Faster billing time increases cash flow
Teams cut volume of unbilled accounts by 73%
Suppose the rules changed this month, and you had to bill your employer for your paycheck. Would you waste any time sending that invoice? Yet, many hospitals let millions of dollars languish uncollected as charts lie around and bills wait for dispatch to their rightful recipients. One case in point was the University of Texas Medical Branch at Galveston (UTMB.) Until 1995, this facility averaged $11 million unbilled accounts any day of the year.
"We were looking at essentially the loss of interest on $11 million," explains Jim Braden, MBA, the facility's director of Health Information Management. In that respect, UTMB was no different than many institutions but its turnaround sets it apart from the crowd.
In the course of three years, the department reduced its average volume of unbilled accounts to a level "hovering at just over $2 million," Braden says. (For an illustration of their progress, see graph, p. 64.)
Staff design longer, leaner coverageThe first phase of the reengineering took about six weeks. Braden, together with his department's team leaders and the director of patient finance flow, charted the billing process."When we started," Braden recalls, "the staff's perspective was generic. It was rare that anyone ever asked them to identify all the steps or people involved in a process.
Flowing out the process helped the teams see how people from a myriad of departments affect the movement of records from clinical to billing areas." Flowcharts identified where the unbilled records were liable to get waylaid. Mammography, autopsy, or the lab were typical bottlenecks.
One ground rule prevailed from the beginning, Braden says. There would be no new hires. Further, it was evident to Braden, and soon to others in the re-engineering group, that they were going to have to extend the Monday through Friday staffing to seven days. "But I wasn't going to tell them that," Braden notes, "they came to it on their own."
Peak-load staffing patterns were obviously the most reasonable way to manage the peaks and dips in the volume of billable accounts. The prerequisite cross-training was not a new concept to the staff because the department had already gone to self-managed teams. "At that point," Braden recalls, "we were straddling the old paradigm where each person did one job and the new one where teams communicate and take responsibility for each operation in their area."
In the re-engineered design, six to seven work teams, four to 13 people each, divide their time among accounts receivable and other records management functions. A "big-bill coordinator" - this could be a different person each day - tracks the large bills to identify their whereabouts and the reason for the delay. (For more information on UTMB's quality improvements in records management, see QI/TQM, April 1998, p. 41.)
E-mail augments verbal messagesFragmented communication was a problem which desperately needed a fix before the department could slash the volume of unbilled accounts. The old methods of handwritten notes, phone calls, or word of mouth messages couldn't begin to reach everyone who could potentially intervene in coding delays or help out with processing bills.
An intradepartmental e-mail system was the solution. "Now all eyes are alert to which accounts need to be expedited," Braden says. "For example, one person might know which department a record is in and will pick it up."
The e-mail also allows Braden and Carl Hula, associate director of records management, to "query the dialogue with regular and immediate feedback," Braden says. "For example I can interject a note encouraging all the teams to work together on one particular bill that's especially complex." When they master an especially tough challenge, Braden and Hula send kudos to everyone on the network.
Positive feedback can take place in a variety of form as well, Braden says. Going beyond the daily postings of hard copy charts of the previous day's and month's output, they recently celebrated a new milestone by ordering $600-worth of pizza for a party attended by the patient finance director, the chief of staff, and other executives, as well as the entire health information staff. When you consider the reduction in UTMB's accounts receivables over the past several years, you'll probably agree that festivities were in order.
'Big bills' a definition in progressWhen they started re-engineering the billing process, Braden's teams designated accounts of $50,000 and over as "big ones." Today's "big bills" are $15,000. To raise the bar even higher, the teams set thresholds for the maximum acceptable amounts of unbilled dollars. When they started, unbilled sums soared as high as $14 million. Now $3 million is the cap.
"It was tougher going from $6 million to $5 million and down to $3 million," Braden says, because some records have $1 million in charges. To stay under their $3 million threshold, the teams constantly monitor their statistics and reconfigure their staffing resources. "We still have blips, like over the holidays, but the teams decide how to manage it back down." (For more on accomplishing similar improvements in an ambulatory setting, see related story, p. 65.)
[For further information on working with self-directed records management teams, contact Carl Hula, Health Information Management Department, Records Management Division, 3.320 McCullough Building, Galveston, TX 77555-0782. Telephone: (409) 747-0699. E-mail: [email protected].]
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