Take Meeting Notes People Want to Read
Record the actions and tasks of your organization with clarity and confidence.
You attend a meeting at which you are given a task to complete, but after hundreds of phone calls, emails, and more meetings, you forget what you were asked to do. If only there were meeting minutes you could reference.
Maybe meeting minutes were taken, but you either didn’t receive them, or the notes are too detailed or not detailed enough. You don’t have time to go through pages and more pages of notes — you have work to do!
In healthcare, the Golden Rule not documented, not done applies to meeting minutes, as well. It’s just as important for minute-takers to document key elements of business meetings as it is for providers to document key elements of patient encounters.
The Meaning of Minutes
The word “minutes” does not come from the reference of clock time, but rather the Latin “minuta,” meaning “small.” The Latin phrase “minuta scriptura” means “small writing.” It’s believed taking minutes began in the early 18th century to condense lengthy speeches for quick reference.
Today, minutes are taken to record decisions and actions made during meetings within a company, healthcare organization, local chapter, advisory board, etc. These minutes are considered legal documents by auditors, the Internal Revenue Service, and judicial courts.
Well-taken meeting minutes help drive action plans for leadership and employees. They also serve as an indisputable reference, especially to team members who weren’t able to attend a meeting (or attended, but forgot what was discussed).
Recording and Disseminating Minutes
Minutes should be taken by someone who is participating in the meeting and able to listen and understand the topics. Minutes should not be taken by someone who is actively running the meeting, such as the president — that person has enough to do. Shortly after the meeting, everyone concerned should receive a copy of the minutes to review.
This is accomplished quickly and easily when minutes are already digital. Although old fashioned pen and paper is still a favorite among many, transcribing scribbles to an electronic source can be time-consuming. Using an electronic device also allows you to audio record meetings, which you can later use to ensure the accuracy of your typed notes. There is also software that can transcribe the audio to text for you! Just be sure you have permission to record the meetings; and take minutes on paper or an electronic device, as well, in case the recording is not clear or is destroyed.
Whatever you do, do not put the minutes aside to type later. We don’t like it when providers take more than a few days to complete their documentation because we know they cannot possibly remember what transpired during that visit after more than a day or so. Neither can you, so get those minutes transcribed within 24 hours, or sooner if tasks were assigned that need to completed right away.
First-timers often want to record each word, which is not usually necessary (unless you’re in the Oval Office). It’s important to document decisions, motions, and assignments, including the people who agreed or disagreed.
Here is a list of the most common notations:
- Company name
- Committee/Meeting name
- Attendee list
- Start time and who is called to order
- Motions or tasks brought forward from last meeting
- Completed items that can be removed from minutes
- Approve minutes from last meeting
- Treasurer’s report
- New action items
- Time meeting adjourned
- Name of person taking minutes
During the meeting, don’t be afraid to ask someone to repeat what they said, especially if side conversations get started and you can’t follow who is saying what (another reason to record meetings). Avoid noting snide remarks and discussions that aren’t relevant, however.
If a discrepancy is found in the minutes, depending on the importance of the meeting or error, note the correction much like you would change a note in a medical chart. If the error is a significant change, strikethrough the information on the original minutes and retype. If using software, such as Word, a comment can be inserted as to why the change was made. If the error was a simple typo, there is usually no need to note the error and correction. Be sure to print/save the new version and place it in the official file.
How and where you store meeting minutes depends on your company’s policy. One option is to print the minutes and keep them in a binder. Another option is to store them electronically on a hard drive shared with the appropriate people. For AAPC local chapter meetings, electronic minutes should be uploaded to the AAPC website.
Why You Should Offer to Take Minutes
Anytime you can add a skill to your resume, do it! If you lack confidence, ask the person taking the minutes at the next meeting you attend if you can take your own, and then compare notes afterward. If you do well, you may have discovered a new skill you never knew you had! If nothing else, you may become a better listener.
First-timers often want to record each word, which is not usually necessary (unless you’re in the Oval Office).
Make Your Chapter’s Mentorship Program a Hit
If your chapter struggles with implementing a mentorship program, give it appeal and make it a success.
