Communication combats payment delays, denials
Communication combats payment delays, denials
Finally, a meeting that brings some good
When Linnea Cunningham, RN, director of Roxborough Memorial Hospital Home Care in Philadelphia, came to her position in early 1997, it took more than three weeks for care plans to be signed and returned. Those 21 to 26 days had a domino effect on the organization: Without the signed plans, bills were sent out late and often contained errors. That led to delayed or denied payment.
Cunningham knew she had to do something. Little did she know that the meeting she called to discuss the care plans would start a communications process that would find other documentation bottlenecks, improve morale, and give staff members a better understanding of how their jobs affected everyone else.
When she called the original meeting, Cunningham says she wanted all those involved in paperwork to attend. "It was practically the whole office," she recalls. With a large flip chart, she walked through the process.
"The nurse was doing the 485 worksheet, which would go to get printed, go back to the nurse, who would sign it and send it out," she says. "But what we found was that between getting back to the nurse and her signing it, there was often a lag time of days. It was spending more time in the office in-boxes than it was in the mail."
The solution was simple: a half-sheet tracking page stapled to the top of the 485 that had spaces for the appropriate person's name, date, and time it arrived. That gave a sense of ownership of the process to those involved.
Cunningham also asked clinical supervisors to go over and sign the 485s, rather than waiting for the nurses to get to it. Turnaround was cut from 21 to 26 days to 13 days.
Ideas flow from meetingsBut more than one solution was found at that infamous meeting. Cunningham says it became obvious that half the people there didn't know what happened before they got a piece of paper, nor what happened after they had it. "That made it impossible for them to know what was slowing down the process," she says. Everyone's role was then discussed among the group.
Another discussion centered on getting things right the first time, and that discussion brought other problem areas to light. For instance, when the 485 wasn't long enough and a 487 form was added, they were often separated and only one page would be signed by the physician. Now, the pages are stapled together so that the second page sticks out at the bottom, leaving both signature lines visible. Sticky "sign here" notes are also added to ensure no one misses a signature line.
Another idea that came from the original meeting was to put out a list of new medical records numbers every other week. "If a patient's case is closed and then reopened, they are given a new number," explains Cunningham. "Sometimes, the nurses would bill using the old number. That led to delays and questions."
By printing a list of new numbers for the nurses, Cunningham says staff are reminded to check their own work.
Most of the meeting centered around subjects other than the care plan paperwork, she says. "There was some griping about people not writing neatly enough, or people not putting last name first on the medical records. But that led to a good discussion about frustrations and problems, and also about the importance of medical records and how vital it was that they be accurate."
Since that original meeting, Cunningham has set up process improvement task forces that meet regularly to discuss problems and potential solutions. One task force is working on an issue with hospitals. "We found we weren't getting adequate information, like that a person had a wound, or that they were diabetic," she says. "We had been having separate clinical supervisor and hospital coordinator meetings, but now we do it together to improve communication. It's already helped."
She has also started sending support staff on nursing visits to observe. "That helps them to better understand what the nurses do. They have to understand the soul and heart of the pieces of paper they work with."
The increased communication has had a real impact on Cunningham, too. Rather than spending her time refereeing quarrels about who should do what, when, and how, she sees her staff working more closely together, and more willing to solve their own problems. "I don't have to spend my time on that stuff."
That, along with faster payments, would be enough to satisfy anyone. But Cunningham says there has been an even bigger bonus: better patient satisfaction. While she doesn't have a statistical measure of it, she says there are more patient satisfaction surveys coming in, and she views that as a measure of success. "If they weren't satisfied, they wouldn't bother with the survey," she says. "I think that our better communication feeds back to the patients. They see a more positive attitude in the nurses and aides, and we respond to their needs better."
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