Educating Your Support Staff: Good for Employees, Good for Business

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By Maria St. Louis-Sanchez
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Nonclinical staff members at O&P patient care facilities are the first people to greet patients, the first to hear about a complaint, and the ones who can ensure that the business gets paid for its services. Yet despite their integral role, they do not have the continuing education training and certification requirements that their clinical coworkers do. Nonetheless, experts say, it makes good business sense to invest in their professional development.

"The reality is that it will be a resource for the practice," says Nicole Godwin-Burns, CPOA, MBA, vice president of Compliance AccountAbility & Training Solutions, Danville, Indiana. "Is it worth it to [attend] a one-hour presentation and get the knowledge you need, or would you rather your claims get denied?"

For example, if billing staff members aren't trained as they should be, it could mean delayed payments and reimbursements, not receiving payments and reimbursements at all, or even exposing the practice to Recovery Audit Contractor (RAC) audits. "If [employees] are up to date as to what all of the payers require, they can make sure those things are done prior to submitting a claim and have some assurance that the claim will be processed and paid," says Brian Gustin, CP, president of Forensic Prosthetic and Orthotic Consulting, Suamico, Wisconsin. "If something gets denied, they will also know how to effectively deal with it."

The benefits of a well-trained staff go far beyond basic skills, says Brenda Archer, administrative specialist for Hanger Clinic, headquartered in Austin, Texas. "First and foremost, it is through continued education that we can best serve our patients," says Archer. "Having a friendly staff that is competent, ready, and able to respond to patients' needs is our first concern. We understand the importance of each encounter, and our education supports our expectations-from how we communicate over the phone with a caller seeking directions to our clinic to complex insurance billing and reimbursement issues-and our ability to advocate on behalf of our patients."

Unfortunately, the nonclinical staff members at O&P practices in general are not as well educated or as up to date as they should be, experts say. Many practices, especially the smaller ones, are often so busy in their day-to-day operations that they find it difficult to incorporate additional, nonrequired training. "In a lot of cases, especially [in] independent practices, they are probably not as well trained as they should be," says Cathie Pruitt, president of PrimeCare Orthotics and Prosthetics Network, Germantown, Tennessee. "The reason for that isn't neglect, it's that every aspect of the administrative and management side over the past few years have been more complex and burdensome, and there's not a lot of time really to get around to the level of training you need."

Even practices that have a strong desire and motivation to keep their nonclinical staff members trained are falling behind, says Andrea Deshaies, business manager for Next Step Bionics & Prosthetics, headquartered in Manchester, New Hampshire. "Even if you work really hard to keep up, it's nearly impossible to be where you need to be because things are constantly changing," she says. Still, it's too big of a risk to ignore the training. "We've decided to jump on the train instead of having it pass us by," Deshaies says.

The Right Staff Training

Getting the nonclinical staff the education they need can be difficult, experts acknowledge. Budgets are tight and staff members are busier than ever just trying to keep up with their work. Additional training duties can seem daunting, says Clint Snell, CPO, president of Snell's Orthotics and Prosthetics, based in Shreveport, Louisiana. "The hurdles you have to figure a way around are time constraints and dollars," he says. "It costs money to do the training, whether it's on the Internet or going to a remote site or a seminar, and basically money is getting tighter these days."

However, some experts point out that getting good continuing education for nonclinical staff doesn't have to break the bank or overly tax the time of staff members. There are several options, which range from sending just a few staff members to a conference to hosting a training day. Other options may be to give employees the time to watch webinars or provide them the needed information via other methods, such as employee e-mails, company newsletters, or in-house training seminars.

Pruitt has seen many practices keep their expenses in check and still attend one of PrimeCare's training conferences. "If you can only send one person, that's still good," Pruitt says. "That person can come back and do cross-training. They can also make contact with the presenter and reach out if they have any questions later on." She says PrimeCare bases its PrimeFare educational offerings on the needs of the O&P profession. In the past few years, the administrative track at the conferences has doubled in size. The administrative track includes seminars about compliance, billing and coding, and audit procedures for the Centers for Medicare & Medicaid Services (CMS).

"You can see the need for it is very strong," she says. "When you are talking about your billing and administrative staff, you are talking about the people who are in charge of your money. You've got to have a lot of in-depth understanding of the regulatory situations to maximize what your practice can collect and the overall profitability of the practice."

While sending nonclinical staff to a regional or national conference is one way for them to gain training, it isn't the only way. For the past 14 years, Snell has hosted a full-day training seminar for his three offices, called Snell's Stars. The seminars, held in a central location on a Saturday, are a great way for staff members to interact and have fun while getting necessary training, he says. Along with panel discussions and outside educational and motivational speakers, the seminars include skits, food, and door prizes. "It's a great way for us to come together, get skills we need, and learn from each other," he says.

At Abilities Unlimited, with offices in Colorado Springs and Denver, Colorado, co-owner Bill Teague, CP, says his two offices host monthly in-house training seminars. Many are required training for the clinical staff, but they often host administrative and technical staff trainings as well. They also have biweekly staff meetings so the clinical and nonclinical staff members can exchange information and talk about what they might need from each other.

"We have always felt that information and knowledge are really the key to any kind of endeavor," Teague says. "We have always tried to instill in everybody that continuing education and updating on current information is vitally important."

Other practices opt for short bursts of information for their staff members rather than full-day or hours-long training sessions. Deshaies says she tries to give her nonclinical employees the information they need in little bits via a company newsletter, e-mails, or short webinar opportunities. "Little bits of information aren't so overwhelming, and they are easier to follow along," she says. "Also, it doesn't put them behind in their work. They can read the information or watch the webinar when they have free time."

