Practices commonly cite conflicts between the front and back (billing) offices as a perennial struggle. Such problems likely stem from both the physical distance between the front and back offices as well as inherent personality differences between both types of workers.
Practices tend to have people in the front who enjoy direct patient contact and are chatty and personable. On the other hand, successful billing staff may prefer to work behind the scenes, are task-oriented, enjoy paperwork, and like to fight insurance companies.
But despite these differences, the front and back offices are indelibly linked. Successful billing efforts depend highly on the accuracy and success of the front desk, where the billing process starts. Not only are there financial ramifications to communication breaches (e.g., unpaid claims due to inaccurate data collected upfront), but the entire practice loses cohesion and suffers under an unhappy work environment, often resulting in higher error and staff-turnover rates.
Often, staff members simply don't understand the other side's responsibilities and challenges. The back office may not have an appreciation for how hectic the front desk can be. For example, in many practices, the same person is in charge of answering the phone as well as greeting and checking in patients, so they feel the stress of two immediate tasks. Their goal is to try to move patients along and keep the physician's schedule on time. As a result, sometimes back-office staff don't get the complete and accurate billing information they need, causing a denied claim.
Similarly, front-office staff may not realize how long it takes to correct errors, or the extra work involved in rebilling because of incorrect demographics. Billers may then get the impression that staff at the front desk don't listen to their needs, or worse, become frustrated that even after they take the time to train the front-desk staff, they still have to deal with seemingly careless mistakes.
But training is not usually the problem. It's more an issue of walking a mile in the other person's shoes, and finding better ways to ensure success instead of failure. The following strategies should help you do just that:
1. Trade spaces
Everyone thinks they work harder than any other employee. To overcome this attitude, try a variation of a "trading spaces" program, in which staff members observe or actually perform the other's job. To make the experience authentic, everyone in the billing office should work upfront for at least one week, each year, and vice versa.
To minimize the strain on the practice, don't have staff swap jobs one-for-one. For example, send only one back-office person to the front at a time and have him work elbow-to-elbow with the front-desk staff. Although the back office will be down one staff member during this time, you won't compromise productivity to the same degree as if you had two rookies working in both areas at the same time.
Set up a rotation for staff members to swap spaces every year, not just once. Having staff repeatedly involved in this experience allows them to appreciate everyone's roles within the practice and improve communication and morale.
2. Meet regularly
Hold monthly meetings with the entire staff. Before the meeting, give each person the opportunity to submit a topic to include on the agenda. Spend at least 10 minutes discussing each topic during the meeting, allowing enough time to describe the issue, and have the group brainstorm a solution. Then set aside time in each subsequent meeting to revisit past agenda items and discuss whether the solutions are working.
For matters that require more immediate attention, supervisors from each department may need to hold a separate meeting to fast-track solutions, then report to the group at the next regular meeting. The goal is to improve communication and help everyone in the practice become more proactive in addressing problems as — or even before — they occur. For example, if you know that your practice is going to terminate its contract with a health plan, discuss in advance what problems might crop up and each person's role in handling them.
3. Streamline systems
In addition to encouraging empathy and harmony between the front and back office, adjust processes that make errors more likely. For example, if busy front-desk staff have trouble capturing complete and accurate billing information, implement systems to get patients registered before they come into the office, like a patient portal.
Define the roles and responsibilities in the insurance verification process. It may seem to be a logical function of registration and check-in staff, but it may be more effectively performed by the billing staff with automation, rather than hold up the patient flow. You can also set up your practice management system to automatically alert front-desk staff to problems such as missing or inconsistent data.
Better teamwork starts with preparation, understanding, and communication. Investigate better work flows by engaging your staff in a discussion of roles and responsibilities, and build appreciation and respect within the entire team.
Rosemarie Nelson is a principal with the MGMA healthcare consulting group. She conducts educational seminars and provides keynote speeches on a variety of healthcare-technology and operational topics. Drawing upon her diverse experience, Nelson provides practical solutions to help medical groups succeed in their practices. She may be reached at www.mgma.com/consulting/nelson.