#200 Your Performance Reviews Are Making Your Billing Team Worse

👉 Free 30-Day Revenue Recovery Plan: https://eligibility.natrevmd.com/nrc/-30day-revenue-recovery-plan

The plan we would build with you if you walked into our office today. Take it home and run it yourself. 

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Your performance reviews are probably making your billing team worse. Not because you're giving bad feedback. Because the format itself is designed to produce defensiveness, not change. 95 percent of managers are dissatisfied with their review process, and 90 percent of HR leaders say it doesn't produce accurate performance information. And in an independent practice, it's usually worse than that: an annual conversation that changes nothing, a reaction to a problem that arrives too late, or no review at all. 

In this episode we replace the annual review with three evidence-based tools. All of them work in a two-person billing office. None of them require an HR department. 

 Why the Traditional Review Fails.  Retrospective, evaluative, high-stakes formats activate self-protection, not development. The employee being evaluated for past performance is managing her reputation, not learning. The billing manager whose Friday claim-scrub pattern gets addressed in an annual review will comply for six weeks and drift back by week eight. Because the review addressed the behavior but not the cause. 

 The SBI Model.  Developed by the Center for Creative Leadership. Three parts, order matters. Situation (specific observable moment). Behavior (what happened, not who she is). Impact (specific consequence, ideally with a dollar figure). One SBI conversation takes about four minutes and can happen at a desk immediately after the event. 

 The GROW Model.  Four questions, in order, without skipping any. Goal (what does excellent look like, from her perspective). Reality (where is she now against that standard). Obstacles and Options (what is in the way, what could change). Way Forward (what specifically will she do, and by when). Compliance fades. Ownership compounds. 

 The IDP.  A one-page Individual Development Plan capturing the outcome of a GROW conversation. Goal, current reality, top obstacle, one specific commitment with a date. Reviewed together every two weeks. After three of these, the billing manager has a roadmap to excellent performance that she helped build. 

Sticky Phrase: Coaching compounds. Compliance fades. 

Three Actions This Week 

• Run one SBI conversation on a specific, recent, observable billing event. Under five minutes. Watch what happens.
• Run one GROW conversation with your highest-potential staff member. Fifteen minutes, four questions in order. 
• Build a one-page IDP for your billing manager. One page, shared before the next meeting, reviewed biweekly. 

Episode breakdown 

00:00 — Your reviews are making your team worse 

03:00 — Why the traditional review fails 

07:00 — The SBI model 

13:30 — The GROW model 

20:00 — The IDP 

23:00 — Three actions this week 

26:30 — Free resource + close 

👉 30-Day Revenue Recovery Plan (free) 

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

 Website: natrevmd.com 

Trusted Resources: natrevmd.com/trusted-resources/ 

Referenced in episode: 

Center for Creative Leadership — SBI Feedback Model 

Lattice — What Is the GROW Coaching Model 

Coaching for Performance by John Whitmore (foundational GROW text) 

The four-episode culture-and-people arc: 

EP196 — Culture is a revenue decision: https://podcasts.apple.com/us/podcast/197-the-%2440-000-hire-with-the-perfect-resume/id1624182351?i=1000777698531

EP198 — The mindset you hire is the culture you build: https://podcasts.apple.com/us/podcast/198-%24300-000-in-old-ar-is-at-risk-during-your-next/id1624182351?i=1000778180219

EP199 — The first 90 days decide the next three years: https://podcasts.apple.com/us/podcast/199-you-are-destroying-half-the-value-of-every-hire-in-90-days/id1624182351?i=1000778687186

EP200 — This episode (series close) 

Next episode: EP201 — The one payer contract negotiation move most independent practices never make. What the team you built can produce when the contracts underneath them are set correctly.