Over the years, I’ve watched chapters (including my own) struggle to launch a successful mentorship program. The last time my chapter attempted to pair mentors and mentees, we received over 70 mentee applications and — wait for it — three mentor applications. This boggled my mind because I know many seasoned members who are very willing to help guide new coders. I asked questions and learned that many members were reluctant to formalize their role as a mentor; most feared they wouldn’t have the time required. I reflected on conversations with my colleagues and my own mentor/mentee experiences and came up with the following recommendations.
One of the frustrations voiced by seasoned members was that many mentees didn’t understand the role of a mentor and thought this person was either: (A) there to find them a job, or (B) their personal Google for all things coding and billing related. To overcome this misconception, define what a “mentor” is with your mentees.
Merriam-Webster defines a mentor as “a trusted counselor or guide.” A mentor merely provides advice and guidance based on experience. It’s up to the mentee to do their own work. Both parties must understand and agree to these terms to ensure a successful mentorship.
I had an amazing mentor early on in my career. Although I never referred to this person as my mentor at that time, nor did I formalize mentorship, this person challenged me by:
- Encouraging me to think through things thoroughly;
- Questioning many of my initial conclusions; and
- Pushing me to ask questions and keep learning.
Sometimes mentees expect instant gratification and do not respect all the other commitments a mentor may have. I know of one mentor who frequently traveled cross country for work. Her mentee would leave her as many as 20 messages while she was in flight, expressing frustration that her first message had not been answered. The mentor reminded her mentee of their first conversation, which included a discussion about her schedule and how often she travels, along with a request that she be given 12-24 hours to respond to all messages. The mentee apologized, but then did the same thing the following week. The mentor quickly changed the way they communicated to reinforce boundaries.
Boundaries are essential to set expectations for all parties involved. If you are involved in a formalized mentor/mentee relationship, be sure to agree upon these basic principles:
Goals – What you are hoping to accomplish? What type of advice/guidance is being sought?
Schedules – When is a good time for your discussions? What other obligatory commitments do you both have that will affect your mentoring time?
Outside influences – Do you have family, friends, and other social commitments? Are you involved in other organizations (e.g., local chapter, church) that require your time? Mutual respect is a must.
Communication structure – Will you meet in person? Will you communicate via email? How frequently will you meet or communicate? Will the mentee compile their questions ahead of time and meet with or email the mentor once a week? Come to an agreement and abide by it.
Expectations – Is the mentee expected to research questions they have prior to meeting with the mentor (highly recommended)? If the mentee leaves a message for the mentor, what’s an acceptable amount of time for the mentor to respond before the mentee follows up?
Consider Group Mentorship
Some groups have implemented what I call group mentorship, where a few seasoned individuals agree to provide guidance and counsel to a small group of members. These are usually specialty- or goal-based groups. If this is something you are considering, have the same discussion with mentees about boundaries. Mentors should also establish clear boundaries and expectations with each other to ensure the workload is divided equally. Communication is essential in this type of arrangement.
Make a Lasting Impression
A mentorship can enhance the careers of both the mentor and mentee in ways you couldn’t imagine — it has mine! I encourage you to seek out a mentor at any point in your career; and as you gain skills and experience, do a good turn and be a mentor.
Payments for Use of X-ray Equipment Further Reduced
Payment for outdated X-ray technology is reduced more each year. For 2018, the Centers for Medicare & Medicaid Services (CMS) is targeting computed radiography.
New Modifier Applies Reduction
Medicare Physician Fee Schedule (MPFS) and Outpatient Prospective Payment System (OPPS) payments for the technical component (TC) of X-ray services taken using computed radiography technology (cassette-based imaging which utilizes an imaging plate) will be reduced by 7 percent from Jan. 1, 2018, through Dec. 31, 2022. Beginning Jan. 1, 2023, the payment reduction goes up to 10 percent.
Claims for computed radiography services that are furnished for X-rays must include newly-created modifier FY Computed radiography services furnished.
