Could a revenue cycle review help? Yes it can, for many reasons. Here are 5 of those reasons:

1. Are you comfortable that every charge you could possibly capture is being captured? Are you sure that the charges being captured are the procedures, supplies and pharmaceuticals that are actually being used or performed? Not only could this cause revenue problems but it can also cause billing and compliance issues, both of which affects cash at some point.

2. Are you confident that the charges being captured match up with your diagnosis codes? There are two problems that can occur here. One, medical records doesn’t code everything, and physicians sometimes have office staff send over codes instead of doing it themselves. Two, in hospitals where procedures in departments such as endoscopy are in the charge master instead of capturing timed charges and then having medical records code them, procedures selected by the department and what medical records codes based on what physicians say actually occurred can be different. These are both compliance issues that can also lead to claims being denied.

3. Are you confident that your charge master is not only up to date, but that the codes you’re using are valid for the departments you’re using them for? If you’re coding because you know you can get a higher reimbursement rather than coding accurately, that’s not only a compliance issue but that’s fraud, and the consequences aren’t worth it. If you don’t know that it was done previously an audit will help find those problems.

4. Denials can occur for a number of reasons, and all of them take a toll on your cash collections. Sometimes having someone on the outside take a look can correct problems and bring great benefits. The problems could be with registration, charge capture, coding, or even computer processing errors. When every person on your staff is already so busy that they can barely keep up with the workload, having someone else do a revenue cycle review can help immensely.

5. Not only do you have to worry about revenue and cash issues but all types of audits. There are Medicare and Medicaid audits, RAC audits, OIG reviews and probably reviews by more local insurances such as Blue Cross. No provider ever wants to have to give money back and possibly deal with bad press at the same time. True, hiring someone to come into your business to do a review will cost you some money, but a review by a competent company will always offer your more financial benefits than the cost.
 

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The book is titled Awakened Leadership, and the writer is Alan Shelton. It’s not necessarily a book on leadership as much as it’s a book about a man looking to find himself. Indeed a lot of the book talks about his quest to find enlightenment, and to that end he traveled the world and had lots of encounters until finally, of all things, one day he was driving and it suddenly hit him.

What hit him? To tell you the truth I’m still not sure, because it doesn’t seem like Alan was able to fully identify it himself. Still, that’s not the overall point of the book. He does talk about leadership, but in many ways it’s a kind of leadership that most of us don’t think to do. He was a successful guy who had no problems letting others take the reins; at one point he left the business for 4 months on a quest, only to come back and find that the company had actually grown and thrived while he was gone.

This book is more about personal journeys than anything else, and that’s actually pretty interesting. From never knowing who his father was to getting one that never lived up to expectation. To a mother who found Mormonism, got him into it, and how he eventually had to leave it and his wife. To seeing how both the ultra rich and the ultra poor lived, and realizing just how little control one actually gets to have in their lives. And finally, do the doorways of awakening, his way of telling all of us his criteria for finding your own way if you dare to take the journey:

Your viewpoint is only a step away;

Contrary to appearances, you are not the doer;

You are enough; let your power come to you;

A leader needs no followers;

Let life live you

If you’re looking for a book that’s only about leadership lessons, this one isn’t it. If you’re looking for a tale about the process of finding out just who you are and what your ultimate goals should be, while learning lessons about leadership along the way, this book will give that to you. There are parts that will slow you down, but overall I think you will enjoy this book.
 

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by Dheepak Ra via Flickr

It’s amazing how long it’s been since I’ve touched upon this subject, especially since it seems to come up more often than not. As an example I’d like to tell this brief tale about me, my mother, and a place where she likes to go to get submarine sandwiches.

She told me a couple of weeks ago when I visited her and went in to get a sub for her that the people behind the counter never listen to her when she tells them how she wants her sub. It’s a very simple order every time: a large ham on wheat with only mayonnaise, and don’t cut it.

Sounds simple, right? I thought so when I went in to get her a sub. I was asked what I wanted, and I said exactly what I printed above. The first question was “did you say wheat?” The next question was “do you want anything else on it?” The question after that was “what about cheese or olives?” The final thing was my saying “are you cutting that”, to which she said “yes, I’m cutting it in half”, which led me to say “I’m sorry, but now you have to make me an entirely new sub because I asked you not to cut it because it’s for my mother and she doesn’t want it cut.”

