As a consultant, every once in a while I’m asked to come in and assume the position of interim director of patient financial services. There’s a difference between going into a position where you know you’ll only be there for so many weeks as opposed to knowing that you’re coming in as a permanent employee.


When you go in as an interim director, you don’t have the time to worry about long term relationships. You’re coming in to either rock the boat or continue the status quo. No matter what, the people who bring you in are hoping you’ll be able to affect some positive changes while you’re there. One might as well, because it’s no fun just to sit around doing nothing.

What always surprises me is when I start to do certain things and the people who are there will either say “our previous director never did anything like this” or “we’ve been asking to do that for a long time.” That’s because sometimes directors get close to their people in the wrong way. They get an impression that their employees aren’t all that good, or are better than they might be. That’s not an indictment against anyone; it’s just the truth.

The truth about being a patient accounting director, or any type of supervisor or director, is that you should always be in the process of evaluation. Even when the numbers look pretty good, you should be evaluating them to see why they’re good, and whether it’s a fluke or it’s because of something you and your department has done well.

Here are five processes that I do whenever I go into a new situation as an interim director that might spark some thoughts into how you run your own departments. If they work for me, they should work for you long term.

1. Look at the numbers, especially the AR numbers. I don’t start off paying as much attention to what someone tells me are the days in AR because everyone calculates them differently.

Instead, I start off by looking at an AR report. I want to know what the percentage of AR is that’s more than 90 days under each revenue category. I want to know what the unbilled revenue under each category is. I want to know that for at least the previous three months, six months if possible. With these numbers, I can get a pretty good idea on a lot of things, if not the people.

2. Talk to the employees based on billing group if possible, or individually if it’s a small department. This is where you really find out just what the people in the department know and what they need to know. It might not work out as well if you’ve been there for awhile, but it still doesn’t hurt to talk to people as a group every once in awhile.


The reason you do this is to try to find out what the specific billing issues are for each insurance type. Ask what the most common denial codes are, whether they’re billing edits or something that continues to be denied time after time. It’s a good way to find out what you might be able to get fixed that will bring some quick results. By the way, talk to them without supervisors or team leaders present.

3. Talk to the supervisors and/or team leaders. You should already be having regular meetings with them at least once a month, but you’re probably not. You should schedule these meetings to make sure you get them in, then make sure you stick to your time frame. You should have an agenda, even if it’s a short one, to make sure you get to everything you want to talk about, even if your conversation is one on one.

4. Do something positive for the department that’s related to the job, then tell the folks what you did for them. One of the ways I get myself ingratiated with people in all departments is I try to figure out which two things are the ones I can address that will potentially make the biggest impact.

Something employees complain about all the time is that they tell management their issues, and then management either does nothing or does something but doesn’t even let them know about it. The impact doesn’t have to be immediate, but the act of letting them know that something they’ve wanted addressed will give you credibility with them.

At one consulting gig, one change I immediately made was to have a batch of charges recoded that kept rejecting so that they would pass edits and get those claims out the door. But the other issue I addressed was the department, which wasn’t in the hospital, wanted a place where they could sit outside to eat lunch in good weather. So I requested, and got, a picnic table put right outside the back door. They loved it, it cost nothing because the hospital had it in storage, and I earned points for finding a way to give them something small, but something that was big for them. That was a nice two-fer. 🙂

5. Make sure you know where to go for help. Nobody knows it all, not even your consultant. What consultants have are ways to find the information they need, including the people they know have most of the answers they need. For instance, they know they can go to the CMS website. They know they can go to whichever Medicaid website is in the state they’re working in. They know they can pick up the phone can call state insurances like compensation or specialty insurances like no fault carriers. And some of them subscribe to services that allow them to ask questions that they know they’ll get answered if they can’t figure out where else to go, such as a consulting service I myself offer.

Consultants also make sure to keep the lines of communication open with other consultants around the country. Directors and supervisors within the revenue cycle also have that same opportunity if they avail themselves of groups within their own area such as that address the health care finance processes they’re responsible for. The people in those groups who do what they do might have the answers that are needed to overcome some things they might not know themselves; if not, they might know someone who does.

Those five tips should get you going. If you’re already doing them, congratulations. If not, there’s no better time to start than now.

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