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AAOS Now

Published 6/1/2007
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Jennifer Bever, MS, FACHE

Staff training with the click of a mouse

Have you ever considered the cost to your practice when an employee leaves? There’s not only the cost of recruiting a new team member, but also the costs of lost productivity. According to human resource experts, these costs can run as high as 25 percent of the employee’s annual salary and benefits. So the cost of turnover for a medical assistant who receives $30,000 compensation and $6,000 in benefits annually would be $9,000. For highly technical or professional positions such as radiology technicians, physician assistants, or practice administrators, costs can run even higher. Consequently, finding quality employees, successfully assimilating them into your practice, and retaining them over time have obvious financial benefits.

In exit interviews, many departing employees will point to lack of training as one of the main reasons they never got comfortable or were not optimally successful. This isn’t necessarily surprising because, historically, physician practices have struggled with how to provide both initial and ongoing training in a cost-effective manner.

To provide the best patient care possible, you’ll need top-notch clinical and administrative staff, and those staff members will require continuing education (CE) to keep up with changing insurance payment rules, new insurance benefit structures, and new computer tools. Although many practices consider training as time- and resource-intensive, it doesn’t have to be. Increasingly, the Internet offers convenient and cost-effective training options.

Training for new employees
Medicare is an increasingly complex payor and your entire staff could benefit from understanding and complying with Medicare rules. The Centers for Medicare and Medicaid Services (CMS) offers several Web-based training modules through its MedLearn division. These free training modules can be accessed at www.cms.hhs.gov/MLNEdWebGuide/. The following modules are samples of what is available:

  • Front Office Medicare—Reviews registration and check-in
  • process for Medicare patients; excellent for front desk/reception staff.
  • Understanding Remittance Advice for Professional Providers—Walks trainee through how to read the electronic explanation of benefits (EOB) file from Medicare; recommended for billing staff to ensure understanding of how to read and act on denial codes.
  • Skilled Nursing Facility (SNF) Consolidated Billing—Reviews proper billing for residents of an SNF who are seen in the office and receive radiology services; a must-review for billing personnel in orthopaedic offices where SNF billing continues to be a challenge.

In addition to the national CMS Web programs, many local (state) Medicare carriers offer additional, free Web modules. Wisconsin Physician Services, which serves several Midwest states, offers the following options:

  • Medicare Physician Fee Schedule Database—Instructs how to use and interpret the fee schedule database; recommended for all billing team members and managers.
  • Medicare Enrollment Application Form 855—Provides guidance on successfully completing the
  • credentialing form for newly enrolled physicians or those who are undergoing mandatory
  • recredentialing; recommended
  • for managers or other team members charged with credentialing duties.

Trailblazer, the carrier for many southwestern states, offers the following online courses:

  • Supervising Physicians in Teaching Settings—Reviews documentation requirements when physicians and residents see patients in clinic; recommended for billing, compliance, and managerial staff in academic settings.
  • Incident to Services—Presents an overview of Medicare’s incident-to-billing rules; recommended for nonphysician providers, billing, and compliance staff.

The health insurance industry also has free online offerings that could be used for staff training. The America’s Health Insurance Plans group offers the following online guides geared toward providers:

  • Improving Claims Processing and Payment—Reviews requirements for submitting a clean claim and improving chances of timely reimbursement; recommended for charge entry and billing staff.
  • Claim Correction Form—Provides an overview of the process for submitting corrections to claims; recommended for billing staff. Access these and other guides at www.aahp.org

Computer training
Every new employee will need an introduction to the computer systems used in your practice. Even if the employee is familiar with the basics, learning the “shortcuts” will make a difference, particularly in improved efficiency.

In too many offices, however, one employee teaches another, so the new employee’s training is only as complete as the instructor’s understanding. If the instructor learned how to use the system from another employee, bad habits and inefficient operations are simply passed along.