Mom was right; these people weren’t listening to her, and they didn’t listen to me. Unfortunately it points out what happens every day in some business, either between peers or with customers. Everyone is so ready to just respond to a question that they’re not taking the time to listen to what the person is saying to them. This makes people mad, and makes the person who wasn’t listening feel upset because they’ve been caught assuming and not paying attention.

There’s two kinds of “not listening”. One is when you don’t understand what someone else is saying and thus you can’t listen. This happens often during training sessions because no amount of listening is going to help anyone learn something if they’re already confused. The other is when you think you know it all and thus are rehearsing what it is you want to say before the other person has even finished explaining everything.

Truthfully, we all do both, but I’ve spent a lot of time working more on the second than the first. That’s because I’m one of the few people I know where, if I don’t understand someone, I’ll immediately start asking questions so I don’t fall behind, or will eventually stop someone and tell them I’m not processing the information and I don’t need to.

I work more on the second one because I try to anticipate what people are saying as much as the next person, but after all these years I’ve also learned that I don’t have to practice what I need to say once someone is finished before hearing it all. I will take my pauses, and I will sometimes repeat what I think I’ve heard if I need to do that. I’ve learned that I have the confidence in myself to not have to give a quick response to any queries that come my way. I’m not afraid of the silence of a moment while I collect my thoughts; that’s a skill that takes practice, and I’ve been working on it for decades. I still haven’t perfected it, but I’m pretty good.

We’re not a good society for listening, and we have to change that. If you want to be an effective leader, it’s something you need to acknowledge, then work on. Come on, join me on this quest; trust me, it’ll be to your benefit.
 

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Companies do this sort of thing all the time. How often do we hear of company layoffs where they’re going to save a million dollars but the CEO is making $10 million? Does that seem fair or logical? I don’t think so and any reasoning person would think the same thing. Is it fair? I’ll leave that one up to you.

This isn’t an article about health care, and yet since that’s my background to a degree it’s where I have to go for examples that I can talk specifically about. These are true stories; see if you agree with my statements that the acts were the result of bad reasoning.

When hospitals start deciding that it’s time to lay off people, often they start with people who don’t generate revenue. While on the surface that might sound like good reasoning, it’s not.

Let’s take the billing department as an example. As a matter of fact, I’ll talk about my own experience some 15 years ago. The hospital needed to lay some people off because we were in a bad way overall. They wanted to take a look at my department first because we didn’t generate revenue. Of course revenue is important to hospitals, and I personally feel that most hospitals need to first review their income via charge master and charge capture processes before even thinking about doing layoffs, but I digress.

They came to me and wanted me to layoff at least one person in my billing department; I only had 5 people. I told them their beliefs were flawed. Of course no one at the C-level ever wants to hear that but I knew my stuff and they knew I knew my stuff so they asked me why. I told them that we were a well oiled machine, and that each person in the billing department was responsible for $750,000 a month in cash. I then said that the average each person was making a year was less than $20,000 plus benefits, which weren’t extremely high back then. I asked them if it was more important to the hospital to lose $750,000 a month in cash, which was needed to pay bills and employees, or reduce expenses by less than $30,000? I kept all my people.

The second one was at a hospital I consulted at, where the move had been made six months before I got there. This hospital had done a marvelous job with offices built in a building that was across the bridge from the hospital. They had decided at the time to move physical therapy into the office space, and paid for a massive design that was absolutely beautiful. They moved the department and started it up, and six months later decided it wasn’t making enough money and that they would shut down the entire department and outsource the work if they needed it done in the hospital, and tell patients to select which outpatient physical therapy company in the area they wanted to go to.

When I got there I saw the charges in their charge master and didn’t see any revenue. I asked about it and was told that they’d shut down the department and farmed out all the work because it wasn’t making enough money, aka revenue. When I took a look at the revenue they had accrued in the six months they ran it at the new facility and in the previous year I saw that they had set their charges up incorrectly and weren’t coming close to capturing all the revenue they should have been capturing, which translates into not getting paid for everything they did.

