Broaden skill levels with cross-trained staff

Absences no longer interrupt cash flow

When a key staff member’s two-week absence resulted in a massive decline in the amount of Medicare payments posted, causing a big decline in practice cash flow, Bill Willis, practice administrator at Medical and Surgical Associates of South Boston, VA, decided to take action.

He embarked on an aggressive program of cross-training business office personnel to make sure more than one staff member was up to speed on posting payments.

"When the key employee was absent, only about 20% of the Medicare checks were posted. That made a big difference in our cash flow that month and pointed out the need to do more cross-training," Willis says.

Now, the nine business office employees who are involved in billing and collection for the multispecialty group have been cross-trained. (For details on how cross-training works, see related story, p. 93.)

"In the past, if somebody was out sick, that job didn’t get done until they got back. This caused some unacceptable swings in our cash flow. It was feast one month and famine the next," Willis says. The cross-training has helped in getting payment posted and making cash flow more predictable.

Improved cash flow

"Cash flow is the life blood of any practice," Willis points out. The practice has now trained a number of people who can function in each of the vital areas involved in running the business aspect of the practice, Willis says.

For instance, four employees have been trained to work at the reception area; two are proficient in posting Medicare and Medicaid payments and are cross-trained to post inpatient and office charges; two also are cross-trained to post third-party insurance payments as well as patient personal payments.

"Rather than having one person who does only one job and nothing else, I have cross-trained my employees so if someone goes on vacation or gets sick, their job doesn’t come to a grinding halt," he says.

Not everybody at Medical and Surgical Associ ates is cross-trained in every area. For example, only three employees out of nine in the business office have been trained to post hospital charges. If the person who usually posts the hospital charges is absent, Willis splits the job between the other two employees who know how to do it.

"If they normally would be posting payments, I ship the payments to someone who otherwise has been doing some kind of bookkeeping function. Any time somebody is out, we lose a certain amount of efficiency. What this does prevent is several days when a particular job isn’t done by anybody," he adds.

Willis began his initial cross-training project when the practice moved to a new, larger facility where staff were more spread out.

"When everybody was in one room, it was easier to cover the job if someone was out. Once we got spread out, it became necessary to have people who could do multiple things, particularly when there was an absence," he says.

Large Medicare population

The practice is in a rural area with a large Medicare population, meaning Medicare is a significant portion of its total revenue. "For that to sit on somebody’s desk for a couple of weeks and not be posted caused a real cash crunch," Willis says.

There’s little managed care, primarily because the area’s population is too small to support an HMO, and there are too many older people to make it profitable, Willis says. However, the practice participates in preferred provider plans that pay a 10% to 15% discount on normal services.