#204 The Most Expensive Thing in Your Practice Is an Open Note

A full schedule is not the same thing as a healthy practice. Our guest this week walked into an independent family practice in Colorado to do finance work, was offered the practice manager role a few weeks later, and quickly found the gap: patients were coming in, the schedule was booked three to five months out, and the money still was not moving. What follows is the sequence she used to close that gap, and it starts nowhere near the billing office. 

In this episode: 

How to find the fire costing you the most money right now, and why you fix only that one 

What a week working a role yourself reveals that no meeting ever will 

The training-first sequence that makes accountability stick instead of driving turnover 

The leaderboard and the 72-hour standard that moved a five-provider note backlog 

The front desk scripts that turn a copay ask into a copay collected 

RESOURCES FROM THIS EPISODE 

1. The 30-Day Revenue Recovery Plan (free PDF) 

The first month of fixes we run when a practice is fully booked and still short on cash. It sequences the work so you are not trying to repair six things at once: what to pull first, what to change next, and what can wait until the bleeding stops. 

eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan 

2. The RECOVER Diagnostic (two minutes) 

A short set of questions about how your practice actually runs. At the end you get a read on where your revenue is leaking and which fix we would put first if it were our practice.  eligibility.natrevmd.com/recover-quiz-lp 

3. Protecting Your Visits From Downcoding (free live session, Wednesday August 26, 4:00 to 5:00 PM CST) 

Stephanie Hilliard, CPC, on keeping your visits from being downcoded and documenting medical decision making that supports a successful appeal. Every registrant gets the physician toolkit: the 90-Second MDM Note Builder, the Is This Really a Level 4 annotated casebook, an EHR SmartPhrase starter pack, the MDM or Time decision card, and the Hidden Work reference. Free, and nothing is expected of you afterward. eligibility.natrevmd.com/em-downcoding-webinar 

4. Practice Financial Health Dashboard (free Excel workbook) 

The tool version of what our guest did first: get the numbers in one place and look at them. Built for physicians who want the picture without building the spreadsheet themselves. 

eligibility.natrevmd.com/free-practice-financial-health-dashboard-for-physicians-natrevmd 

5. Practice Revenue Leak Scorecard 

A self-scored walk through the places money goes missing between the front desk and the deposit, so you can see which ones are yours. 

eligibility.natrevmd.com/nrm-revenue-scorecard-v3 

Delegation starts with doing the job yourself. When a front desk staffer needed a week off, she covered the desk for the full week instead of observing for an hour. Day one she describes as burnout. By day three she had a flow. What she came back with was not a complaint list, it was a map of what the team was capable of and what nobody had ever trained them to do. 

Technology is a workload decision, not an IT decision. Ninety percent of inbound calls are not scheduling calls. They are refill requests and follow-up questions, and most of them belong in the patient portal. Push the portal and the text reminders and the phones quiet down, which gives the desk time to do the work that actually gets the practice paid. 

Accountability comes after training, never before. Her rule is direct: you cannot hold someone accountable for a job they were never properly trained to do. So the checklists came first. Same steps at every check-in and every check-out, so the result is identical no matter who is at the desk. Once the tools exist, the excuses stop and the standard is fair. 

Turnover in year one is a training problem. Nobody accepts a job without knowing the pay. So when someone leaves inside the first year, it is usually because they are unhappy or they do not know how to do what is being asked of them. Her nursing staff have been there fourteen and fifteen years. The front desk is where the churn lives, and that is a training signal, not a compensation one. 

The front desk is where collections are won or lost. During her week at the desk, daily copay collections ran two to four thousand dollars against a normal range of eight hundred to a thousand. The difference was not effort, it was scripting. Not "would you like to pay today" but "how would you like to pay today." Not "do you want to book your wellness" but "who would you like to see for your wellness next year." 