History Repeating Itself
Last year, CMS created modifier FX X-ray taken using film. Beginning Jan. 1, 2017, claims paid under the MPFS for X-rays using film must include modifier FX, which applies a 20 percent payment reduction to the TC.
Medicare administrative contractors (MAC) will compare the OPPS facility and non-facility payment fields to the MPFS facility and non-facility amounts and use the lower amount to apply the reduction.
For claims billed with both modifiers FX and FY, Medicare administrative contractors will apply both reductions, if applicable. The modifier FY reduction will be applied after the modifier FX reduction.
Reductions may not be recouped from the Medicare patient.
Reduction Doesn’t Apply to Packaged Services
No reduction is made when these services are packaged in the payment of another item or service under the OPPS because no separate payment is made.
The OIG Work Plan Becomes More Transparent
Instead of posting a yearly work plan for their invesigational efforts, The Office of Inspector General (OIG) now posts Active Work Plan items monthly. It’s because the U.S. Department of Health and Human Services (HHS) announced in June 2017 that it is updating the OIG Work Plan more frequently as an ongoing effort to enhance transparency.
If you are unfamiliar with the OIG Work Plan, here is summary, according to the OIG website:
The OIG Work Plan sets forth various projects including OIG audits and evaluations that are underway or planned to be addressed during the fiscal year and beyond by OIG’s Office of Audit Services and Office of Evaluation and Inspections. Projects listed in the Work Plan span the Department and include the Centers for Medicare & Medicaid Services (CMS), public health agencies such as the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH), and human resources agencies such as Administration for Children and Families (ACF) and the Administration on Community Living (ACL). OIG also plans work related to issues that cut across departmental programs, including State and local governments’ use of Federal funds, as well as the functional areas of the Office of the Secretary of Health & Human Services (HHS). Some Work Plan items reflect work that is statutorily required.
You can use the items on their list as an auditing tool to compare and review your own provider billing activities and compliance plans. The Active Work Plan items added in January under investigation for Centers for Medicare & Medicaid Services (CMS) are:
• Financial Impact of Health Risk Assessments and Chart Reviews on Risk Scores in Medicare Advantage
• OIG Toolkit to Identify Patients at Risk of Opioid Misuse
• Potential Abuse and Neglect of Medicare Beneficiaries
• Questionable Billing for Off-the-Shelf Orthotic Devices
• Status Update on States’ Efforts on Medicaid-Provider Enrollment
• Hospitals Billing for Severe Malnutrition on Medicare Claims
You can view the OIG Work Plan archives and monthly updates all the way back to 1997.
2017 Salary Survey: Right on the Money
AAPC credentials pave the way for many paths to success.
With almost 12,000 responses to AAPC’s 2017 Salary Survey, and the data indicating overall higher pay for healthcare business professionals than the year before, 2017 was a good year. For all employed respondents, the average salary climbed nearly 6 percent, to $52,648.
Even better, the overall respondent unemployment rate dropped from 6.6 percent to 5.9 percent. Although this is still above the U.S. national average, we’ve noticed a trend in the data that may help those who are still looking to get hired. The challenge may be rooted in education, but not in the way you might think.
Education is crucial; however, if you’re looking for a job, don’t let your academic background get in the way of taking a stepping stone position.
Advanced education carries the highest jump in value at the top levels. This year, those with a master’s degree or higher are making 32 percent more than those with a bachelor’s degree, alone, and over 46 percent more than those with no college experience.
Multiple Paths to Success
Our respondents prove, once again, that there are various ways you can reach the financial heights of your career: through higher education, additional certification, or work experience. These three routes offer similar monetary outcomes for the informed individual (keep reading…), commensurate with growth in the respective area. Of course, combining any or all of the three options would indicate elite status and merit even more remuneration.
Since 2011, every AAPC Salary Survey shows a marginally higher rate of unemployment (usually a couple percentage points) among those who hold a college degree versus those who don’t. We infer this to mean that individuals who have no college degree are more willing to accept any position in healthcare— perhaps even a job considered menial, which pays little — to at least be working in their chosen profession.
Graph A shows the 2017 average salary changes compared to 2016, based on education levels.
