the organization down rather than only focusing on the lowest position on the totem pole when finding solutions for problems. Understanding what a healthcare leadership consultant is helps one understand why these six reasons are valid and why a consultant may be a good fit for your practice.
The six reasons hiring a consultant can be the right direction for your organization are as follows:
1. Consultants have subject matter expertise: While leadership may see adding a consultant as a high expense, consultants can be highly valuable assets to one's business model. Their subject matter expertise brings years of specific knowledge to your organization and they can produce results immediately compared to hiring several employees to equal the knowledge one consultant has as well as the leeway to produce results more quickly than a hired employee as they are focused on very specific roles and not an entire position's roles and job within the organization.
2. Consultants are low risk, high reward. With today's economic landscape, getting the most for your money is of high importance for many small to medium practices. While consultants may seem a high cost, the quick results they produce far outweigh the initial high cost that seems to appear. This is because, consultants can hit the ground running rather than taking months to train employees, over benefits, and hire new employees to fill gaps in the organization.
3. Consultants guide during periods of change and challenges. Organizational changes can be due to expansion, relocation, implementation of new policies, procedures, or systems, or when a new owner or management team comes in and employee changes happen. During these transition periods, workloads increase, more specialized projects come up, and new job functions are often created. Having the guidance of a consultant can make these changes easier and implement more quickly.
4. Consultants bring an outside perspective. Bringing a consultant on board can bring an independent view, that has no bias, to the table. This can be a huge benefit to healthcare organizations to help solve healthcare-specific problems and offer healthcare-specific problem-solving approaches to the challenges that are identified. This means that laws, regulations, and guidelines required for healthcare organizations will be followed in the recommendations offered.
5. Consultants get projects done and do so quickly. All too often in healthcare, there are lists and lists of projects that are waiting to be completed. Teams have the best of intentions on completing those projects but often find themselves focused on the day-to-day tasks, and projects get pushed to the wayside. Consultants focus only on the projects they are hired to complete so there is little to no distraction to completing the tasks associated with the project. Consultants take the time to understand the project requirements and keep the project at the forefront of what they are doing for the organization.
6. Consultants streamline processes. Consultants become highly familiar with your organizational culture, team, and processes right from the start of the contract with your organization. They draw from their expertise, vast experience, and training to successfully identify areas that can be improved, streamlined, or automated. Consultants are a great tool to fill gaps in your organization once the gap is filled, the problem is identified, and the solution offered may no longer be a gap that needs to be filled thus no need to fire any employees or move people around or try to create positions to not let anyone go. Consultants can give your organization expertise and experience leading to quick results, fresh perspective, and a high commitment to the success of your organization.
If you are looking to hire a consultant, consider the six reasons above and always make sure that your consultant has the experience and expertise your organization requires. For more information on consulting and how it can help your business, please feel free to reach out today.
Sources:
Canato, A., & Giangreco, A. (2011). Gurus or wizards? A review of the role of management consultants. European Management Review, 8(4), 231-244.
Brady, K., & Lowell, W. (2014). Theory vs. Practice: A study of business consultants and their utilization of corporate culture in daily practice. Journal of Practical Consulting, 5(1), 1-22.
Evers, H. D., & Menkhoff, T. (2004). Expert knowledge and the role of consultants in an emerging knowledge-based economy. Human Systems Management, 23(2), 123-135.
How Do Leaders, Make Great managers
How do leaders enhance their partnerships with their managers? What are the essential skills that help make great managers? How do leaders have better conversations with managers? How do leaders help managers align team and company goals?
These questions are often overlooked by leaders and when leaders do ask these questions, they may not know how to answer them. Here, I will take a look at each question and through a review of current research and studies, will help to answer these questions to help today's leaders head into the second half of 2024 prepared for the ever-changing challenges and opportunities facing leaders of healthcare organizations today. Leadership must be prepared, trained, and educated on ways to make the best decisions that will help guide and benefit their employees and patients.
What are the essential skills that help make great managers?
The first skill is that of communication. In my dissertation for my doctoral studies, this came up over and over and anyone can talk and say what is on their mind, but they do not necessarily communicate and make things clear and understandable for those they are conversing with. The key to excellent communication is to be an excellent listener and then learn to only respond to what was heard and stated and not go beyond that. Too much information or too much chit-chat can confuse the topic at hand and what needs to be relayed.
