When goal is consistency, all details come together

Organizing your business in a manner that produces consistent results requires thinking and processes developed with consistency as a goal. In my complex rehab and O&P practice, we had to grow to survive—not just growing in size, but in the maturity of our thinking about our operations and management strategies.

We underwent a significant business management improvement effort in the last 18 months that radically transformed how we do business. One of the most difficult processes to implement was a paperless work-in-progress (WIP) workflow management structure. We took inventory of how we managed sales orders and found that the location of the chart was the organizing factor. Our intake, order development, coding and documentation process did not lead us to a clean billing process. We were not using our Brightree software effectively, and we were not staffed appropriately to get where we needed to be.

Early on, we decided to implement a pre- and post-delivery management doctrine. There was to be a clear solid line between these two processes. The billing effort was to start with a clean “chart.” This sounds basic, but it presents some significant organizational challenges and offers day-to-day discipline that we did not have when we started.

The main problem was that quality improvement was not part of our ongoing operations. We did chart audits (when there was time or a problem) and found problems in the post-delivery process. We would count on our billing folks to clean up our little messes and then have the gall to ask them why secondary billing was delayed or posting was behind. They were furious with us when we looked to them to “tighten” our company's processes because we had a “collection” problem. It was from those conversations that we developed the pre- and post-delivery doctrine. (I am apologizing publicly!)

It all starts in the beginning of course. Intake staff had to be trained and staffed sufficiently to start with the whole picture. They needed time, training and resources to get each order off on the right foot.

The sales professionals (order development) were then expected to collect serial numbers, existing equipment conditions and photos, and thoroughly complete assessments before they would even consider pushing an order forward. The manufacturer quotes had to be 100% complete with only the latest versions in the chart.

If we were replacing equipment, a repair versus replace estimate was required, or at least notes with details explaining the situation in a manner that could be conveyed to the coding and documentation specialist. Custom items that we fabricated had to have materials listed and explanations of what the heck the item was for, so we could explain it in the documentation process. If any of this was not present and in good order, it went back to the sales professional with clear instructions about what was missing. Nothing goes forward to the next step until it is right.

The coding and documentation professionals needed more efficient tools to track and manage their workflow. The WIP process we implemented had a profound impact on their day-to-day efficiency. We also wrote software called Conduit Office that works with Brightree to collect and manage all clinical and compliance documents using the Brightree data from the sales order.

Every order was assessed for profit with easy to understand margin indexes. If the order was not clean and profitable, it was sent back to be re-worked by the sales professional.

Now that the coding and documentation staff started with detailed information and had better resources to accomplish their work, they were empowered to be a rigorous go/no-go stop in our order development process. With this robust quality stop, the authorization process was more fruitful and reduced re-work and endless supplemental documentation requests. This is a critical step we missed, which created a significant amount of chaos and re-work simply due to poor management performance. (More apologies to my amazing staff!)

We moved one of our billing professionals, who understood quality assurance and had a good understanding of the big picture, and trained her for a new role on the pre-delivery side of the process. She was given the authority to check everything before it was sent to purchasing to ensure that all of the previous steps were completely correct, and that the client and sales order were still viable.

Looking into this before we purchased equipment seems redundant, especially considering the detailed nature of our process, but we found that this coordination paid off because the insurance was verified, and delivery tickets matched what was approved by the payer and what was ordered. Then, after the delivery, all of the signatures and out-of-pocket details are verified.

The reality is that one less billing professional was an easy choice because we now needed less billing firepower. The billing professionals now had to do two things: bill and follow up. The whole story is told for them in the Brightree software before it gets to their desk with all of the notes and details laid out for them. The post-delivery process was closer to point-and-click than we ever imagined was possible.

Our management team needed to lead by setting up detailed standards for quality work, healthy time frames and a clear plan that could be consistently executed. When consistency was the goal, all of the details came together.

Dividing your business process into a pre- and post-delivery processes is a logical choice. Each aspect of your business has professionals who want to accomplish their work efficiently and effectively. Tight, disciplined order intake, order development, and coding and documentation processes that are run by educated and empowered professionals will yield the fruit of a healthier and more profitable business.

Companies that want to grow and be healthy adopt more disciplined and detailed approaches to their operations to adapt to these strenuous times. The answer to surviving in this tough new world we live in is to be smarter, more efficient and prepared.

Keep the faith! hme

Jim Noland, SMS/ATP, CRTS, is the founder of Presque Isle Medical Technologies and Conduit Technology. Reach him at jnoland@conduittechnology.com.