I wrote this in my journal about the consulting job I did this past week. Thought I would give you an insight into what I did and because I can't think of anything else to blog about and I don't want to talk about my foot and ankle.
Wednesday: Right now I am sitting in a hotel room getting ready to do that consultant work on a doctor's office starting tomorrow. I had a full day already today with the officer manager's meeting I did from 8am to 1:30pm then went to the L office and worked there until 7pm when L picked me up to come up here. We made it up here in less time than I anticipated. We elected to have separate rooms mainly because I needed a handicapped room and those only offer 1 queen sized bed in them. Sharing a bed with another female especially one who is your employee is not good for me. I have the splint on the knee, the splint on the hand, and the cast on the ankle plus I am used to sleeping in a king sized bed and tend to do the snuggle thang. Not good if I am in a smaller bed and with an employee. Wonder if that would fall under employer sexual harrassment? Anyway, I am sitting here drinking a glass of milk going over my game plan. I can't get on the internet because the secure wireless connection wasn't working. My brain is still wired from today's activities and I can't concentrate on the book I brought to read. Called hubs and we talked for a while. The doctor called and we set up the time we were meeting for breakfast so guess I better get to bed since it is now 11pm and the alarm will go off at 5am.
Thursday: Met with the doctor for breakfast then over to the office. Met all the employees. Within the 1st 15 minutes I had a headache from the chaos of the office dynamics. So game plan changed and I decided to change what I did when. I started with handing each employee an unlined piece of paper. I then gave them the instructions that they were to write on one side what they did and on the back what they thought each other employee did. After collecting those, I spent 30 minutes with each girl and then had L do the same, taking notes all the time. That took up the entire morning. Lunch was takeout from a local burger place (and yes although I hate hamburgers, I snarfed it down because I didn't know when my next meal was going to be). Then it was time for patients. I reobserved how the patient and paperwork flow was and took notes to compare that to what it was like without patients. I thought it was chaotic before...OMG it became psychotic. It was really hard to keep myself focused when everyone around me was so disorganized and the whole flow was so disruptive. I am actually surprised they had a practice at all. I then 'became a patient' and went around experiencing what they were seeing and doing, how long wait times were, seeing what they were seeing as far as room decor, cleanliness, etc. Around 4pm I started in learning their software system and after seeing that no one really knew what reports the software they were using could produce, I called their software management people and got trained fast. I ran reports and compiled them for anaylsis later. I looked up and it was 8pm so we took off with everything and went to dinner with the doctor and office manager. Really nice place....called a supper club and decorated 50's style.....great food though and fantastic view of Lake Michigan. Right now I just got finished analyzing the data and reports which were off the wall. AR (accounts receivable) was off in outer space with most of their AR in the 120+ days. Interesting was the fact that there was no AR for the 0-30, 30-60, or 60-90. That meant that NO billing has been done for at least 3 months at all. I found this one report called the unsubmitted report which means the charges were entered into the computer but not submitted to the insurance company. Normally there should be zippo unsubmitted. The report was 22 pages long and included charges dating back to 2005. What I found most interesting though was what I had the employees do (the job description of themselves and each other employee). I found there only to be 2 employees who knew what the others were doing. The others instead of listing the names of the employees listed them instead by department letting me know they didn't even know their names. Also interesting was how they followed directions. One employee got lined paper to write hers on totally going against the instructions. Then I analyzed their handwriting which told me what I had already found out that day. Interesting things you find in handwriting analysis. I complied my observations and plan to go over with the doctor tomorrow at breakfast again at 7am. Before we left the office the doctor got an email from one of the employees...calling me a bitch and interfering and that if the doctor was going to listen to me then she was quitting. Interestingly enough she was the one who didn't follow directions and also the one who couldn't produce what she was working on and contracts the doctor was credentialed with. She just gave me excuses. Note she is paid 40 hours to do nothing but credentialing and contract negotiations yet couldn't produce one thing she was currently working on.