The leaderboard did what memos could not. A backlog of open provider notes was choking the revenue cycle, and reports alone had not moved it. She built a weekly leaderboard ranking providers by open notes, then layered a 72-hour closure policy on top with a real consequence attached, applied to owners and part-time providers alike. Fifteen days into the leaderboard the backlog had dropped by more than 150 notes. 

Measure the standard, not just the pile. The tracker evolved past a raw count into a percentage: of the notes a provider has open, how many are still inside the 72-hour window. Below eighty percent and they hear from her directly. As Heather puts it, what you do not measure, you do not make progress on.

THREE ACTIONS THIS WEEK

1. Pull your open encounter count and your AR over 90 days. Do not guess the number, print it. Most practices are surprised by it. 

2. Pick one role and work it yourself for a full day, minimum. Not observation. Do the job. 

3. Before you ask anyone for accountability, ask whether the training and the checklist actually exist. If they do not, that is this month's project. 

EPISODE BREAKDOWN 

00:00 Meet our guest and how she landed the role 

02:30 Delegation starts with knowing what the job actually is 

03:38 A full week working the front desk 

08:47 Ninety percent of your calls are not scheduling calls 

13:37 You cannot hold someone accountable to training they never got 

19:58 Nobody quits in year one over pay 

21:43 What one week at the desk did to daily copay collections 

23:40 The scripts that changed the number 

26:11 No job is above me or below me 

27:52 The math was not mathing 

30:28 The open note backlog and the leaderboard 

31:40 The 72-hour policy, owners included 

35:13 Measuring the standard, not just the backlog 

36:44 Why we are not adding patients yet 

38:10 One piece of advice for a practice that is stretched thin 

Transcript

SPEAKER_02 0:00

Hey guys, welcome back to another beat. I am so excited to have with us an incredible office manager who really has shown to be such an asset for the practice that she works for. And I truly believe the stronger the individual in this specific role, the more successful a practice. Welcome to Nat RevMD, a podcast where we share tips on optimizing medical billing and improving practice efficiency so you can have the business of your dreams. I'm your host, Dr. Heather Signorelli, founder of Nat RevMD. Let's get started.

SPEAKER_00 0:34

So with that, Brianna, welcome to the show. Yes. So my name is Brianna Hill, and I am a practice manager for a private practice. I've been in the world of healthcare ever since I graduated college. I've started as an x-ray tech, dabbled a little bit in pharmacy and purchasing, and ended at my last job at a hospital in finance, taking care of audits, cost reports, month-end closing, pretty much anything you could think of. And I was looking for a change. So I reached out to this family practice. They were in need of someone for just a finance position. And I came in to work for them on site for two days because it was going to be a hybrid remote position and actually offered the practice manager position.

SPEAKER_02 1:30

Well, and from our standpoint, you know, from a billing company's perspective, we to have individuals like yourself to work with on a day-in and day out basis that helps us get stuff done just makes the entire revenue cycle management system work better. We all have to be one partner. And you have truly embodied that and help us succeed. And we're just so excited to have you on. And one of the things that I was so impressed with when you started is that you really you knew what key things needed to be fixed first. Because whenever you step into a new role or even are just running day-to-day operations of a practice, there are things that come up to your plate, the fires, right? And you have to decide, okay, what little fire am I going to let burn versus what big fire is going to take us down if I don't address? And I think you've done a really good job with that. So the first thing is delegation. Like, how do you approach delegation? Because you can't do it all. And you know you can't do it all. So how do you approach delegation in your office so you know who can be your other individual that you can help get stuff done?

