Do You Need to Look for a New Business Office Manager? (Part 2)

Though it may seem obvious that the most important factor in how a Business Office performs is the Business Office Manager. In Part 2 of our “Red Flag” Blog Series we consider this very critical staff member and the indicators that could be telling you might need to consider taking action.

In every Skilled Nursing Facility, the Business Office Manager’s performance is critical to the financial health, stability, and success of the facility. The Business Office Manger may not always be the source of any billing troubles however, they always set the tone in the office and are responsible for everyone under them.

A good Business Office Manager has to be capable of managing themselves, as well as the Business Office Staff. They need to be knowledgeable and experienced in the processes involved in SNF Billing. They are responsible for, and need to be held accountable for, completing accurate and timely billing and providing courteous and professional collections. They must also be able to identify and resolve obstacles to performing any assigned tasks. This is absolutely not a position you can trust to just anyone. Hopefully you have the individual with the skills, dedication, organization, curiosity and knowledge to fulfill this demanding role.

Outlined below are 5 Key Indicators that our experienced staff, have observed over decades of experience, and now consider as possible “Red Flags”spa when evaluating a Business Office Manager.

1. A Cluttered, disorganized office. It is true that some people work well in what looks like chaos to most of us. More often than not you should be concerned when there is paperwork all over the place and you are unable to get a quick, accurate response to questions about current or past due balances. The Business Office, and of course the Business Office Manager need to be organized enough so everyone concerned can easily locate, open and understand all resident files, submitted claims, correspondence and collection notes
2. Selective Availability – they are seemingly never available when a Resident, Family Member or Staff come to ask a question or for assistance. This type of avoidance is always concerning and should be looked into.
3. They never take time off. When someone is struggling, or covering up their struggles, they have to stay on top of their mess. They need to be in control of the cash and payment posting to cover their tracks. The vast majority of cases like this are the result of falling behind or incompetence and not theft. The result to you is the same though, your facility is being denied revenue that has been earned.
4. Excessive delegation of responsibilities to other Business Office staff or continuing complaints from other Department Heads regarding reliability, communications and the ability to work cohesively.
5. Basic Business Office Practices/Accounting indicators that if observed could represent a “Yellow Flag”:

• The Resident Trust Fund is not balanced.
• No receipts/backup for withdrawals from Resident Trust Fund. Mis-posting and not posting Beauty and Barber or other specialized private service charges can hide the misappropriation of funds if the proper procedures are not in place or followed.
• Petty Cash Box Reconciliation is not completed accurately on a monthly basis. Also, not having the appropriate backup receipts and documentation available.
• Lack of Deposit Slips or Backup documentation to support any Private or Non-Private Pay cash posted.
• Missing or not easily located Remittance Advices from Medicare/Medicaid Payers, or Explanation of Benefit forms from Commercial Insurance, Managed Care Part A Payers
• No clear and concise collection notes or backup documentation to support collection efforts related to outstanding balances on the Aging

Finding one, two or even a scattering of these things to be true is not necessarily an indication that you have the wrong Business Office Manager. If you see some of these signs then it is probably time for you to have a serious discussion with her or him. They may be just experiencing burn out and/or need a little extra training, support or coaching to get back on track.

However, if you see a consistent pattern over a period of time or you check these areas and several of them are questionable, you should start asking questions and it may be time to look deeper. Ultimately only you can decide, based on what you discover if it is time to Look for a NEW BOM, retrain the one you have, or stop worrying.