The second skill is that of emotional intelligence. Again, in my dissertation study this skill set was discussed and many studies today acknowledge that the new employable generation is lacking in emotional intelligence creating a gap in their skill set and ability to be empathetic and compassionate with patients. Emotional intelligence involves being able to take social cues, read body language, and hear between the lines when working with patients to make the best decision regarding patient care or interactions. Emotional skills help healthcare workers help their patients in times of crisis and without this skill set, help is often lacking for these patients as signs and cues were missed.
The third skill is that of relationship development. If your manager lacks this skill or is untrained in relationship building it can create challenges for leadership as well as the employees under the manager and then flows over to all other areas of the facility. Relationship development is the action of causing to grow, expand, or improve through a deliberate change in character over time. If your managers can develop relationships they will connect with their employees on a higher level and build trust and buy-in for the tasks and goals of the organization. This then leads to success for the organization.
The fourth skill is delegation and mentorship. Why are these two skills together as one? Well, delegation requires the manager to trust the person they are delegating to and this trust is built through mentorship or guidance in tasks they are assigned. Mentorship allows the manager to teach their employees how to improve performance thus allowing the manager to delegate to them more important or high-level tasks or roles within the department.
The last main skill for great managers is that of supporting professional development in themselves and their team. The chance to gain on-the-job development opportunities has become the standard for clinical workers and care teams. This is why it is so important for managers to support this learning, offer learning opportunities for their employees, and take professional development opportunities for themselves. This skill will provide motivation, and job satisfaction, and improve the entire team's capability.
How do leaders have better conversations with managers?
This question can be challenging because often conversations with managers involve corrective action, delegating tasks, or having tough conversations about employees. However, learning to have better conversations with managers can change the receptiveness of the topic by your manager thus more positive reception by the team under that manager. There are five questions you can ask yourself before the conversation that will make the conversation more meaningful.
What do you, as the leader, want the manager to know about the situation, topic, task, opportunity, or challenge you will be discussing?
How do you share the information in a way that they will hear it and understand the importance of what is being said?
What details are necessary to share that are important and impactful and what details can be avoided?
What do you want the manager to do exactly?
When the conversation is done, what are the next steps after the meeting ends, and are those clear to the manager?
When these questions are answered, before the meeting, the conversation in the meeting becomes more meaningful as it is clearer and concise, and the next steps are evident and able to be followed through. Better conversations mean better productivity, happier managers, and happier employees, and managers often will reflect to their employees how they are treated by their leaders so professional development is occurring.
How do leaders help managers align team and company goals?
Aligning team and company goals can be challenging for even the best leader and even more so for the best managers. Aligned goals connect employees and teams allowing for the goals or tasks to be met or completed quickly and at a higher level. Aligned teams and company goals bring a sense of camaraderie among the team and other teams in the facility. Aligned teams and goals have a greater impact on their patients, family, staff, and facility.
Great leaders have learned that to help managers align team and company goals they must be consistently effectively communicating with their manager and the manager must consistently effectively be communicating with their team. Making sure, as a leader, you remind your manager of their role and contribution to meeting or exceeding organizational goals helps them see how they fit in. These managers should then be doing the same for their team members.
When priorities are clarified employees and goals are connected and aligned. Leaders need to make sure managers understand the goal, its importance for the organization, and how they contribute to meeting the goal. Leaders need to make sure that managers are relaying the same information to their team members and delegating as necessary and appropriately based on employee's skill sets. Leaders must demonstrate, through action, what they want their managers to do and be like with their employees.
Key Takeaways
Developing great managers takes work by the leaders and leadership team and this is true for any organization. Managers are only going to be as good as the leader helps them to be. If, as a leader, you are hands-off and your only contact with your managers is to inform them of expectations, corrective actions, or project due dates, you will have a manager that reflects relationship style with their employees and may find yourself with challenges that prevent goals from being met. To excel at managing others, you--as leaders--need to bring insight to your actions and interactions with your managers. Leaders need to be constantly tweaking the environment for their managers and using managers with high-level skills in the appropriate applicable positions. To make great managers', a leader needs to ask the questions discussed and find a way to align the company with employees through their managers.
References for the article:
Zaleznik, Abraham. "Managers and leaders." Harvard Business Review 1 (2004).
Troy, Wykowski, et al. "What great managers do." Advances in Management 10.3 (2017): 1.
Santos, Gilberto, et al. "New needed quality management skills for quality managers 4.0." Sustainability 13.11 (2021): 6149.