Certain credentials merit higher pay rates; since 2008 the CPC-I (for instructors) has held the top spot when comparing certifications to salaries, save for one year. For 2017, the CPC-I salary average was $75,077, and Certified Professional Compliance Officer (CPCO™) came in at a close second (a title it has held frequently in the past) with $74,557.
The Certified Professional Practice Manager (CPPM®) credential was third with $67,234, which is comparable to its average from last year, and just barely above the average for Certified Documentation Expert – Outpatient (CDEO®), which came in at $66,413, and is still proving to be in high demand. Both the CPPM® and CDEO® certification salary averages are comparable to the average amount earned by those who hold three or more credentials.
Table A shows the 2017 average salaries, based on credentials, along with the average years of experience and average quantity of credentials each respondent possesses.
TABLE A CREDENTIAL AVERAGES (Salary, Experience, Certifications Held)
|Average Salary||Average Years of Exp||Average # Certs|
|Any Specialty Credential||$58,648||14||1|
|Any AAPC Credential||$54,274||13||1|
|2 or more AAPC Credentials||$60,899||13||3|
|3 or more AAPC Credentials||$66,256||15||4|
Key points to notice from Table A:
- The average salary of those who hold any AAPC credential is $1,626 higher than the average for all employed respondents.
- Of the 11 non-specialty AAPC credentials, eight of them (more than ever before) average a salary higher than $60,000.
- The credentials linked with the highest salaries also tend to be linked with more years of experience and multiple certifications.
As always, there is a clear trend of average salary increase with more years of experience. The biggest areas of growth this year came for those with 26-30 years of experience (10 percent salary improvement over 2016) and those who are just starting out in the industry (7 percent salary improvement over 2016). When comparing the ranges of years of experience to each other, however, the five- to nine-year range is consistently where we see the largest spike in average salary. There’s still growth after that, but this level seems to be a real turning point.
Graph B shows the 2016 and 2017 average salaries, based on experience.
Over the past few years, many respondents selected the highest option for years of experience. In response, we’ve gradually offered a wider range of years. In 2015, for example, 5 percent of the respondents marked 31+ years of experience. In 2016, 2 percent of the respondents marked 36+ years of experience. In 2017, 1 percent marked 41+ years of experience. The range finally seems wide enough to encompass sufficient possibilities for all respondents. But in addition to gathering more specific data, the numbers tell an important story:
- We have a high number of healthcare business professionals with a wealth of experience. These seasoned professionals’ insight and expertise are essential to our industry.
- There may be an influx of job openings soon as these veterans retire.
Employers will be looking for individuals who embrace the new technologies and digital advancements coming to all facets of healthcare. For those in the middle stages of their career, now is the ideal time to prepare to take over those responsibilities, either through going back to school, earning additional certifications, or just making sure the years of work experience speak for themselves.
One way many respondents go the extra mile to illustrate their dedication in work experience is by putting in extra hours. The majority (57 percent) still works a regular 40-hour week, but nearly 30 percent of the respondents work 41-50 hours per week, with another 5 percent who say they work beyond that. Those who work overtime are almost evenly split between being paid hourly versus salary, and they make an average of $60,304.
Where We Work and What We Do
The 2017 data didn’t show much of a change in terms of where individuals are employed, but health systems continue to grow (from 18.2 percent of the respondents to 20.8 percent). Hospital outpatient facilities and large group practices saw a bit of a decline since 2016 (1 percent and 1.6 percent difference).
When comparing employment types and experience levels, the percentages of where respondents worked showed minimal fluctuation, almost regardless of the amount of experience. At the highest levels (31+ years of experience), respondents indicated the widest workplace diversity, probably because they have more options available to them. Salary averages can be determined by workplace, as well.
Graph C shows the 2016 and 2017 average salaries, based on workplace.
Of the most common workplaces, hospitals saw the largest increase in average salary for 2017. The average salary for those working in outpatient facilities rose 10.1 percent, while inpatient facility employees’ salaries rose 11.1 percent.