SPEAKER_00 2:42

Yes. So like one of your prior podcasts that, you know, everything starts at the front desk. So that is kind of where I started. And to figure out who needs delegated for what, I kind of started with just general knowledge of what are you doing? What do you do day to day? What do you not do that you think you should be doing? What is not getting done? What do you think somebody's getting done, but you're just not sure. So I talked to each individual front desk person because I feel like that's where our pain point started, making sure that eligibility is done, making sure patients' insurance cards, you know, if if we can't bill you, we can't make any money. So it all trickles downhill. So I started by we had a we had a front desk staff that needed a whole week off of work. I jumped in and worked the front desk for an entire week. And it opened my eyes to all of the day-to-day stuff that the girls deal with, the things that they should be working on, that they don't have time to work on because the phones are ringing off the hook. So understanding what they struggled with on a day-to-day allowed me to realize what I can delegate to them, where we need to move some of our operations to and what they are fully capable of doing, but nobody's given it to them. Nobody's gave given them the correct training tools to do so. So after my week of working up front, I had a meeting with our front desk crew and kind of explained to them what I see, what I'm hoping to fix, and kind of streamline, streamlining the processes. So no matter who is working the front, things are getting completed the same. I might take 10 minutes to call a patient, you might take two minutes. I don't care your speed as long as the job is getting completed and everybody is getting the same end result. So I think the biggest thing too is understanding what your staff are capable of. I have people that are extremely efficient, but they're not always the softest when it comes to dealing with patient front facing patient. Yeah. But they're so efficient. Then I have other people that are amazing with their patients, but never get their stuff done. So figuring out that everybody has different strengths and different weaknesses and helping them make their weaknesses not as weak and showing them what they're good at and making sure that it's not all negative. You know, everybody deserves a pat on the back. So once I have figured out who's good at what and who can delegate and who can't, then that's helped me kind of figure out where tasks should lay and where they shouldn't. We I feel like we spend a lot of time doing manual things that we need to understand our EHR better. We have one of our support staff, she spends a lot of time scanning papers, consents, things like that. Those can all be done through the EHR. So taking the time, even though we do have all these fires, taking the time to get that process done and completed now gives you more bandwidth. Yes, yes, yes. So I never want to come into a place and just be like, this is what we're doing, this is how we're doing it, this is how we're changing things. I want to understand what you're doing now, why you're doing what you're doing, what works, what doesn't. Then we start making the changes.

SPEAKER_02 6:17

And I don't think that would have been possible had you not sat in the front desk for you know what I'm saying? Like you can't get that until you do it. Right. And you don't get that from an hour's worth of, okay, let me just sit here for an hour and observe. Like you get there from, you know, going, sitting there and actually doing the job, at least for an extended period of time. Like I think a week, obviously, you were covering, there was a different scenario, is a long, uh, a long period of time. I think the minimum that I recommend is a day. But obviously, the longer the framework that you have an ability to do that, the longer the time that you go and do that, the more you get to actually really truly understand the workflow issues.

SPEAKER_01 6:59

Yes.

SPEAKER_02 7:00

So that you can put a plan around. And like you said, you started gathering, okay, here's all the inputs of what has to be done. Here's what's going well, here's where it's struggling, here's why it could be struggling. And then you went back to the team and had the huddle of, okay, now let's prioritize this and start checking these off the box in order to solve the issue.

SPEAKER_00 7:22

And along the lines of like all of the phone calls that we get, I think reiterating the importance of the technology that is at our fingertips is huge. 90% of the phone calls we see we receive are not to schedule a visit. They're to get a med refill request. They're to ask, like, hey, I came in for this last week, still not clearing up. Can I come in again? Those are all things that you can do through your patient portal. And for us being a private practice, our portal is pretty darn good. So I have really instilled into my front desk staff, push for those text reminders, push for that patient portal. Because the more people that sign up for the portal, the less phone calls you are going to take because they can talk to their provider right there. They avoid the front desk. They they bypass all of that and they get directly to who they want for what they want. And it's going to get addressed a lot sooner than a telephone call that maybe someone forgot to put an encounter in for whatever. So I've really pushed things outside of their job that will help make their job simpler. I know that our text reminders that go out as of right now are are strictly just for appointments. But one thing that is nice is our portal is integrated with our EHR that if I get that call and I'm like, oh, I forgot to cancel my appointment, I can cancel through that phone call so I don't have to call back the next day and it cancels it on our schedule. So that's right. So those those calls are mainly for appointment reminders, but we I actually just got some patient flyers created regarding our portal. I hate flyers because I feel like you hang up too many of them and they all just get ignored. So I'm really trying to streamline what that looks like in our patient exam rooms in our waiting room. And it's straight to the point. Here's what you need, here's how you get it. But I think using your EHR use them. And if you use them, it's less people that you either have to pay or jobs that they have to do when they could be spending their time elsewhere to provide a better patient experience.