Transcript

SPEAKER_00 0:04

If you've ever worked inside a large company, you know exactly what an annual performance review feels like. It's a form, it's maybe even a webinar, maybe a how do you set your goals, maybe a checklist, and then a 30-minute conversation with a manager. You say what you need to say, they say what they need to say, and you move on and repeat that in a year. 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 Signarelli, founder of NatrevMD. Let's get started. So today we are going to replace that with something that I think is super tangible for medium to even large-sized medical practices and something that we have been evaluating ourselves because as I came over from the corporate side, I was very regimented about the forms and self-rating and manager rating and going over goals. I think there's some pros and cons to that, but it just never felt genuine to me. It just always felt like I was rehearsing something that didn't really have meaningful change. And so today I'm going to talk about some strategies that I really like and ways to manage not just an annual review process, but how to give staff feedback, how to really understand where somebody may be struggling or what goals they may need around a specific process. So we're going to make this very specific around examples of what staff is doing within an office and then how to bridge that to performance improvement without it being this formal once-a-year situation. Again, if that's where you live today, there's no shame in that. It's just, it's just never felt super useful for me. So when I started digging into this, I actually started going down the rabbit hole of just the annual performance review process in general. And I think it has evolved quite a bit over the last 10 to 20 years. And there are certain findings that are consistent regardless of what sort of industry you're in. And so the format really is the problem, right? Not that you need to give feedback or that you have feedback. It's really about the format itself. And it's just, it's a way to do to funnel employees into certain buckets. You know, are they a five out of five or four out of five? And then that allows you some objective way to measure them against their peers or to see on a, you know, a larger scale how ready those individuals may be for the next role or for graduated responsibility. But think about like how that comes across at times, right? You know, how has performance been over the last year? But when you sit down to discuss it, you're not really in this learning, troubleshooting mindset, right? You're in this reputation management mindset. The conversation maybe is a little awkward or it feels postured or fake a little bit, more of like it's just this rehearsed thing that I have to go through. And oftentimes I felt like it doesn't produce actual change in behavior. It doesn't give me things, concrete things that I should go work on. And you walk out with these fake goals that you put on that are smart and, you know, specific and measurable. And so the frameworks that I'm sharing today are quick wins and easy ways for you to really have dynamic conversations in your practice that are applicable to a front desk coordinator or a billing manager or an office manager or COO so that you really get actionable improvements in their day-to-day performance. It's not quite as formal as those checklists, forms, and documentation and so forth. And sometimes you have to do that with performance improvement plans. And I do really believe that those need to be very concrete, specific, and with, you know, forms that everybody signs. But I do think that to have effective feedback, it needs to be specific. It needs to be about the behavior that's happening, the results that are potentially lacking, and that it's delivered close to the specific event that occurred, not hey, I'm going to talk about and try and remember stuff that happened a year ago. So the good news is that what I'm talking about today doesn't require fancy HR department or fancy performance management platform, which I evaluated a whole bunch when we started this company. But I just always felt like at the end of it, what I'm what is my true ROI with this annual performance review? And so today we're going to talk about a couple specific tools or frameworks that you can use consistently and can be applied and taught to your department leads to use that in in different scenarios within your practice. So the first is called the SBI. The SBI feedback is something that's built that helps prevent defensiveness. So it's easy to get feedback and you immediately go, well, no, I didn't do it like that or I didn't mean it like that. And so this is a framework that you can use to create feedback, but in a way that doesn't make the person feel bad about themselves. Hey, we're gonna talk about something specific and we're gonna have a plan around improving that. So SBI stands for situation, behavior, and impact. And it is a framework, I did not develop this, but it was developed for the purpose of delivering feedback that produces learning rather than defensiveness. And I have seen a lot of success with using this within our own team. And I think that these components are super straightforward and actually easy to implement within a practice. We all know that there are going to be situations or certain positions that may have higher stakes when giving feedback, leaders, physicians, providers. And so using this framework still doesn't eliminate the fact that you have to