There is change in the air. Providers are leaving behind substandard business models and replacing reaction with progressive ideas designed to refocus on value and the patient. Time and attention resources are finite, so it is important that new initiatives are developed with purpose. At MiraVista, we have found the following five steps to be extraordinarily useful.
1. Clearly state the objective.
This is simple enough. It is not, however, obvious. Clearly stating a specific objective provides an organizational focal point that individual members can use to recalibrate when the detail work goes astray. It is the metaphorical North Star.
A clear objective is attainable and realistic. Moreover, it should be specific and measurable. Where “improve the bottom line” is a general goal, a clear objective might read “increase gross profit 10 percent in three months by filing all applicable Medicare claims as unassigned.”
Now, each member of the team can envision their individual contributions:
“I can prepare a schedule of our top Medicare products by volume and the current gross profit margins so we know what it takes to get a 10 percent increase!” – Yeah you can, accountant person.
“I can call our software provider and get instructions for setting up patients to bill non-assigned!” – You go, girl!
“As luck would have it, MiraVista is hosting a webinar on March 22, 2017, called Living with Non-Assigned Claims, that will provide all of the reimbursement education, tips, and tricks we could ever need to meet our goal!” – Register today and prepare for shock and awe…
2. Put together a small implementation team to run experiments and analyze the results.
With all of the excitement, everyone is amped to start filing non-assigned claims. It takes real discipline to resist having the whole organization charge the hill at once. That, if you are wondering, sounds like this:
“This is your manager speaking. Beginning today, we are no longer accepting assignment on any claims. Additionally, everyone needs to work this weekend so we can resubmit every open Medicare claim as non-assigned.”
(Do not do that.)
Getting results is about execution. Because most system knowledge is based on the concept of “this is how it is supposed to work,” it provides limited guidance for success in the real world. What if EDI systems are not configured properly or there is confusion with secondary insurance payers?
Instead, put together a small team to implement a test phase and analyze the results. Continuing with the non-assigned claims example, it is very important that this team is not limited to the billing department and/or management. Include payment posting representation so you know how non-assigned claims change the business of posting payments and denials. Appoint CSR representation so you are prepared to educate and satisfy your patients and referral sources.
3. Run several small isolated tests…and run them all the way to the finish line.
The first attempt will throw some curveballs. It is much easier to adapt to the unexpected with a small team and small data sets. You are going to find that there is one more checkbox that needs configuration in the billing system to properly transmit claims. You may find that secondary payers and commercial insurers are different so other existing processes need to be adjusted.
The test is not over until the claim is resolved. Simply transmitting a claim is not success (see clear objective above).
4. Deploy the minimum viable product to the whole staff based on test results.
French writer and poet Antoine de Saint-Exupéry is credited with writing:
“Perfection is achieved, not when there is nothing more to add, but when there is nothing left to take away.”
The scribes at Basecamp echoed a similar sentiment in their book Rework:
“A kick-ass half is better than a half-assed whole.”
After several iterations, it will be time to roll the new process out to the whole company. Resist the urge to add features to pacify everyone. This ship has to sail if there any hope of getting our hands on that sweet 10% increase to gross profit. Roll out the most basic version you can to get the best results. Less moving parts means less opportunity for error.
5. Rinse and repeat for new features and complexities.