SPEAKER_02 10:03

I think you hit that. Like the EHR PM softwares, obviously, there's some bad ones. I've named them in the past. I won't name them again. I actually really like your EMR. It's e uh for the listeners, it's e-clinical works. Um I I mean it's there are pros and cons to them all. So we could sit here and like go off the negatives, but I think really having an understanding of what the workflows can look like in the EHRs, whether that's the clinical side or the PM software, you know, what is the staff's role? And then what am I asking them to do? And is their workflow optimized in the software that we have? You know, I know eClinical Works has a lot of additional features that you do have to turn on, and sometimes they're available to you depending on the product or like the level of service that you have. Right. And so you do have to be cognizant of, okay, not overspending money and uh and having a whole bunch of subscriptions to stuff you don't need, but to what you just described, simple things that decrease phone calls, that increase options for your patients to cancel or reschedule, like those things actually drive bottom line. And so I think sitting down with the software vendor, like you guys have done, and really understanding, okay, here's the problem I'm trying to solve. What can we do to get there? And then if it is extra money, then it's like, okay, well, what's the ROI? Because, you know, we all know that the the budget to spend on softwares and stuff is low. But at the same time, if it does have a really strong ROI, because it cuts phone calls down 50%, or exactly somebody scanning what you know, whatever paperwork in, like those sorts of things, that's a real ROI.

SPEAKER_00 11:39

Yes, absolutely.

SPEAKER_02 11:41

Um so one of the things that I think you've done really well is, and we can talk front desk or another role, maybe the uh how you're how do you really hold people accountable? Like what is the the strategy that you use? Everybody's busy, everybody comes to work trying to do a good job. So it's not like anybody comes to work to not do a good job, but how do you really hold people accountable?

SPEAKER_00 12:04

I am definitely a process and list person. I know everybody is not, but here's the deal. If you have a list, a checklist of okay, every time I check this patient in, I need to physically look at their insurance card. I need to check that we have the right phone numbers. If you have that list, you might only need to use that list for a week and then you're in your flow. You don't need the list anymore. But we're all guilty of being in the flow and then having this epiphany, like, crap, how do how do I do that? And I want people to have a list or a process or a procedure to refer back to. So I'm designing that right now for our front desk staff that every time they check somebody in, this is what they have to do. Every time they check somebody out, this is what they have to do. And again, that goes back to everybody's doing the same thing every time. So we don't have a nurse or a provider thinking, oh yep, Sarah's the one who checks that patient in. We can tell because XYZ was done. It's gonna be this a standard that we set, and that's what we hold people accountable to. I cannot expect someone to do a job that they were not properly trained to do. And I'm not gonna come in here and assume that they were trained or that everybody was trained the same. You know, our EMR has a way of getting to a certain screen four to five different ways. So I'm learning every day that somebody clicks a different button to get to what they want. But I I'm retraining, I'm restarting. And I'm starting with the front desk because I do feel like that's where all the action happens. That's where that's how we make sure we get our money. That's how we make sure our patients are, you know, we have all the correct demographics and everything we need to send them a bill and to make sure they're getting the best quality care that they can. Once I have feel like I have conquered the front desk, I plan to move to individual nurse doctor groups. I want to see how are you grooming patients? When are you making time to call your patients on results? Um, I know being a patient myself, and this is everywhere, practices are terrible about calling their patients with results. Once they have the tools to do the job I expect them to do, then there's no excuse. Yeah. They have excuses right now. Well, I didn't know that. Well, I wasn't trained to do that. Well, I've never been to that screen. I'm making sure those questions don't pop up. Then I can hold them accountable. I can't hold them accountable for something that I don't or do know that they know how to do.