Alvesson, Mats. "Upbeat leadership: A recipe for–or against–“successful” leadership studies." The Leadership Quarterly 31.6 (2020): 101439.
Murphy, William H., and Rolph E. Anderson. "Transformational leadership effects on salespeople’s attitudes, striving, and performance." Journal of Business Research 110 (2020): 237-245.
Does paper still have a role in healthcare facilities today?
In a world of technology and fast paced advancements, healthcare is becoming more and more paperless; but, is there still a place for paper in a healthcare setting? The answer, based on research, is a resounding yes! Why?
The biggest reason to not get completely rid of paper is for legal reasons. There are many discussions around this topic and the legal argument for maintaining medical documents on paper is not going to go away any time soon, if ever. First, documents that are on paper are more easily tracked for fraudulent entries and more easily accessed in the event of an emergency or need for the information for legal reasons. Second, the cost is lower in maintaining paper forms and records than having the costs that are associated with purchasing applications or programs that can create, track, and regulate the forms in an electronic format. Third, the versatility of paper allows for easier transportation, sharing of documents, and easier to make notes on and "think out loud." Fourth, paper records do not require cloud servers with limited space that must continually be upgraded or sorted to delete records. Yes, paper records need storage, but it is often cheaper to have storage for paper records that cloud storage that is HIPAA compliant and federally compliant with health care laws and standards. Fifth, there are no inconsistencies in the layout of paper forms when printed versus electronic forms. Often times electronic forms are inconsistent from program to program and computer to computer. Paper forms are just the same and standardized for printing. Lastly, they allow for business continuity planning (BCP) in the case of power outage or failing of electronic systems, paper records are just always there and available thus allowing for continuity of care despite the technological failure.
Perhaps the biggest key to paper forms in healthcare continuing to be "a thing" is because of the privacy and security concerns. The fear of data breach is high today and having paper healthcare records limits the ability of online hackers and others to access a patients records. While, EMR and EHR is federally mandated for practices today, having backup paper charts means that if there is a breach, the system can be shut down quickly and care can continue as the records are still available and accurate. Does this mean we need to print a record every time a patient has a visit and put it into a paper chart? No, should there be a backup paper chart that is stored for the patient that is updated on a set schedule, yes. For all the reasons above as well as ensuring interoperability of the businesses by using systems to exchange data, use data, and ensure business continuity of patient care.
Healthcare offices need to find a way to use both technology and paper to ensure they have BCP as well as the ease of customizing forms and records to their own facility. It is easy to just use a program like Word or Publisher and make a customized form to your office than have to go into an app and look for something that "fits" your office or pay someone to design a form for the app specific to your office. The key takeaway here is that technology is great and can make certain tasks easier and more organized, but at the same time paper formats can save time and make things easier. It is finding the balance of how to use both.
While electronic health records are mandatory today and do offer many advantages such as efficiency and ease of access, there is a place for paper in healthcare and often times can be seen in personalized forms specific to each office, note taking for doctors in meetings and patient visits, and fill the gaps in record keeping that technology creates. Studies have proven that paper serves as an important tool and continues to assist healthcare workers across the globe. Studies have also shown that patients prefer to leave with paper in hand regarding the care they received versus access to an online portal for the reason of out of sight out of mind thinking. If a patient leaves with a checkout record of some kind, they often are more apt to read it and see the findings, recommendations, upcoming appointment reminders, and things they can do to relieve symptoms and when to call or go to an emergency room. If they are simply told to look at their portal, studies have proven that it often does not occur as the "out of sight, out of mind" process takes over.
So, is there a place for paper in healthcare today? Yes! All practices need to find a way to have a blended approach to records, forms, and management of their facilities regarding paper versus technology. If a practice focuses on one more than the other, they may find themselves behind the eight ball. However, if a practice can find a way to fuse paper and technology they will find themselves in a better place than those facilities that use one more than the other.
References:
Electronic health records: managing the transformation from a paper-based to an electronic system by R.V. Weeks https://journals.co.za/doi/abs/10.10520/EJC141104
Electronic Health Records: Just around the corner? Or over the cliff? Richard J. Baron, MD, Elizabeth L. Fabens, MD, Melissa Schiffman, MD, and Erica Wolf, MD https://doi.org/10.7326/0003-4819-143-3-200508020-00008
Swindler of the week
Catheter Medicare Fraud scheme estimated at $2 billion dollars has come to light as a company that produced wigs and supplies for cancer patients gets hundreds of angry calls from Medicare recipients asking why their insurance was being billed for something they do not use or want. The scheme started small in 2022 but by 2023 had billed more than $1.9 billion dollars for catheters that were never shipped, requested, or needed to Medicare recipients. Click here to read more.