sit down and give the feedback, but it does try and remove the personal element from the conversation, which I really like. And so it makes this conversation a little bit easier to stomach. So you're not telling somebody that they are careless or that they are forgetful or lazy or whatever the adjective is. You get into a situation where you're describing a specific observable event, and then you're naming the behavior around that event and then naming what it produced, right? The impact. And so it the goal here is that it drives a different conversation. So I'm going to give an example. So let's first talk about situation. So you want to anchor in a very, very specific moment. And it is a time, it is a place, it is observable, it is unambiguous. So not, well, you always leave charts unassigned. It is, hey, on Tuesday afternoon, you finished your afternoon and you know, the four patients you saw between 3 and 4 p.m., all of those encounters are were unsigned out still at 72 hours or whatever your cutoff is for hours in terms of how often you require, say, a provider to fill out their charts. And please know, please set those expectations. So if you don't have an expectation of how quickly your charts need to be signed out, and maybe you're the owner and you maybe you're part of the problem, or maybe you've got colleagues that are part of the problem. Either way, having rules of engagement around certain specific situations will help you do this SBI framework better because again, you have expectations that you've set, everybody's weighed in on those expectations. You've written them out, everybody has signed and agreed. And then that allows you to then give specific feedback, you know, according to, you know, our expectations, and then be able to drive home change. So again, back to our specific situation here is we're not just saying we're not generalizing. I think that's the the goal here. It's not generalizing. You're being very specific that, hey, on this date, we had these encounters that were still open by X, you know, due date. And that removes the argument, argument about whether this is a pattern is real or not, because it's specific, it's verifiable, and nobody can argue that. So that specificity really matters a lot in the clinical setting because it allows, you know, any of your clinical staff who typically tend to be pretty precise individuals, they know the difference between a generalization and a specific situation. And then there's it, there isn't that immediate need to jump and defend themselves for the most part. Then the behavior. So this is about describing the action, not the person. So the behavior is what happened. Describe it in very observable terms. So not like, oh, you were not paying attention or you rushed through something. It was about that you had a visit, it was documented, but the encounter was truly just not signed out, which means that, you know, in this situation, a claim wasn't able to be submitted. That is a behavior, right? So the patient's copay, another example of this is the patient's copay was waived at check-in without a documented exception or supervisor approval. Now that is a behavior attached to a specific thing that occurred, right? You can name the patient, you can name the date, you can name the time. And so you're removing the judgment about, you know, someone's character or their intentions, et cetera. And so super important when giving feedback is you don't want to, you know, have somebody hear, okay, they were lazy or they weren't thorough or they're trying to defend something. You just want to keep it very, very specific about, hey, this, these, these charts were unsabbed out on these dates, you know, physically wasn't signed out in the EMR, therefore the claim couldn't be submitted. So the IP part, which is the impact, is the is then naming that concept consequence, right? So it's what the behavior produced, right? So then an example of that is this could be operational process or a financial consequence. You know, for example, the charts were not signed out on these dates and times. You they have this many unsigned out. And the impact is that we're not able to submit the claims. And because of that, that's going to impact revenue X amount. And so again, it's being very specific, but getting all the way through the impact of that encounter that couldn't be submitted. I think super important to use both of these. This should be a super quick conversation, a few minutes. It should not require this scheduled review meeting. It could happen in the hallway, it could happen at a desk, a brief one-on-one at the end of a clinic day. Um, really closer to the event, the better. That's the key here. And so you don't want something that happened last Wednesday to be dealt with, you know, the following Friday. You really want it to be, again, as close to the same day or the day after as humanly possible. So the next tool is then really being able to take that and then be able to improve on consistent actions moving forward. And so this is called the grow model. And so the app, the SBI really addresses what happened, right? We had a we had a specific incident, the behavior that got us there, and the impact that that caused. So then grow is really about what happens next. And it's a way for you to coach a staff member and it has been used in many different executive, you know, coaching scenarios applied in organizations like Google. It's been something that we have been playing around with, and it's really four questions and