For the first time since 2013, coding and billing managers earned the highest average salary, coming in with $64,623 in 2017. For those who want to stick to the coding and billing arena, management in this field may be the best career plan. Of the most common responsibilities, coding and billing managers have maintained one of the top three average salaries (usually the second) since 2008.
Coding and billing managers also saw a decent increase in average salary over the 2016 numbers, coming in 4.1 percent higher in 2017. Coders and billers were the only group to top that by improving on their 2016 average salaries by 4.8 percent.
Graph D shows the 2016 and 2017 average salaries, based on job responsibility.
Analyzing job responsibilities by years of experience indicates some interesting trends. Practice and office managers and educators show very similar percentages of slow, steady increase as healthcare experience grows. Some break into coding and billing management within the first decade of their career, but after about 15 years of experience, coding and billing management seems to hit a plateau and hold steady at around 10-12 percent of the populace. Auditors peak at 21-25 years of experience, and then begin to taper off in the following years.
High Standards for Some
Only one-third of respondents have production standards set by their employer, while about half of the respondents work in environments where internal audits are conducted, with set requirements for accuracy rates. Having production and accuracy guidelines in place usually comes with more pros than cons, provided expectations stretch employees to perform their best while remaining realistic. Look for an article in an upcoming Healthcare Business Monthly for the specifics of those pros and cons, and analysis of the standards considered to be ideal.
Of those who indicated they had production standards for an inpatient setting, more than half marked the survey’s highest option: more than 15 records handled per day. For outpatient and professional services, the largest responses were on the opposite end of the spectrum, with a little over a quarter of the respondents indicating they were held to a standard of less than 50 records per day, the survey’s smallest option. And for both outpatient and professional services, nearly 15 percent of the outpatient respondents said they are required to handle more than 150 records per day.
About a quarter of those who must maintain accuracy rates are held to the highest quality of work: more than 95 percent accuracy. Roughly 20 percent of the respondents said they must maintain a 91-95 percent accuracy rate.
Tables B, C, D, and E show employers hold their employees to diverse standards, depending on place of service.
TABLE B PRODUCTION STANDARDS: INPATIENT
|Less than 5||9.4%|
|6 to 10||16.3%|
|11 to 15||16.1%|
|More than 15||54.8%|
TABLE C PRODUCTION STANDARDS: OUTPATIENT
|Less than 50||27.8%|
|50 to 75||22.9%|
|76 to 100||18.7%|
|101 to 125||10.6%|
|126 to 150||6.8%|
|More than 150||13.2%|
TABLE D PRODUCTION STANDARDS: PRO SERVICES
|Less than 50||27.3%|
|50 to 75||22.2%|
|76 to 100||18.1%|
|101 to 125||9.8%|
|126 to 150||8.0%|
|More than 150||14.6%
TABLE E ACCURACY RATE REQUIREMENTS
|Less than 80%||0.8%|
|80% – 85%||3.5%|
|86% – 90%||4.7%|
|91% – 95%||19.3%|
|More than 95%||24.9%|
Calculating for the Cost of Living
Average salaries improved across all U.S. regions in 2017, with about a $10,000 range, which is normal. The West South Central region saw the largest salary advancement, with a 7.3 percent raise over the 2016 data. Considering that in 2015 and 2016, this region saw slight decreases in year-over-year salary averages, this seems like a long overdue raise. The Pacific region is consistently the highest paid, while the East South Central region is normally the lowest paid.
Graph E shows the 2017 average salaries, based on region.
There’s Still Time to Participate
AAPC will soon launch a new tool: the Salary Survey Calculator. This tool will let you pick the filters for the data and see what the average salary is under those conditions. Employers and employees alike may use this tool to determine appropriate compensation plans based on specified parameters. In preparation for the launch of this tool, and to gather as much data as possible, the 2017 Salary Survey remains open through the end of February 2018.
If you didn’t get a chance to participate in the survey, you can do so here. We’ll close the survey on March 1, 2018, and update the online information shortly thereafter. The statistics noted in this article are based on the data gathered as of Jan. 1, 2018.
*Note: The 2017 Salary Survey is sponsored in part by AAPC’s national conference, HEALTHCON 2018.