When faced with a denied claim, your first question as a physician, biller or consumer should be why? Your best defense against these denied claims, and your greatest chance of winning an appeal, comes from understanding why the claim was denied by the insurer.
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Malpractice suits weigh heavily on the minds of physicians and healthcare facilities. However, there is another concern to consider that can also cause irreversible damage – customer service complaints. While good customer service is important to every business, it is imperative in the healthcare industry. From the office and lab staff, to the medical assistants, nurses and physicians, polite and helpful attitudes need to resonate throughout the entire practice, clinic or hospital.
President Obama announced earlier this week that consumers with healthcare plans that do not comply with the new law will be able to renew their plans for another two years. Previously, the extension was believed to be one year at best, so the announcement of a two year grace period came as quite a relief for the million or so Americans with transitional coverage.
The Center for Medicaid and Medicare Services (CMS) is moving ahead as planned with its October 1st compliance deadline for ICD-10 implementation. Many healthcare systems have requested that the deadline be postponed due to the mounting challenges they face with co-occurring Meaningful Use Stage 2 deadlines.
We would like to suggest a different approach that promulgates that lean implementation should begin at the microlevel; if a lean project is to be implemented only for a specific area, then the definition of “senior management” will turn out to be the “senior management of the specific area where the implementation is conducted.”
We mentioned that the lean philosophy calls for value creation through elimination of waste. These wastes are common in all industries and are not unique to healthcare. The following is a summary of these wasteful activities:
Recipes for implementation and lessons learned from failures have been reported; the common threads of these were that organizations need to change at a behavioral and cultural level and this should be translated directly into an endless process of continuous improvement. Despite these being framed in the realm of tangible strategic business direction, “cultural changes” and “endless improvement” are abstract concepts; furthermore, these principles imply that there is no horizon for successfully completing the task because the improvement process is infinite.
In healthcare, as in numerous other industries, lean management is gathering increasing momentum. In a 2013 article for the National Center for Biotechnology Information titled Lean Management—The Journey from Toyota to Healthcare (©2013 Teich and Faddoul), Sorin T. Teich, D.M.D., M.B.A., and Fady F. Faddoul, D.M.D., M.Sc. provided a comprehensive overview of what lean management is, and how its principles can be applied to the healthcare industry:
Preventable visits to the Emergency Department are a significant source of waste contributing to the exorbitant costs of healthcare.
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