"We've never had a budget for staff training."
After years of working with physician practices, I've heard this more times than I can count.
If it holds true for your practice, here are five reasons why 2017 should be the year you shift away from this mindset and get serious about investing in employee development.
1. Reduce the risk of lawsuits, paybacks, and audits
Managers and staff who don't refresh their knowledge regularly (at least annually) are working under outdated, often false, and sometimes even illegal assumptions. Just as physicians are required to take CME courses, administrators and managers must attend professional association meetings in their specialty. Billing staff need coding and billing regulation updates. And annual HIPAA training is a must for everyone.
Failing to budget for these updates will leave your team frozen in time, following old rules. Simply put, they won't know what they don't know, putting your practice at risk of violating current regulations or laws or maintaining costly or inefficient operations.
The manager of a large orthopedic group insisted that refunds were not to be made unless patients or plans requested them. Had her knowledge been current, she would have known that the $75,000 in credit balances our consulting firm identified should have been refunded long ago — regardless whether patients or payers asked. CMS requires providers to report and return overpayments within 60 days of identification. And according to healthcare attorney Michael Sacopulos, founder of the Medical Risk Institute, most managed-care contracts have clauses that state overpayments must be refunded upon discovery. Sacopulos also notes that even out-of-network claim refunds must be refunded to patients, based on certain language in the Affordable Care Act.
And, we regularly observe under-trained billing staff following procedures that put their physician employers at risk for False Claim Act and HIPAA violations, as well as payer audits. Unbundling procedures because they don't understand current coding rules, naively submitting level 4 and level 5 E&M codes when the physician's documentation and/or medical necessity does not support them, and emailing protected health information (PHI) to patients or third-party billing services instead of using secure messaging, are a few examples.
2. If you budget for it, you will spend it
Funny thing about earmarking dollars for something specific. They typically get spent. And, you will be more apt to seek out training opportunities knowing there is a budget to cover them.