Additionally, providing training in this fashion helps Deshaies as a manager. This way she doesn't have to spend hours or days planning a long seminar; rather, she just incorporates little bits of information to give out as she goes about her work routine.

Technology is also a great resource that can be used to help keep staff trained and up to date, says Archer. "Our primary challenge may also be one of our greatest strengths-our size of more than 740 clinics nationwide," she says. "We have turned to technology to aid us with computer-based training and facilitated web sessions, which are a couple of tools in our diverse toolkit."

There are a lot of ways for any O&P practice to access training through technology, says Godwin-Burns. She points out that there are many free resources that you can take advantage of just by signing up for them. She recommends joining various listservs to keep track of the industry and also what changes may be coming down the line from CMS. She also recommends participating in webinars offered by various vendors and organizations, most of which are inexpensive. "When you are talking about spending $25 to $50 for something that can provide you that much use, it's almost foolish not to," she says.

What Topics Are Most Important?

There's so much training available for nonclinical staff that it's important for practices to focus on what is needed most. The experts agree that the highest priority training for the nonclinical staff should be about CMS regulations and compliance. "Medicare documentation and training is ongoing and always something we want to address," Deshaies says.

Godwin-Burns agrees. Training in this area is just common sense, she says. "The payoff for this training is so significant. Otherwise you might not get paid because your documentation isn't in line."

Teague says his staff tries to keep up with training on CMS compliance through webinars and by tracking the free resources already provided by CMS, such as quarterly bulletins about changes.

Additional resources include taking advantage of trainings provided by O&P organizations that deal with CMS changes from an O&P perspective, the experts say. For example, PrimeCare hosted an all-day CMS boot camp in February to provide in-depth information on new regulations and how to meet them. It hopes to offer other boot camps in the future, Pruitt says.

Gustin says that good CMS training for O&P practices should go beyond just upcoming changes. "The administrative staff needs to have appropriate training on how to make an appeal if something is denied," he says, adding that the best training is often to spend the time dissecting denials and understanding why they were rejected. To help make those appeals, it's also helpful for nonclinical staff members to have at least basic training in anatomy, physiology, and O&P terminology, Godwin-Burns says. If the staff member writing the appeal doesn't fully understand what he or she is reading or writing, then he or she doesn't know if all the documentation CMS is requiring is included, she says.

"It's usually the administrative staff that is turning in the documents for the audits, but what I see a lot is that they collect the clinical records but don't understand what's written in them," Godwin-Burns says. "People who at least have a basic clinical understanding can write a better appeal letter that is convincing and can help their office get paid." Pruitt agrees. "There are a lot of times you are told things or read things that don't sound exactly right, but you don't know if they are or not unless you are well trained."

That's one of the reasons Teague says his O&P practice works to provide basic clinical training to nonclinical staff members. "We try to give them enough training so if they hear or read these clinical terms in a correspondence, by phone, or in person, they have a better understanding of it," he says.

Godwin-Burns says there are also outside resources for practices that want to give their office and billing staff more clinical training. She suggests putting key nonclinical staff members through certification as O&P assistants. This training will give them an introduction to anatomy and physiology and also expose them to what's happening on the clinical side of the business and be able to communicate better with practitioners and physicians.

That kind of communication is another important training element for nonclinical staff that O&P practices should focus on, experts say. Snell says that communication skills are essential. "One of the chief hurdles to having a good customer experience is communication."

Snell adds that nonclinical staff members need to provide a welcoming environment for patients and they also need to communicate effectively about billing practices and costs. He continues, when staff members need documentation from practitioners or physicians, staff members need to communicate what they need effectively. Clear communication of this information enables nonclinical staff members to do their jobs.

Godwin-Burns says that many times physicians are willing to cooperate but don't understand what kind of documentation the O&P office needs from them. Knowing how to ask for what they need and, when it comes to audits, knowing how to argue the point accurately are key skills for nonclinical staff, she says. "If you are communicating with doctors...and say, 'This is what we have to document to Medicare,' then it usually gets put in the records," she says.

Along with CMS compliance, Godwin-Burns also recommends continual training on the Health Insurance Portability and Accountability Act (HIPAA). If practices aren't well versed in HIPAA, they put themselves at legal risk, she says. The training should be well documented to help protect the practice from any potential legal issues.

"If there is a HIPAA breach and training is not documented, then the providers will be held at a higher level of accountability," she adds. "Generally it's recommended that you train new hires about HIPAA even if they are from a medical background and that you sit down with your employees annually and reiterate that information."

The Benefits of Good Training

O&P practices that spend the time training their nonclinical staff often see rewards beyond the scope of their day-to-day duties, the experts say. "Through our education programs, we have come to realize that the benefits-of not only the skill training, but the 'people' part of it-are many, and include positive recruitment (people want to work for a company that invests in their employees), improved retention, increased energy and morale, and more positive attitudes when training is ongoing [rather than] an isolated occurrence," Archer says. "Education also leads to creativity and innovation, which we always encourage, and ultimately builds solid foundations through teamwork and engagement."

The reason for these intrinsic benefits is simple, Deshaies says. A well-trained staff is less frustrated and happier overall. "When they have the education they need, they are able to face the challenges head-on with confidence," she says. "It gives employees pride in their work."

The alternative, Pruitt says, is a staff that is constantly frustrated because they don't have the resources they need.

"If you go to work every day and you have a very complex job that you aren't entirely certain how to do correctly, then that won't make a very happy person," she says.

When employees are trained well, the benefits are sure to shift to the patients too, Snell says. If employees are happy, competent, and well trained, the patients see it and have a better impression of the overall practice, he says.

"I kind of see the clerical support staff as the face of the business," Snell says. "Those are the first contacts that people have in our corporation. It makes all of the difference in the world what that first impression is."

Maria St. Louis-Sanchez can be reached at