Stratify your aged trial balance by payer, dollars, number of accounts and average account balance.

Start with the oldest accounts worth the most dollars and establish a strategy to impact those accounts. Try a new tactic as older accounts leveraging previously used tactics have a lower likelihood of success. If you work with commercial payers, meet and negotiate changes that
decrease costs for both parties and increase throughput and processing times. Do your homework—approach payers with solid, well-developed data to increase likelihood of win-win situations.

Look for root causes of payment delays especially for government payers.

If Medicare claims are backing up, ask what are the common issues, and what needs to happen to improve clean claim rates to avoid problems in the future. Does a payer consistently deny claims for the same reason, and is this valid? What has to change? Is the problem not related to collectability but a revenue integrity issue needing attention within the chargemaster?

Measure the value of the work completed by account representatives.

Every action documented on an account has a relative value. Establish relative values and attach them to the canned comments your staff add to accounts during the account resolution process. At the end of each month, add up the scores to see the specific staff members focusing on high value activities.

Implement a white board to record daily initiatives—the MDI list.

As a team, develop daily, weekly and monthly targets, and huddle every day for no more than 5 minutes to track results. Focusing on positive results will change how staff approach their work.

Validate your staffing levels.

If staff are consistently telling you that they are unable to handle the volume of accounts assigned, do a time and motion study. To do so, sample how long it takes, on average, for each account representative to complete the standard work for their inventory of accounts. If you have not created standard work for each group of accounts, STOP! Do this first. If a staff member has 1,200 accounts assigned, on average, and standard work requires 5 minutes, on average, per account, simply calculate how many accounts the staff member can review and resolve in a month. In this example, 1200 x 5 = 6,000 minutes = 100 hours of productive time needed. Assuming your organization uses a 7.5 hour day, with two 15-minute breaks that are not off the clock, then you have 7 hours per day of productive time work day. Based on this information, the staff member has 14.3 days of work in their inventory, which suggests that more accounts can be handled. If the results are higher than the average days in the month, then too many accounts have been assigned, or, the standard work is not reflective of what is actually included in the assigned tasks.