In physical therapy, an overwhelming number of charges are based on 15-minute increments, but if you don’t know that then you only capture one unit instead of multiple units, since quite often treatments and processes go for up to an hour. In your own terms, imagine how you’d feel getting paid $10 an hour when you should be getting $40. The reasoning shouldn’t have immediately been to kill a department that so much time had been put into; it should have been to take a serious look at it first, with “competent” people who understand charge capture, and then made a decision as to whether it’s doing what it should be doing.

The third bad reasoning came during another period where a facility felt they needed to layoff a bunch of people. In this case what they decided to do was to layoff all LPNs and unit clerks on the inpatient units and have registered nurses handle everything. Their original reasoning seemed sound on the surface. Registered nurses could handle a lot more legally than LPNs can, and unit clerks were only seen as secretaries that didn’t help produce revenue and, in their eyes, anyone could be a unit clerk so the nurses could do the work just fine.

What was the problem? Registered nurses suddenly had a massive workload because they had to keep up with the paperwork, which means all the medical charts, they had to deliver charts to doctors and medical records which meant they had to leave the floor, suddenly they had to do everything with every patient and thus they had more patients to take care of, and initially they also had to learn all the paperwork, which they didn’t know how to do because upper management fired everyone on the same day without realizing that none of the registered nurses had done any of it before. Eventually they realized they’d made at least a partial mistake and rehired some of the unit clerks to help, but never rehired any of the LPNs; the hospital ended up being closed a couple years later anyway.

Bad reasoning happens when people don’t know what they’re doing, and when they feel their backs are against the wall. The examples I used are in health care, but I bet everyone reading this has experienced bad reasoning where they work, or have worked, as well. Don’t ever let the person doing the bad reasoning be you, and if you’re in any position of leadership never go along with what you know is bad reasoning “just because”. You might either end up having to try to fix something or not have a job left because of it.

Or you might be one of these people:

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Instead it turned out to be a book about a guy who emigrated to the U.S. from Russia as a kid and worked his way through language difficulties and biases against people from Eastern Europe to eventually become the CEO of a major real estate financing organization that he created. It was fascinating read, even if I didn’t get what I was initially hoping for.

One of the things I found interesting is that he recognized at a certain point that he had to give up some of the control he had in his own company to progress. Not that he couldn’t keep up with the workload, which, if you read the book, is astronomical. Instead, it turns out that as successful as he was, he found that some potential business partners were put off because they didn’t want to work with a founder who was also a CEO, CFO, etc. The belief was that founders can tend to be inflexible when new ideas are presented because it’s their baby, and indeed, that’s why Steve Jobs lost his job at Apple the first time around.

Milstein took a big step at that point. He went and hired some C-level personnel and gave them the reins to basically run his company while he retained the title of CEO. This allowed him to look at his company globally while letting other people create a vision and make business deals to push the company forward financially. It’s all worked out well and he gives kudos to the people he hired to basically run his company.

It’s hard to step away from one’s vision. If you have employees, you probably have in your mind exactly what you want them to do. Sometimes, even if you don’t see it, you want to control their every move, and want them to do everything exactly as you did it.

The problem can be twofold. One, no one else will ever be exactly like you. Two, it’s possible that what you’ve been doing has been limiting the success of your business. I see this example shown often on the TV show Restaurant Impossible, where it turns out that the restaurant owner really don’t have much experience in running their restaurant, cooking, etc, which explains why they’re in trouble. The host of the show often evaluates them and tells them they need some kind of manager, either a head chef to handle all food or a floor manager to handle staff and customers, and sometimes even an accountant of some type to handle the books.

What happens to the leader? They end up being the face of the company, the greeter, the cheerleader, sometimes the top marketer and recruiter. No one buys a restaurant because they want to hide in the shadows, although some buy restaurants, hire great people to run them, and just sit back and collect their share of the profits.

If you hire well, there’s nothing wrong with that as long as you keep your eyes on the prize overall. It does take a lot of guts to let someone else lead here and there, but the benefits can be awesome.
 

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I have one friend where, almost everything I ever say to him, in some fashion he has to disagree. It pretty much doesn’t matter what it is; if I say it then it has to be wrong. What eventually happens, though, is someone else says the same thing to him and suddenly it’s totally correct. Every once in awhile he’ll own up to it; other times, he acts like it was his idea all the time.