Is Tenacity in healthcare leadership important?
Tenacity is a fierce combination of persistence, courage, and willpower. For healthcare leaders, it is a characteristic that can mean the difference between their healthcare facility failing or thriving and being highly successful in patient outcomes, revenue cycle, and so much more. So, does tenacity matter more than you think?
Tenacity in leadership is all about strategic persistence and having that unwavering commitment to see things through while being flexible to adapt to the necessary changes to meet or complete a goal. Tenacity is about the brain function during challenges and leaders with high tenacity tend to find themselves better able to maintain focus and clarity during highly challenging or volatile times. They are hardwired to see past the setbacks to the finish line. They tend to manage their emotions allowing them to stay cool, calm, and collected in the face of adversity. This control of emotions allows them to transform the potential stress others would feel into a driving force to get out from under the problem and reach the goal or outcome desired.
How do healthcare leaders put tenacity into action? Often many leaders will look to cut their losses and move on. Tenacious leaders look for the shortcomings of projects, processes, and procedures to find new ways to rally their team and give them renewed vigor to continue by making adjustments that turn the sinking ship around. There is a stubbornness involved that the leaders are just not going to give up on something they believe will help their facility in whatever goal they need to meet. It is this stubbornness that helps drive them to see things from a different light. Traits of tenacious leaders are:
· Seeing the glass half full not half empty
· Strong analytical skills
· Stubborn
· Driven
· Proactive not reactive
· High levels of perseverance
· Reflective
· Inspiring
While there are so many other traits of tenacious leaders, these are the top skills that help them stay on course for completing their projects and meeting their goals.
It is important to note, tenacity is different than resilience. Tenacity is persistence and resilience is the ability to recover from a challenge that one may not see through or a goal not met. Resilient people are the ones who get up when they get knocked down and tenacious people are the ones who do not let themselves get knocked down. This does not mean that tenacious leaders will not face challenges that are designed to take them out and they will not struggle and appear knocked down. The difference is that tenacious leaders step back, regroup, redesign, and continue completing the project, or task, or meeting the goal. Resilient people are often the ones who will cut their losses, regroup, and begin again with a different approach and change in goals. They seem similar, but they are different, and knowing this can help you, as a healthcare leader or leader in any industry, find the way to not just dust yourself off and start over, but find a way to continue despite the challenges one faces.
The takeaway here is that this single trait of tenacity can make you a highly successful leader in your facility and create opportunities for your facility to become known as the best in the business or the one with the highest positive outcomes for patients, staff, and the organization. In today's ever-changing, fast-paced world tenacious leaders are a necessity for all healthcare facilities to be successful and stay in business as those just meeting standards will find themselves falling to the side. A key takeaway for readers is to find a way to be a tenacious leader, employee, or provider so that your patients can reap the benefits that come with being a tenacious leader.
References for article:
https://link.springer.com/chapter/10.1007/978-3-030-26684-4_10 Tempered Tenacity: The Leadership Required to Work Across Boundaries by Liz Wiggins from Transitions and Boundaries in the Coordination and Reform of Health Services pp 223-242
https://link.springer.com/chapter/10.1007/978-3-031-38534-6_17 Leadership and Health Scholars by Richard G. Milter and Kathleen M. White from Education Scholarship in Healthcare pp 253-263
https://www.emerald.com/insight/content/doi/10.1108/JHOM-07-2018-0210/full/html The making and sustaining of leaders in health care by Terry J. Boyle and Kieran Mervyn from Journal of Health Organization and Management ISSN 1477-7266
OIG 2024 Report Hints at Fraud Areas they will be investigating
Swindler of the Week--Normally on Fridays I post about someone who has swindled the insurance companies out of millions; however, this week I would like to focus on what the Healthcare Fraud Enforcement Agency has indicated as areas they will be looking at most in the next year or two.
The OIG report for 2024 gives us a few indicators of what the Enforcement Team will be looking for as they investigate fraud and waste claims. Some of the top initiatives are strengthening the Medicare and Medicaid Program Integrity, using strike force teams for targeting abuse and fraud, and Covid-19 fraud and abuse.
To find out more information, click this link for a great article with a lot of great information.