Hayes' Healthcare Blog

Susan Eilman

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8 Tips to Help Understand and Avoid Denials

Posted by Susan Eilman on March 29, 2018 at 9:00 AM

Are you drowning in claim denials and rejections?  Are your denial rates high? It is inevitable for healthcare organizations to experience denials in today’s complex billing arena. Industry standards for denial rates are between 5-10 percent.  If your denial rate is above 10 percent, then "Houston you have a problem!” It is time to build a strategy to reduce your denial rate.

Claims denial avoidance processes should be proactive but in most healthcare organizations, they are more reactive. It is important to be proactive from a revenue integrity perspective at the front-end, and accurately collect and report patient and insurance information before or at the point-of-service. There are ways to be proactive from the billing side as well.

As you develop your action plan, it’s important to define your terms. You and your staff need to understand the difference between a claim rejection and a claim denial.

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Topics: reduce denials, claims denials, denial management, Revenue Cycle Health

Culture Shock: 9 Ways Your Organization Can Prepare for a System Change

Posted by Susan Eilman on June 21, 2017 at 9:04 AM

If you’re like most organizations, you’ve probably come across your fair share of bumps in the system transition road. Workflows are interrupted, unfamiliarity is commonplace, and sometimes organizational leaders are met with staff resistance to change. Confusion as to why the organization is changing systems is present, a hesitation towards change is palpable, and leaders are frequently left frustrated as to how to unite their staff.

Instead of viewing the system change as an uphill battle, try to look at it as though you were experiencing culture shock from visiting another country.  Routine activities may no longer be available to you, your default resources may be hard to find, and you may even have to speak a foreign language.  This may be similar to how your staff feels about a systems change.

One of the top reasons for resistance to change is the discomfort of the unfamiliar and this can manifest in a variety of ways: some staff may not be aware of the organization’s vision of the finished project and therefore question the purpose of change, others may question how this change will affect their jobs, and others may be hesitant to change the ways in which they interact with the system simply out of routine habit.  Another common barrier with system changes is lack of organizational communication.

So how can organizations prepare staff for a systems change successfully? By reviewing these key elements, you may be able to avoid culture shock and resistance to change.

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Topics: healthcare system management, system migration

4 Steps to creating super users for your system implementation

Posted by Susan Eilman on July 6, 2016 at 9:00 AM

In the world of healthcare technology, there are numerous system implementations occurring each year.  In order to make an implementation successful, it is crucial to develop your users into “super users” during the implementation process.  It is common for implementations to include and involve roles such as Project Managers, Practice (Operations) Managers, IT System analysts, and trainers, among others.  Each of these roles  have well defined parameters and expectations.  Often implementations involve super users, but this role is not always well defined and expectations are not always clear. 

A super user is your department’s champion for system knowledge and workflows. This person becomes your expert for the system implementation and teaches other employees how to use the new system features. Once you've identified your super users, you need to have clear expectations for this critical role. 

Questions should be asked early when selecting the super user.  Questions to consider include: Which user should you pick? What qualities should a super user have? How do you train them? Sometimes, you may pick someone that you feel is right for the job but turns out to be someone that is not quite fit for the role. 

Consider the following tips when choosing your super users for your next implementation:

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Topics: training, EHR, EMR training, revenue cycle management

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