This doesn’t tend to be my general MO, if you will. Whereas I won’t agree with anything someone says “just because”, I will often go to great lengths to build people up, possibly offering suggestions I think will help them to get where they want to go.

I do that because I don’t believe anyone is ever helped if all they ever get is rebuff in some fashion. Everyone likes validation, whether they need it or not. We like being told that our dreams, goals, fantasies, whatever, are legitimate. If you’re 5’1″ tall and say you want to play center for your favorite basketball team I’m not going to urge you to keep on that road to ultimate failure. If you said you wanted to learn what it takes to become a professional basketball coach, no matter your age, I’d encourage you to figure out how you can get the information and the experience needed to get there. Even if it seems like a pipe dream to many others there’s nothing saying it’s not a possibility.

If you’re going to be a leader, you need to know when to give positive responses and how to do it to get the maximum benefit out of your employees. You also have to be genuine; telling someone how great they were because they knew the right keys to push to enter information into the computer when that’s what their job is supposed to be comes out sounding false and patronizing. Giving someone kudos for the way they handled a difficult customer on the telephone is something else; who hasn’t had to deal with an unhappy customer at least once in their professional lives?

Today I give you permission to dream about the things you want in your life, and while you’re doing it dream about ways in which you’re going to make someone else’s life positive today.
 

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via Flickr

This wasn’t the first time I talked about the concept of perspective, though it was the first time on that blog. Over here I wrote an article titled Perspective Is Always Interesting, where I talked about how many people can look at the same thing and see it different, Trusting Leadership – A Blogging Perspective, where I inquired about the “trusting” nature of other leadership bloggers who decided to moderate comments instead of just trusting people that commented first, and Communications From A Cultural Perspective, where I talked about how people in different parts of the country and the world can look at certain words and phrases and have them not only mean different things but sound differently based on what they were taught.

As leaders, our hope is that we can guide a diverse group of people to work towards the goals we set for ourselves and our organizations. In my case, since I work independently, my goals are to help guide people towards achievement, no matter what field it happens to be.

To that end, it begs the question as to whether we’re also trying to influence perspective, and how ethical it might be. One of my friends once wondered if this was all a type of manipulation, which she saw as a great evil. I’ve never considered it so nefarious, but I could understand her initial point.

Any time you’re trying to sway someone else to your side for your purposes, it is a kind of manipulation. And yet, there’s no other way around it if you hope to get as many people on the same page as possible.

I tend to view it as more of a team building concept than manipulation. I do so because the intentions aren’t necessarily to benefit me personally. Sure, I might get a benefit out of it by having some recognize my leadership skills. But the ultimate goal of being a good leader is to get the team to act towards a common goal, and that can’t be done if everyone is doing their own thing. It also can’t be done if everyone has a different perspective on what the ultimate goals really are.

In my mind, purpose determines whether influencing perspective is fair or not. Trying to change the testimony of a witness to put someone in jail who doesn’t deserve it is unethical. Trying to change the perspective of someone for the goals of the organization, which could benefit them as well by getting them more money and possibly promotions, is not only ethical but small business.

That’s how I see it; what say you?
 

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by Jasoon via Flickr

The thing I found interesting after thinking about it is that it’s not the type of work that one can just decide to do internally. In essence, if the hospital already had the person in place who was responsible for the work then they wouldn’t have called me to begin with, but to suddenly say they were going to do it internally… nope, I wasn’t buying that one. Nothing I could do at that point but I knew there had to be something amiss.

Turns out I was correct. The hospital was in financial distress and, unfortunately, just closed its doors for good a couple of weeks ago. It’s too bad because it’s an area that needs all the hospitals it had for its population, and now a large portion of people will have to be absorbed by the remaining facilities in the area.

I’m not saying that I could have saved the hospital, but I know I definitely could have helped. For that matter, I think these are the times when facilities need to reach out to consultants for help, before things are at a critical mass. Without knowing everything this hospital was going through, my bet is that I could have increased their revenue by at least 50 to 75%, if not more, based on the fact that I know they didn’t have anyone already doing the kind of work that I provide services for. I’m also betting I know at least 3 or 4 other consultants that I’ve worked with in the past in addressing these types of issues in the past who could have gone in and worked with the administration there to help turn things around.