the discipline in using them in order, and you don't want to skip any of them. So super important. Again, we'll go through these. So the reason why I recommend this is that the four questions put the team member really in the driver's seat of their own success or their own development. And so the goal here with Grow is that the team member answers the questions and the manager or leader's role is going to be to listen, reflect on that, you know, maybe ask some clarifying questions or expand the, you know, the discussion, but it's really about shifting the ownership to the team member specifically. Uh, let's talk about what Grow stands for. Stands for goal, reality, obstacles, and options, and then a way forward. So that's what Grow stands for. So the goal part of this is really asking the employee what does excellent performance really look like to you? Not just like some job description or some task list that you're giving them. But if we're talking about a specific scenario, eligibility, audits, whatever, what does good look like to them? And have that conversation and explore that first. So everybody's on the same page of what good looks like. And then the question comes to, okay, let's talk about reality. Where are we right now with this? Where are they? And ask the team member, ask the employee to really assess their own current state. So this isn't meant to be some trick question or you know, you've got an aha or gotcha moment, but this is really listening to, you know, what their reality is in terms of how they think that they're doing with that. And it's an honest read of where they think that they stand. And so they can say, I know my eligibility checking is not consistent. I know that I missed days, or I know I don't know how to get onto certain payer portals, or maybe they don't know that and then they're saying, I've I've missed 20% of them, but I don't know why. And then you can explore that further. And that's what the obstacles and options is about, is really what is in the way? What is what is the challenge and barrier? Is it time? Is it bandwidth? Is it uh payer portal access? What is it about the task at hand that we're talking about that is in the way to excellence? And then way forward is then now what do we do about that? How do we get the person, the training that they need, use the checklists, make the checklist simpler, get them, you know, that the bandwidth or the time so that they have dedicated time to, again, get eligibility, for example, addressed. And so this is less about some script and some form. And of course, if you feel like you have a large enough team and you want to document these things, I don't think that's a bad idea. I mean, you guys know I'm a huge fan of documentation, especially if you think it's going to lead to a performance improvement plan. But I think it's just more about a conversation of you've got it, you've got a task that needs to get done. You've got somebody who's in charge of doing it. How do we get them where we're where we need them to be? And these, these, these conversations can take 15 or 20 minutes. They can be targeted or something that you do in one-on-ones, or it can be something specific where, hey, we're gonna go over eligibility today on our one-on-one. I really want to talk about like where things stand, how to get us to where we have no eligibility denials. Again, specific, and we're using that grow method in order to get us to where we want to be. So, really, really uh two tools that are incredible mechanisms by which you can give feedback and grow together in terms of getting lasting results for your practice. Now, there are some other tools like the individual development pan or pips that are, you know, more formal ways to make these conversations documented. I won't go over those today, but maybe we can do another podcast about that here down the line. So, another example for like an office manager that could be an SBI and grow grow framework is we could say, like in the last week, two weekly meetings, the unlocked encounter tracker has grown without a true owner. No action item was actually addressed, but the impact on this is, you know, $15,000 in unbilled claims. And so what would it take for you to feel fully accountable? Actually, scratch that. All right. So, again, in summary for today, we've spent some time really going over two different frameworks. I really like the SBI and the Grow framework. And they can be a really good mechanism by which to get people talking about things that are going on in the practice, coming up with solutions and working on them together in a non-defensive way. So, uh tasks for you. Um, I love to make some suggestions around how you can implement this. So try at the SBA, the SBI conversation with one employee this week, somebody that reports to you. Or if you are listening to this and you have leaders, say, hey, I've got this really good idea. I want to try this SBI framework. Can we use it and, you know, and and try it with either some scenario in your practice? And then, of course, adding on a grow conversation to a next one-on-one or something that you know you're trying to problem solve and get results around. So, as always, um, thanks for being here. Um, we do have a uh revenue audit uh down in the show notes. So go check it out. And as always, if you could, we'd love for you to share this with a friend or a colleague. Just share the podcast or our website, notrevmd.com, with others who you think may benefit. All right, have a great rest of your week. Bye.