Post-Implementation Support
By Diane Walizer
Engagement Manager
Beacon Partners, Inc.

How did this happen? We had a good plan when we first implemented the functionality. Where did it break down? If you are asking yourself these questions time and time again over various processes within your operation, you are not alone. The problem was not necessarily in the initial plan design or with the implementation. The problem most likely is the result of post-implementation management.

Every health care entity is supported by numerous procedures. These procedures were designed to move information from one point to the next in order to complete a task. When each of these individual processes was designed, a great deal of attention was paid to what it takes to make the process flow. As a result of all the attention spent, management walks away thinking that they have a good handle on the flow and that, due to the improvements, the organization will be better supported. While that may be true initially, in the long run without post-implementation management for the life of the functionality, it will begin to fall apart until one day you are asking, “How did this happen?”

To illustrate the problem, we will use a typical process for claims submission.

• The function – charge batches are automatically evaluated and processed for claims on a nightly basis. After evaluation the clean claims are sent systematically to the carriers; the carriers respond with acceptance/rejection reports.
  • The potential problems:
    • The systematic evaluation of batches fails several days in a row, and, as it is considered automated, is not routinely monitored. The result is a cash flow delay after the claims did not go out as expected.
    • The non-clean claim edits are not worked in a timely fashion, and this was not discovered until several weeks later when the days in accounts receivable began to climb.
    • The carriers did not return the expected acceptance/rejection reports, claiming that they did not receive the file. This was not identified until the follow-up team began to work the claims several weeks after they were sent.
    • Individual rejection reports from the carriers based on the claim submission were not forwarded to the appropriate staff for correction and re-submission. As a result, the individual claims that were rejected were denied for untimely filing.
    • Claims were not submitted automatically due to system maintenance. Once the process resumed, the next submission was based on the file created that day, ignoring the one created the previous day. This was not found until the follow-up team began to work the claims several weeks later.
      
      

As this illustration shows, an effective post-implementation support system could have prevented the cash flow problems that un-recognized failures in the claims flow caused. While monitoring cash flow and days in accounts receivable will eventually catch major problems, the reality is that too much time may elapse from the point of break down. This causes management to go into crisis mode, having everything reviewed that happened before and after the problem occurred to make sure that they will not be plagued by the problem in the future.

Post-implementation support is really the day-to-day management of business operations. All processes need to be monitored to evaluate accuracy and effectiveness. Key monitoring components are:

• Documentation
• Statistical and log reports
• Training
• Audits
• Communication

Documentation consists of the policy and procedures that support the processes. It should be detailed enough for those who rely on it to understand what the expectations are. Good documentation is very useful in auditing functionality and provides a tool for management to hold their staffs accountable.

Statistical reporting provides management with information at a glance on a routine basis. Good managers are intimate with the data reported in the statistical reports and, based on that, can spot deviations and begin an investigative process to determine the cause. Log reports record recurring events and should be routinely reviewed by supervisory and/or management personnel. Routine monitoring ensures that the staff that is accountable to record the log entries does so.

Training is an often over-looked component in any process. It is often assumed that staff can figure out what to do given that they are surrounded by co-workers who should know what they are doing. The problem with staff self-training is that they can miss key steps that are required for continuation of a process within an organization. Training should include the tools that staff use as well as the functionality for which they are responsible. Initial training should be conducted by a trainer and not by co-workers. Trainers provide the ability to send consistent messages. Their roles are to train, not to try to complete their own work in addition to training their co-workers.

Auditing the process on a routine basis will identify where given functionality has gone off track. The result of the audit may yield several outcomes.

• Procedure is working as planned
• Problems with the process itself, which would require a re-design
• Re-training needs for staff

Auditing is best conducted by someone outside of the area responsible for the procedure. Staff close to the process may be willing to overlook problems for a variety of reasons.

Communication is the buzzword in all organizations. We can never do enough to address communication issues, such as changes in functionality, problems with the procedure, and, most importantly, what the process is. Staff is more likely to adhere to their areas of the program if they understand the impact to their co-workers.

In our above example of claims submission, timely statistical and log reports would have eliminated the problems within a few days of their occurrence. Understanding the downside of not performing validation tasks provides an incentive to the staff responsible to make sure that the validation is complete. This would have resulted in no more than one day’s delay. As we can clearly see, monitoring is imperative to maintaining cash flow.

In summary, post-implementation management is an essential component of maintaining optimal organizational functionality. The resources utilized for the initial design and implementation phases are wasted if the post-implementation process is not effectively monitored. As health care organizations seek to reduce expenses, essential resources can be efficiently utilized by employing an effective post-implementation strategy.

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About the Author
Diane Walizer has over eighteen years of experience in the health care industry. She provides guidance and hands on support for application assessment, design and implementation. Her expertise covers professional billing and scheduling systems as well as provider managed capitated insurance plans. As an Engagement Manager with Beacon Partners, Ms. Walizer is responsible for managing large projects and performing operational assessments. Ms. Walizer can be reached at 781-982-8400 ext. 452 or dwalizer@beaconpartners.com.

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