Does this type of thing always work? It always does at least temporarily. I know that when I did one of my consulting gigs that lasted over a year and helped them increase their daily revenue by more than 100% that they had turned the corner and were profitable for the first time in a decade; no, I wasn’t the only one working on that project.

I also know that in the last two years, which was about 4 years after I and most of the other consultants were gone, that hospital has once again reversed fortunes for the worst, based on the fact that they hired a lot of people to replace many of the positions consultants were holding that were “good enough” to put bodies into position that needed more than that, and that’s led to multiple layoffs and the closing of the nursing home, with more coming.

No matter what it is you do, or what your business is, if you know things aren’t going great or on the right path don’t wait until it’s almost too late to ask for help and assistance. If you feel you’re capable and will reverse things, then fine. It’s never a bad thing to look outside for help; it could save everyone and everything in the end.
 

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by the U.S. Navy via Flickr

I’ve had others tell me that I’m being stupid (though not necessarily that specific word) for giving away so much information without getting paid for every bit of it. Some have said that I give away so much information on this blog that people have no reason to hire me to work with them. I’ve been told the same thing about my newsletter. One guy specifically told me that if I wasn’t generating money from my newsletter after six months that I was wasting my time; I’ve been writing my newsletter for 9 years and never made a dollar off of it.

I want to make money as much as the next person, lots of it. Yet I never have set myself up to be someone who wouldn’t give anything if money wasn’t on the table. Yes, I have given a lot away for free, and yes, many people have benefited, even monetarily, from advice I’ve given them without my getting paid for it.

Truthfully, most of the time I haven’t even thought about it, but maybe I should. When one guy I gave a free coaching to told me that he’d signed a contract with $85,000 about 2 weeks after we’d talked, I didn’t necessarily expect to be paid for helping him focus on doing it, but I guess I had expected that, somewhere, he’d have written a testimonial of some sort thanking me for helping him. Sure, coaching is confidential, but I guess I saw it as more of business consulting after the fact.

But that’s just how I am. I figure I’ll get my money and recognition when people really value what I might help them do; everyone has a different way of evaluating value. I don’t see myself changing all that much, although I do recognize I have to keep a better watch on how much I’m restricting my own income.

When it comes to being a leader, though, there can’t be any thoughts except in being altruistic to those who report to you. If you want things done correctly and you want the people in your office, or wherever you work, feeling motivated and confident in what they do, you have to be selfless and available and encouraging. You can’t expect that any of them will thank you for being that way or will even notice that you’re doing things for them.

Instead, you have to feel your own sense of accomplishment in doing the right thing, as well as be pleased when your production numbers are looking great and you know the part you played in it. The more selfless you are in business, the more you’ll end up getting back from it if managed properly.

Compare being selfless versus being stupid in this case; which one do you think will bring the most benefit back to you?
 

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Of course there are no absolutes, and children in both circumstances will sometimes become what their parents didn’t expect, but there’s a lot to be said for deciding how to influence people to go in the direction you’d like them to go. Some might call it manipulation but I tend to think of manipulation as a negative whereas motivation is seen as a positive.

What do I mean? Let’s say that your company makes some kind of widget and you have an assembly line process where each person is responsible for one thing as it pertains to your product. For everything to stay status quo for the company you need each person to complete at least 300 pieces of their part of the widget each day. So that’s the figure you as the manager look for from each person. Sounds good, right?

What do you then do if you’re putting things together, reviewing the process, and suddenly realize that your employees could actually be putting out 500 pieces a day? Or what happens if you know that some of your people are so good that they could easily put out way more?

This type of thing happens in almost every business I’ve ever seen where there’s more than 10 employees. There are people who are supreme, and there are those who are there to only get a paycheck. If managers expect their employees to only live up to a certain standard, that’s exactly what most of them will live up to without some kind of engagement in the company. If there’s no benefit to an employee to do more, and it’s not expected of them, then that’s where an employee will stay until they get so bored that they decide it’s time to find something more challenging and mentally stimulating.

Sometimes there’s a fine balance between pushing someone too much and not pushing them enough. Leaders have to figure out which way they want to go, but it’s always better to try to get people to live up to and surpass expectations. It’s always best to try to motivate everyone to be the best they can be; no one at the top ever complains when someone gives them more than what they thought was possible. And while you’re at it, expect more from yourself as well; nothing works better than leading by example.
 

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