Although the best option is formal training from the vendor, many practices can’t afford the fees for onsite consulting. So Web-based training for staff, managers, and physicians is an excellent alternative. For example, MISYS (www.misyshealthcare.com), a system often used by orthopaedic practices, has a wide array of Web-based classes covering various aspects of the system, including scheduling, billing, and reporting. New hires could spend much of their first two weeks taking online courses, after which managers could administer skills testing.

Online courses enable new employees to get the training they need without pulling current employees away from their day-to-day duties. Most of the MISYS courses are 2 hours long and average $100 per employee, per class. (Note to new system purchasers: See if your purchase price includes credits that can be used for online training.)

Continuing education for employees
The Internet doesn’t just offer courses for new employee training; all types and levels of employees can benefit from going online for educational opportunities. The convenience factor of being able to log on during slow times at the office (such as Friday afternoons) or at home in the evenings cannot be understated. In this way, employees get the training they need—and the practice won’t be affected.

Certified clinical employees, who may be required to obtain CE credits, also have online options (see sidebar). Administrative staff, particularly coding team members, have online options as well. The American Health Information Management Association (AHIMA) offers audio conferences (http://campus.ahima.org/audio/) and distance education opportunities such as the following:

  • Web 101: Introduction to the Internet—a free-trial online course
  • Coding Basics, a comprehensive overview of coding principles that includes 12 courses and provides employees with the skills they’ll need to take the AHIMA coding certification exam.
  • Focused courses and assessments such as Arthroscopic Musculoskeletal, Fracture Care Coding in Ambulatory Settings, Non-Physician Practitioner Coding, and Using V Codes Appropriately. Many of these courses include assessments to cement learning and allow the practice to confirm that the investment in employee learning was worthwhile. Details and costs are available at http://campus.ahima.org.

The Medical Group Management Association (MGMA) offers courses for managers, such as Enhancing Financial Reporting to Key Stakeholders, a 5-to-6 week Web-based module available at www.mgma.com. The cost is $595 for members. MGMA also offers audio conferences and Web casts on a variety of topics, including orthopaedic-specific topics from time to time.

Bring training home to your practice
With so many cost-effective resources available, orthopaedic practices are encouraged to rethink how they conduct initial and ongoing training for employees. If employee training isn’t a formalized process at your practice, now is the time to develop a program.

Start by ensuring that the practice has sufficient access to PCs with high speed Internet. Next, create a list of training for each position in the practice; a checklist format is especially helpful for initial training for new employees.

Many training courses include an assessment feature, enabling managers to review post-training results and discuss any areas in which scores were not acceptable.

If the online course does not include such a feature, you’ll need to determine how to ensure that the learning was a quality experience; practice-administered quizzes are one route.

Many practices use learning at the individual level as an opportunity to share new knowledge with the group. Employees completing courses are expected to present a 5- to 10-minute overview of what they learned at the next staff meeting.

With these steps in place, practices can develop internal team talent and benefit from enthusiastic and top notch employees who provide excellent patient care.

Jennifer Bever, MS, FACHE, is a consultant with KarenZupko & Associates, Inc. (www.karenzupko.com)

Online options for clinical employees
American Society of Radiologic Technologists (
www.asrt.org): Online, directed CE readings for radiology technologists are available; courses are free for ASRT members.

American Association of Medical Assistants (www.aama-ntl.org): Self-study courses can be ordered online. Topics range from accounts receivable and workplace violence to IV infusion therapy. Course costs range from $20 to $136 for AAMA members.

American Nursing Association (www.nursingworld.org): More than 30 online CE courses are available on topics ranging from patient privacy and healthy aging to children’s health and needle stick safety. Some courses are free for members; others have a fee.

National Association of Orthopaedic Nurses (www.orthonurse.org): The professional association for nurses specializing in orthopaedic nursing also offers online CE courses that focus on common orthopaedic issues and would benefit all clinical employees in an orthopaedic practice. Topics range from club feet and Dupuytren’s disease to wound care and osteoporosis treatment. Costs range from $19 to $33.

American Academy of Physician Assistants (www.aapa.org): Home study programs are available for members on topics such as HIPAA, osteoporosis, and risk management. Online CME is also now offered. Registration fees may apply.