Working with Teams

HCA 230
March 16, 2014
Linda Jones

Working with Teams

Inaccurate coding and patient information are slowing down production and delaying payments to the doctor. This team plan report will explain how a new process will be implemented. As director of the billing department, I created a process to help solve problems on this issue. A team will be assembled to solve problems due to the fact that the current process is not working and losing productivity. We need to find where the error is and recoup the loss revenue; this will be our goal.

The front office personnel that checks in a patient upon arrival is the first person to question. Once the insurance card and demographic page are obtained, that information needs to be compared to the information on file to ensure that it is accurate, and up to date, this is an important step. At every visit take a copy of the insurance card. This does not change even if the patient was just in a few weeks ago, this is to establish a quality routine. Now the front office needs to check with the insurance carrier to see if a referral is needed. Not all insurance carriers require a referral for a family practice; however some have advantages when they use a doctor in the network.

The medical assistant will ask the patient the reason for the visit when they are in the examining room. The medical assistant is to write down the information that the patient has stated such as signs and symptoms. This documentation is necessary and must be detailed and properly recorded on the patients chart. Scrubbing the documentation before it is submitted to the billing department should be completed by the department manager of nurses. For example, during a routine check the physician decides to order labs for the patient, the lab draw needs to be documented; even though it was not the reason for the visit. Communication starts with the first point of contact, which at check in with the front office. The front offer personal needs to be detailed, efficient and willing to ask questions without hesitation. They are not to assume or fill in the blanks. Assertiveness and being responsible are needed from them to answer staff questions. This is significant to the team otherwise the team will spiral downward like a domino effect. For example, if insurance is not determined and verified at first, then the checkout personal will not be able to excuse the patient without collecting the co-pay. This is way it is important to have the insurance information entered correctly by the front office. According to Veean (2012) "We are paying more attention to electronic devices that to one another. The person to person communication between doctor and staff; and doctor to patient is decreasing. The answer to the question, is we can save health care by utilizing a balance of words and computers".

Personality types are how the team will be organized. It is important to remember that the group of people has a variety of experience, skills and talents working to help each other achieve a common goal. The task of problem solving why the billing codes are incorrect and where the missing link is for payment is to be made by the group. According to Chong (2007) "team performance can be positively correlated with the teams that are organized based on their individual characteristics". Every person is responsible for their own role. Team selecting will be made by department which will ensure all employees are contributing to their individual duty and create equal success. One leader will be appointed, a couple of nurses to scrub the documentation for errors, two administration personnel to ensure the demographics and insurance information are accurate. A report for the last 120 day will be done by a person from the billing department. A friendly reminder to the doctor to document according to the procedure. It is important that the doctor knows that treating the patients is not their sole responsibility in an office.

Every team member was selected according to each of their talents and skill level. Including how well they communicate with written and verbal communication. According to Cheesebro, (2010) the ability to solve problems and think critically are excellent traits to have. Everyone has a desire to accomplish a task and be held accountable for their performance. Pointing fingers and judging without investigating are a potential for conflicts. If a person knows whom the employee is that started the problem and approaches the person unprofessionally is another potential for conflict. Therefore, this process needs to be redefined and no once singled out as the culprit. If communication is not open conflict and happen. Such as if one person feels that an idea or strategy is not helpful to reach the goal. With good teamwork, it creates a positive environment. When a disagreement is heated, it lowers the mood and demotivates the rest of the team. Conflict can be healthy in certain situations because it can bring a team together. research has shown employees that feel they are part of a strong team are happier and more productive, according to Cheesebro, (2010). Team is to trust, have empathy, attitude and have a mutual respect for each other.

In conclusion, to avoid future billing failure the best practice is to call the insurance company. Billing offices will be notified of reasons for denial from insurance companies. Some reasons could be that the birth date is not a match to what is on the enrollment application. A modifier may not be placed after a disease classification code. A current code could have been entered with four digits instead of the required five digits. If a report catches the error and a person overlooks it and uploads it electronically anyway, it will be denied. In order for payment to be received the rules of assigning codes is complex and plays a significant role in coding. The front office is presumed to be the reason for failure in payment which is presumptuous. It could be any number of reasons why it is rejects; therefore, it is important to have a team approach to help solve the reason why there is a lack of payment. The billing office can have a person concentrate on the rejected claims, repair the error's, and return them for payment. Fifteen days will be allowed to reprocess the claims, and recover the mistake.

References

Cheesebro, T., O’Connor, L., & Rios, F. (2010). Communicating in the workplace. Upper Saddle River, NJ: Prentice Hall. www.kevinmd.com, Satyam H. Veean; Communications Skills are Lacking Health Care Today. June 13, 2012