Together and Yet Separate

I was at a Workshop last week and observed and disturbing and yet familiar sight. This was a group of hospital administrative workers representing admissions and billing. And there were a number of facilities represented.

What was interesting was that the room by its nature was divided; Registration on the left and Billing on the right. In fact, as you watched the speakers you could see the two groups respond separately to the questions. One astute facilitator caught this and dug a little deeper (and a little off topic) and we found that while conceptually they recognized the challenges that each faced and their role in each other’s business; there was still a sense of, “if only they (pick your department) would d their job better…”

Now as a leader, I have to sit in the back of the room observing this and ask my-self, “where has our team building gone wrong? What can we do so that these departments have a better and more empathetic understanding of the role they play in each other’s workload”?

What is interesting about this is I have been seeing this dynamic played out and discussed for over 25 years. And, the experts say that by understanding the role that registration plays in the ultimate payment of the bill by insurers and patients organizations can reap big rewards in terms of lowered cost of rework, follow up calls to verify information and processing claims that just have incorrect information on them.

One example is verifying insurance. One consultant I know did an audit a few years back, where over ten percent of the initial claims were being denied, due to poor insurance information. As she dug deeper many of these claims had photo copies of the correct insurance cards in the file. They just had not put it into the billing system. This seemingly little thin results in the need to spend more money to correct and re-bill the claim and then there is the cost of money waiting for the now delayed claim to be paid. Then there is the patient that hasn’t heard about their portion of the bill in a long time that now gets their bill.

These are some of the lowest paid people in the organization and yet what they do has a very large impact on the financial outcomes that the organization experiences. So what is a leader to do? Let me suggest a couple of things.

1.   Training – It is important to provide initial training so that staff has a basic level of competence. I have observed that we need refresher training on a regular basis. My friend Coach Dave talks about how we often learn the same lessons over and ove r; even when we have spent good money to learn the lesson the first time.
2.   Cross training – I don’t know that billers need to be able to register a patient or vice a versa but, by spending time with each other reviewing the impact their actions have on each other could eliminate a lot.  (What does this cost a couple dozen bagels and a carafe of coffee)?

While this is obviously specific to healthcare, I am willing to bet this dynamic plays out in most industries. What will you do tomorrow to get your teams working together?

I am sure many of you have some good ideas as well, Lets share them.

Take Good Care,


  1. Hi John,

    The challenge you reference is certainly not limited to the medical field. Every organization in every industry faces similar challenges. In Telecom it was Sales and Service Delivery. “If only they had done their job better, we wouldn’t have these problems.” Of course, lost in all of this debate is the real issue, the customer.

    Your recommendations above are good ones. I would also suggest that a change in attitude will likely start with the department heads and their decision to put the customer above the value of their own silo. In addition, process controls can be implemented to determine the most common causes for errors and then the two teams should work together to determine the best solution. Too often the analytics themselves are either never completed, or done by only one of the two departments.

    Teamwork starts with a common goal. And that’s where these two teams need to start as well.

  2. You are right Dave,

    It starts with a manager that says, “We can do better, lets work together.”

    Thanks for your insight

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