SPEAKER_02 14:50

So and I think that that helps with turnover because I think in general, the majority of the population likes to do a good job. They like to feel like I came to work, I did a good job, I had good results because of the thing that I did good or done, you know, that I did well. And but when you don't it in in healthcare, and maybe this is other businesses too, healthcare is just what I know. It's so easy to have turnover, and then you're starved for that person to get back. So then when that person gets back, you're like, oh my gosh, take these hundred things off of my plate. I don't even have time to train you. We'll do it super quick. And so then you hand that back to them. And then, you know, somebody who's new is looking at three months. Totally, they're lost because they're they're frustrated that they don't know what to do. They're frustrated that they didn't, they don't feel like they're doing a good job. And then that's where you see turnover. So I do think like this process-oriented, what am I supposed to do? What does good look like? What are the steps? What it give me a checklist. And yeah, I've talked about this before, but Claude, AI, you can do that, and and it's not PHI, so you can use that to your heart's content. Like you can type in something that is your mind, being able to just talk through the process, right? It still needs your input, but it can make it pretty, it can make it simple, it can do, you know, a checklist and a policy form like that. And so I just don't think there's any excuse.

SPEAKER_00 16:14

Claude last week to create our no-shell cancellation policy. So I told Claude, next time I ask you to write a policy, keep the same format flowing.

SPEAKER_02 16:24

Then everything's we do the same thing for our billing policies. Like we do the we have a standard policy for all of your practices. Actually, your practice that we did was the first that we did videos for. So Mandy created videos. So then the videos are linked within the policy so that when we have new staff, they can go watch the thing. Everybody alone is different. Yes. And then you have it written and you have a like a literally a show and tell.

SPEAKER_00 16:55

I'm gonna go back to your last podcast about the turnover too, because you know, you said in those first 90 days, and in my opinion, 90 days to even a year, people are not quitting because they're unhappy with their pay. When people get hired for a job, they know exactly what their pay is gonna be before they accept it. So if they're leaving within that first year, it's because they're either unhappy or they don't know how to do what they're expected to do. And we are human and we don't love failure, we don't like screwing things up on purpose. So if somebody's leaving in that time frame, it's probably due to a trading issue. So I I'm trying hard on that cycle here because I know our front desk has struggled a lot with retention, and that's really our only place where we have retention issues. We have nursing staff that have been here for 14, 15 years. Like, yeah. And it's not because, you know, we're rowing in the big bucks and everybody's making all the money. It's because they love to be here. They know what they're expected to do and they do it.

SPEAKER_02 18:04

Yeah. So and you're not alone in that front desk position. And I do think it comes down to the process, the complexity, the knowing what good looks like, and then knowing, okay, here's my checklist, here's what good looks like, here's what good results look like, and how it all ties together. And I think that that's the the best place to start. I mean, so if you're a practice and you're listening, starting in your front desk, having your office manager or your leader go and spend a time, not just an hour, but you know, a day, a week to go actually do the role. Not just watch, go do it.

SPEAKER_00 18:35

No, do it. And I'll be honest with you, I was slightly terrified when I went up there for a week because I knew how to navigate the schedule. I knew a couple clicks in the system, but I don't feel like I even myself was truly trained per se. So I'm like, all right, we're going in, boots on the ground. We're either gonna do really good, do really bad. So I warned all the staff, I'm up front, bear with me. And we made it. We made it through the week. I learned so much. Uh, I would say day one, I was traumatized. I was burnt out. My brain was like, oh my, how do these girls multitask this many things all in a day? And then I realized, what's my flow? I need a flow. So that way, when I check in a patient, boom, boom, boom. When I check out a patient, boom, boom, boom. I'm doing these things every time. And before I know it, check in and check out is a breeze. And I'm not stressing about anything. And I would say by day three, I got in my flow and the rest again. You don't know what you don't know. If the girls don't have the right script script to say to collect that money, it's intimidating.

unknown 19:48

Yeah.

