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This is part three of “Business Rules in People’s Heads.” In some of the prior ones, we talked about some of the challenges you will run into and why these things might not be correct.

Formalize rules and policies

One of the biggest things, of course, is that if you don’t get these loose rules, not formalized, and in people’s heads written down. You don’t get them to put it into a system where you can track and analyze them and determine whether or not they’re correct. You have significant issues. You can’t find errors. Further, you can’t prevent future problems. You really can’t systematize and make progress off of them. Also, you can’t have continuity.

One of the things we also mentioned is that the rules sometimes are not correct. We’ve seen situations where many different people in one department, in the same department, let’s say all in the payment posting or all in appeals or something like that. All operate under a different set of rules where they all believe that specific payers do certain things or don’t allow certain things, or you have to do X, Y, or Z to get them paid.

Create a knowledge base to maintain procedural standards

Part of the problem, of course, is you don’t know who’s right. A lot of what is considered to be right frequently in the industry is based on who’s been in that department the longest, who has the greatest seniority, or “I’ve been in billing for 25 years, and therefore I know X.”

One of the problems, of course, that we’ve mentioned, is that the rule may never have been correct. Somebody may have misunderstood or misinterpreted the rule. Or it may have changed along the way. In addition, they may have updated something. However, there is status in having this information, in knowing something, and being right.

Allow room for mistakes

There’s a rooster in the background, in case anybody’s wondering. I’m still out in the middle of nowhere, climbing in Joshua Tree. If something is incorrect or we don’t even know if it’s correct, is somebody going to be willing to admit that that rule that they’ve been pushing for so many years…?

There’s the rooster again. It’s crowing. It’s not even early in the morning. It’s like afternoon. I thought roosters crowed in the morning. Crowed? What do roosters do? Cock-a-doodle-doo. Cocorico. It depends on the language, I guess.

People don’t admit that they may be incorrect on the business rule. Part of that is because they might be concerned about losing status within the organization. It might be that it’s, “Hey, I’m considered an expert in this organization, and I can’t admit that something is wrong or that something here maybe even has changed. Where I was right at one time, I no longer am because that might diminish my status or, worse, I might get fired if I’m not considered to be an expert or if I’m somehow wrong.”

When doing these types of analyses, if the rules are written down and formalized, and codified into an analysis, it shines a light on many things. We need that in revenue cycle management so much. It’s one of the things that I think is missing.

Clear out misinformation

Myth and misinformation run rampant. When you do these types of analyses, it will show that certain business rules are incorrect, what people thought was correct. Still, it will also bring out operational problems in the organization. That means they become very public, and everyone sees them. That creates a lot of fear.

We’ve run into this quite frequently where if we come in and say, “We’re going to analyze something,” some people are excited, a lot of people are scared. They’re concerned because you can’t “not” find problems. Part of the purpose of doing these types of analyses is to find issues to fix them. Even maybe, the word “problem” isn’t the right thing, but find opportunities for improvement or find opportunities for increased revenue.

There comes some of the problems. If people are afraid and are concerned that any analysis will make somebody, in particular them, look bad, they’re going to be frightened, and there will be resistance. They might even put up roadblocks or try to torpedo or tank the projects. So how do you deal with this problem? You get a rooster. That’s what I recommend doing.

Get buy in from every relevant team member

We generally suggest that top management, whatever that might be, talk with the organization upfront before implementing some analytical program to reduce the fear and anxiety. If you want to improve, you’re going to need to measure the current productivity, the current success levels, the current whatever it is that you’re measuring, and then analyze to find problems, to find those root causes, quantify, prioritize. 

Better than that, of course, it is finding the worst problems or the ones that cause the most significant financial damage or the most incredible opportunity for improvement. That means they will target those involved in those processes or parts of the organization that will feel mainly targeted. That’s scary, but you need to be able to track improvement.

Our suggestion is to tell people up front that there’s going to be this analysis, assuage fears, put it in writing, tell people not just, “Hey, you don’t have anything to be afraid of,” because that doesn’t do it. Tell them how people will be graded. You have many opportunities, and one of them is to say who’s the best, like which part of the organization or which individual in the organization is the best on whatever measures you’re doing.

Celebrate the milestones

There’s another way to do it, which is to tell people they’ll be graded on improvement, not just the starting point. That changes so much. That means the people who are doing the worst will not try to tank everything, will not attempt to sabotage everything because they have an opportunity to look like heroes, to look like stars. Give points and credit to people who identify and help bring to light problems. 

Celebrate those people, say, “Hey, this is great! We found something we can fix. We found something we can improve.” Instead of, “Oh, we found a problem. You’re bad,” “Hey, great job finding that. That’s amazing. Wow! Okay, how are we going to fix that?” And then, when somebody finds how they’re going to fix it or comes up with an opportunity to do that, more celebration.

Review your processes before sandbagging occurs

One little, tiny caveat in terms of grading on improvement, it can’t be based on the last point in time before you start measuring because you will find some people sandbagging themselves right before the measuring period to make themselves suddenly get a massive pop once you start measuring. Watch out for that! We’ve seen that. We had that in our previous company, where people sandbagged to get bonuses off of improvement.


Okay, so rules in heads. It’s all about how you communicate this to the organization. That’s the number one thing that will result in success.