By Donna M. Sherwin
Traditionally, in all but the most progressive organizations, the majority of billing positions were filled with entry level candidates who, with the exception of some rudimentary system training, learned by doing. Formal conceptual training was virtually non-existent. As a result billers learned what keys to use without any knowledge of why they were using them. Further, they learned about only those things for which they were directly responsible. Appointment schedulers and registrars learned what data to collect and how to enter that data into the system. However, few knew the importance of that data relative to the financial viability of the organization. The same can be said for charge entry personnel and payment posters.
In fact, even in many organizations today, only collectors are thought to be responsible for maximizing reimbursement, when in fact the collection process begins with the initial patient call. If the correct questions are asked, the appropriate information is given (for example you will need a referral, a payment will be due at time of service, etc.) and the data is documented accurately, the subsequent collection process will be nil or minimal.
From my experience, there are many team leaders and supervisors who not only don’t have the basics but they haven’t been kept up to date as changes take place. How many of us feel confident that our supervisors could pass a basic test that would require minimal knowledge of Evaluation and Management services?
How then do you make sure that every employee has a respectable level of competency and that he or she is working toward a common goal? I propose that you start with a uniform and basic level of testing and training for every staff member and that additional layers of training be provided selectively. This will not only ensure that all personnel are reading from the “same sheet of music” but it will give your current employees knowledge that may help them move within the organization more easily. As a result, you will have created a much happier and more productive employee from the front desk person to the accounts receivable management supervisor.
I have used the following system successfully for the past six years. It is based on the belief that the organization will benefit from everyone striving toward the common goal: maximization of reimbursement through timely and accurate billing while maintaining an optimal level of patient satisfaction. Given the uniqueness of each practice, this system can and should be customized to your specific needs. However, if a basic core is not provided to all employees, the success of any training program my be jeopardized.
• A series of tests to determine the strengths and weaknesses of each member of the staff.
• A core of conceptual training for all staff members.
• Basic system training.
• Selective training based on positions.
• Re-test to determine that objectives have been met.
To implement the above, you will first need to determine exactly what it is you want every member of your staff to know. A suggested outline might be: the flow of a patient from the initial call to the resolution of an account receivable (including a review of the basic functions and/or positions needed throughout the process, a minimum level of medical terminology, the importance of CPT 4 and ICD 9 codes, an introduction to self-pay and third party billing etc.).
Once the training has been outlined in sufficient detail, a document can be developed that clearly tests for the knowledge that you have determined is essential for all staff members. Your core training schedule should then be based on the results you have ascertained. You also need to make a decision as to whether or not you will allow individuals to opt out of the training based on test scores.
Based on several years of providing basic training, the allotted time should be between 15 and 20 hours. Depending on the size of the organization, it could conceivably take several core sessions before all of the staff is trained.
Another suggestion to facilitate implementation is to divide the core into several self contained modules. For example one module might be an introduction to medical terminology with concentration on the terms most often used in your practice. Another might be on the importance of CPT codes including a brief introduction to the CPT book and the most often used CPT codes in your practice. A similar module might be presented for ICD 9 codes. Each of these modules could be presented in sufficient detail in two to three hours.
Flow charts are an excellent visual tool particularly for displaying the flow of a patient through the system. Providing a flow chart for a charge from initial data entry to resolution of the account is also an excellent visual aid.
All trainees should be tested again to ensure that the training was effective and that your objectives have been met. I would suggest that you establish a minimum acceptable grade and that anyone who does not meet the minimum be required to retake the basic training.
Once the core conceptual training has taken place, you will then be able to review and apply the concepts taught through system training. If your organization is structured along functional lines, appointment scheduling, the registration function, charge entry, payment posting, etc.,you may choose to have those individuals who are responsible for the function receive training in that function only. However, I propose that there will not be a better time to provide cross-functional training than immediately following the core conceptual training. If you are organized along product lines in which one person is responsible for multiple functions within one product line, (physician, specialty, etc.) you will necessarily have to provide them with multiple function training.
At this point participants need only learn how the system captures and processes the information they received during the core conceptual training. Knowing that all participants have a basic understanding of physician billing concepts will allow the system training to take place in a relatively short period of time. Again, I would suggest testing at the end of system training to ensure that your minimum level of competency standards have been met.
The above training will allow any entry level candidate to perform effectively as an appointment scheduler, a registrar or a charge entry person. It will also provide an excellent base from which to build payment posters and junior level collectors.
The same logic that was applied in developing the core training can be applied to all other positions. First consider what it is that the position(s) must know, develop a training outline, test for strengths and weaknesses, train in general terms and test again to ensure standards have been met.
When analyzing positions, you should first look for commonalities. For example the knowledge base for both payment posters and accounts receivable personnel is similar. I would strongly suggest that even if your posters and collectors are payer specific, that you train all posters and collectors in general third party billing detail, that is EOBs in general, filing limitations, rejection types, etc. Once they have the general knowledge, it will be very easy to move into payer specifics with a smaller group. The benefits received from providing general training first is that you can train larger numbers of individuals at once. Again everyone is “reading from the same sheet of music,” and it will be easier for individuals to “cover” for each other. In other words you have provided cross-training to a point.
Training updates and new hire training can be implemented by using the same technique as outlined above. While training can be and often is time consuming and expensive, it is no longer a luxury. As professionals responsible for the billing function we need to ensure that all employees feel responsible for and have the ability to protect the cash stream. They can only do so if given the proper tools.
Donna M. Sherwin is president of PBSI, a firm in Wayne, Pennsylvania that provides temporary and permanent staffing as well as testing and training to physician and home health billing offices.