SPEAKER_00 19:48

But then you have to go back to the basics and realize these people are coming here for services that they are expected to pay for and they need to pay their portion. Uh it's it's the same with we really struggle with holding people accountable to come in for their annual visit. And so I've really pushed the girls that when somebody is checking out from a wellness, the way we script it is who would you like to see for your wellness next year? Yes. And then it's in their mind, it's not an option. Right. Same with if we don't have an active insurance card. We are we are calling those patients the morning that we run eligibility, and we are saying, if you expect to be seen today, we need an updated insurance card, or we will put you on our self-pay fee schedule. Like it's not a choice. If it's not a choice, then they just do it. So really rewording how you script things to make it sound like it's not an option, but you're not being rude about it.

SPEAKER_02 20:54

We have a COO that we work with in another group that we do billing for, and she had another great one that's probably in your playbook as well. It's how would you like to pay today?

SPEAKER_03 21:04

Yes. Buy cash, card, or cra or check or whatever. You know, like not would you like to pay? It's how would you like to pay today?

SPEAKER_00 21:15

Like, again, you don't know what you don't know. Let me get you scheduled. And it looks like you have a $20 co-pay today. Done. So, yeah. And I think you as a practice manager, I think my biggest like strong suit is no job is above me or below me. I am willing to do whatever to make sure that we can see the next patient. A couple weeks ago, I was autoclaving, never autoclaved in my life, but I figured it out. Auto claved, worked the front. I'm trying to meet my front desk girls in the middle to avoid burnout. And I am all about having a schedule that meets the needs of our staff. So my girls are actually working four nine hour shifts and then. one of their days they are only working a half day. Well that's it gets a little too crazy to only have one front desk person. So one of those half days I am filling in that helps me stay current, understand what's going on, realizing if processes needed to be updated, changed, so forth. I I just I firmly believe that happy employees get what they want but it also has to benefit the practice. 100% you know today if you ask me hey can I get you to work the front desk today it's chaos. I really probably don't want to nor do I have the time to but our employees have to be happy with their work home life balance and that's huge for me. So me staying at the front one day a week ensures that I stay current they stay updated.

SPEAKER_02 22:53

We're all in the loop so I love that that I love that that's a win-win for everybody. Another win-win that you had for the practice is working through chart note closures. And this is a struggle that many of our offices have and um I can understand how it also gets there because once they start building then you just look at that number and you're like who has time to to to get current because it's just it piles on and piles on and piles on. I would love to hear just some general strategies that you've used to help you know get get you where you want to be because it sounds like at least from our perspective we've seen revenue growth with the practice since since we've come on you know and since you've started as well. So it I would love to hear some of those strategies.

SPEAKER_00 23:46

So when I started I was just doing the finance side of the world I started by analyzing all of our accounts and seeing what money was going out, what money was coming in you know were we making enough to run that practice and still have a little bit of a cushion in case something were to break or whatever.

SPEAKER_02 24:07

The math wasn't mathing we're seeing patients our schedule is overflowing but why isn't the money coming in so I spoke with Mandy our amazing billing gal at Natrev and she's like Brianna you got too many notes open that's why we're not seeing money come in and I'm like okay what are we talking like 100 notes she was like no I'll send you the report no and and she had been sending the report to the practice but you because you you were in the finance role you weren't you weren't getting those lovely reports.

SPEAKER_00 24:44

So she sends me the report and I have it pulled up right now we had 622 notes open 622 so I had a meeting with the owners and expressed all of my concerns with these open notes. First accountability what is the point of seeing a patient if you're not going to close their notes and we make the revenue off of it. You guys are basically working for free right now is what's happening. I need you to close your notes I said here's what I'm gonna do I've got a couple people who thrive when there is a challenge so I made a leaderboard and every week they got ranked on how many notes they had open and holy cow it woke them up in just 15 days we went from 622 notes down to 469 and then it slowly slowly slowly started closing. So then I added something else I created a policy that said you have 70 72 hours to close your notes if you do not close your notes you will be suspended without pay until your notes are caught up boy that lit a fire.

