Have you noticed the desk that everybody seems to gather around? Or that one person in the department who gets all the emails from the staff wanting to ask a quick question? Why is it that one person appears to be the go-to? Why can't the rest of the staff figure out the answers themselves? Maybe the problem is that the most up-to-date policies your organization has are “whisper policies.”


Whisper policies are the unwritten rules of billing. Whisper policies are how people communicate when they do not have another route to follow. By talking to each other, they learn how to bill, what modifiers to apply and the level service to choose. Whisper policies happen when there's no written process or map/decision tree for people to follow when they try to do the job. Whisper policies fill the gap when the real policies and procedures of the organization are not routinely updated (or have not been created). Whisper policies are used because people have no other way to get the information they need to do their jobs well.


Of course staff should be encouraged to talk to each other and share information! One of the best ways to learn and improve is by collaborating with other members of the team. Sometimes a new type of denial comes along or a unique manner of documentation and a good discussion is the best route to solution. Furthermore, you do want to have a happy work environment where staff has good relationships with each other. But whisper policies are a different matter. Whisper policies can impact production and could risk your compliance. Too much problem-solving through constant talk means that there is not a consistent method to resolve issues – and when talking, billing work may not get done. The reason that the whispering gets done is there is no other approach to a problem. And, sometimes, those discussions at the side of someone’s desk go from a discussion of billing process or procedure to non-work related topics (hey, there’s an election process underway, the spring television season is wrapping up, our kids’ sports teams are very active, etc.). It’s easy to get distracted.


What can be done? If you are the billing team, get together and discuss why you need to keep talking or why you keep going to that one person. What problems need guidance? What policies would help? For example, do you need a financial hardship policy so everyone consistently deals with patients who can’t make payments? Or, do you need to know when and how to challenge a denial for timely filing? What about your software? Is everyone comfortable and knowledgeable about its use? Would it help to have a refresher on the software’s functions? Once you have identified the areas where you don’t have guidance, bring it to the attention of your manager. Or, if you are the manager, bring your team together for a staff meeting just for the purpose of getting better policies in place. The billing staff knows where they need help and support. Listen to them!


For management, we cannot emphasize enough the absolute critical need to have good billing policies and procedures coupled with a good compliance plan. These documents are not something that would be nice to have; they are essential. Don’t allow your productivity to fall or your staff to flounder because they have no choice but to talk to each other about how to do everyday functions. Provide them with good tools (policies, procedures and a process map), so they can perform well for the organization and capture your reimbursement. Check your policies annually. Last, but not least, don’t wait until you notice that the rug has gotten worn out from people always wandering to one or two desks for information. Gather your people together routinely (once a month is good) and ask them what they need to do their jobs. Their answers will help improve productivity and lead to better reimbursement.

Let us know if there is anything we can do to help!

About the author:  Maggie Adams is the president of EMS Financial Services, with over 20 years’ experience in the ambulance industry as a business owner and reimbursement and compliance consultant. Known for a practical approach and winning presentation style, Maggie has worked with medical transportation providers and billing companies of all kinds to support their billing, auditing, and documentation training efforts. Check out our newest documentation training webinars and billing webinars on our website.Friend EMS Financial on Facebook, or for more info, contact Maggie directly at maggie@ems-financial.com or visit www.ems-financial.com