Friday: L and I met with the doctor this morning at 7am giving her my thoughts and proposals. I got full approval to implement all changes and firings. Yep we fired people and the one who couldn't follow directions was the 1st to go. I set up a credentialing application online that goes out to a lot of insurance companies (one stop place) and downloaded the master form into Microsoft Word and filled it out (that took me all of 30 minutes to do). All they have to do to keep it up is update the info and then I trained an underutilized girl on that. The dear doctor I am doing all this for arranged for me to get an MRI of my ankle today free of charge! She is a peach and people are just walking all over her. So I found out today what I did to my ankle. Just loverly. Now I have to work another surgery into my schedule. Anyway, mostly what I found in the ones I fired were lazy people who were taking total advantage of the doctor who had retired but had to come out of retirement when the doctors who had bought her practice ran up huge bills and then declared bankruptcy. Since she was a cosigner on the loan given to them, she had to repay the money. She currently has a lawsuit against them. She came back out of retirement and is trying to keep the practice going and believe me, it is a great practice just zippo cash flow. I have already been doing her surgery center billing and she trusts me (the prior biller brought in only 1/25th of what I made for her this past year because of stupidity and not appealing denied claims). As for the billing department: the doctor is keeping the biller but it has to be done inhouse now so her hours can be accounted for. She is only to work on the AR in her system. All new billing is coming to me. I set up the new software application then L and I trained the girls on it. It is a much easier system than the one she has and the girls were really excited about it. For right now I will do the billing but I plan on training one of the girls I really liked to do it. She was so underutilized before. I had each girl redefine their jobs with everyone. They were all introduced to each other and complimented on what they do. As for the 2 other billing girls: one was working 20+ hours a week and her only job was inputting new charges...she was fired (she has been paid 20 hours per week since May and no charges were entered into the system since May so what was she doing? Heaven only knows!); and the other was paid for 20+ hours a week to do nothing but send out statements (yet interesting enough not one dime was collected on any of those statements) and it takes my office only 2 hours a week to do the same job. I will be going through day by day their entire schedule for the past year to see what else was never even billed into their system. As I said I found the things from May that not even billed let alone the files I found that were unsubmitted. I can only imagine what else I will find for the entire year. There was another redundant employee whose only job was to clean the rooms after a patient was in it. Yeah right for $25.00 per hour for 40 hours a week to do nothing but clean rooms. That one went too. There were 2 nurses and 2 certified medical assistants there. Their new jobs are to clean the rooms themselves. Total of who lost their jobs: 5. I retrained the front office girls who have more brains than what they were doing. They are taking over some things and lessening what the OM was doing. I put them into a proactive mode rather than a reactice chaotic mode. By today when I left, there were pleases and thank yous and good employees left and a pride in the office and a comfort level that they are going to make it and not end up closing their doors. I plan on going back up within a month hopefully depending on my ankle to follow up and start some more teaching on the new software, etc so they can take billing and credentialing back in their own office. We finally left there around 4:30pm.....not a good time to drive back to Chicago right into the midst of rush hour and bumper to bumper traffic. It took us an hour and half to go up there and 3 hours to drive home. Hubs got home about an hour after me so it was me and one of my granddoggies. I decompressed, exhausted from the past 2 days, then looked for something in the frig/freezer for dinner. I scanned the mail (nothing but bills which can wait for another day). Did get the proposal though for the new roof which was about what I expected. Threw frozen marinara into a pan to thaw for dinner. Called son and had him pick up a loaf of bread to make garlic bread on his way home from work. Made mostaccoli with marinara for dinner with garlic bread and salad. Gave hubs the MRI x-rays and the report from the radiologist who read them. Then unpacked and went to bed. I am so happy I have 2 days to decompress before going back to work on Monday although I know I will be doing work for this doctor over the weekend. Just knowing though that I can do it in my robe without makeup makes me happy. Just have to convince the surgeon for my ankle to postpone it until next week so I can get things rearranged workwise to be off a week.