SPEAKER_02 26:04

Again like the owners were part of like you guys were were working together to create this like they were on board with hey we've got a problem we need to get a change put together and I was honestly hesitant to roll out the policy because I'm like my owners were like let's do it we're gonna get awesome and that's and that's what they needed one I know and uh and adore the owners of of your practice two like I think sometimes though you get so deep into you're running the practice you're trying to see the patients you're hiring people you've got to you know at that time you guys were going through a billing change an office manager change like I feel like you guys blew up on multiple things at once which is a struggle and so to have someone like you come in sit down with the partners and you guys divide you know create this because I'm sure that it takes a weight off of their plate because they're not having to think creative. You know what works.

SPEAKER_00 26:59

So I just it's it's hard because they're seeing patients all day every day. I don't have time to have a two hour meeting with them to figure out how we're gonna conquer this issue or whatever. So we have a meeting once a month and there's times we're here till eight o'clock at or nine o'clock at night figuring out what we're gonna do. And I think the biggest thing in the past is they're all good at talking about what we should do and how we should do it. I think the fact that I have this open encounter leaderboard and this sucker has been updated, it's holding them accountable because they know I'm not dropping this. I am not giving up on this we did take our tracker one step further and of the open notes that the provider have that they have open we are monitoring like how many of those open notes are actually within that 72 hour policy and if they are not at 80% or higher they're hearing from me. So I sent that email yesterday and told the two that were not within the 72 hour window and one of them is halfway done with what were not in the 72 hour window and the other provider is completely done caught up good to go.

SPEAKER_02 28:21

That's awesome. That's awesome I mean and you know it's like they they lose track of it and so you know getting the reports creating the dashboard creating an expectation like I think that's to me half the battle is okay what is everybody good with in terms of an expectation and then how are we going to measure that because what you don't measure you you don't make progress. Because they are so up for a challenge. I know you've got a lean background and as a laboratorian huge fan of like the black belts and the lean processes. So I do think that that background has really helped you be successful in this new role. As we kind of conclude the questions if there's if there's another office that's listening to this right now, what's one piece of advice you could give to them that would make their week or month even better?

SPEAKER_00 29:07

Stay present and stay accountable and know that you are one person and you can only do so much in a day. But make yourself do so much in a day like I know there is a huge long list of things that I want to do need to accomplish to get our practice exactly where I think it could be but I'm human. I have a family outside of work I have friends. I I will do as much as I can do for this practice so don't don't think you've got the whole picture by talking to one person. Really invest in your staff make them feel like they are an important piece of this practice and they are so listen to them. Absorb what they do how they do it and help make their job more efficient they know what they're supposed to be doing when they do it and then before too long like this practice could run itself as long as everybody has the tools they need to do so.

SPEAKER_02 30:11

Yeah I love that that's such a great advice and um again I just we've been very impressed with your entire practice with the owners for identifying what they need with getting you on board with you working through the checklist meeting with the front desk identifying processes that need to be improved. We're excited to see you guys grow and continue to to um crush it. So I just appreciate you spending your busy day on a Monday of all days of the week and school starting this week we just got to lump that all in so I appreciate you spending the time and it's been great working with your team. Yes thank you Heather All right we'll talk to you soon. Thank you so much. We've got some great resources so we're doing an E and coding webinar on August 26th at 4 p.m central, 5 p.m Eastern and one of our CPC educators to really go through some of the important key characteristics of your notes and your documentation so that if down coding is happening, if that is a risk for your practice or if you're starting to see that and are having to appeal those, that your documentation is locked lock that your documentation is complete so that you win the appeal every single time. So you are not going to want to miss out again that ENR again that ENM webinar link will be down in the show notes. We also have another diagnostic tool that is really critical for you to understand where you're at and where your opportunities are so that you're focusing in the right places. So check those links out down in the show notes. Thanks so much