We’ve all been late before – and inevitably caused more problems by rushing and forgetting things and becoming even later. It’s times like that when I truly identify with the Mad Hatter rabbit from Alice in Wonderland who ran around the forest singing, “I’m late, I’m late for a very important date. No time to say hello, goodbye, I’m late!” I’ve stopped singing that aloud when I’m late though because I started getting strange looks.
I also identify with clinicians. The sinking in your stomach when you realize you’re going to be late for a meeting or your dinner plans is pretty similar to the sinking feeling when you realize you’re incredibly late in submitting your progress notes. Whether the unfinished progress notes were buried in the backseat of your car or lost in the sea of electronic alerts on your computer – it happens to everyone.
I talk to a lot of our behavioral health customers and they often ask me “how do I fix late progress notes?” And I tell them that the key to taking care of their late progress notes is to conquer their progress note float.
But what’s Progress Note Float?
That’s normally the next question I get. Progress Note Float is the first stage of a billable claim and is the number of days from the appointment to when the progress note has its final signature fully compliant. If progress notes aren’t getting signed efficiently, then they’re holding up the rest of the billable claim process and will eventually hurt your overall revenue.
The three stages of a billable claim are as follows:
- Progress Note Float: number of days from the appointment to when the progress note has its final signature fully compliant
- Create the Claim: Number of days from progress note signed and completed to the creation of the financial charge/claim
- Billing File Generation: Number of days from the creation of the financial charge/claim to when the claim is included in a billing file and first sent to a payer.
For now, I’m going to focus on Progress Note Float. It’s more effective to begin assessing a process for change at the beginning. When you start at the beginning, you know that every step you take will affect the subsequent stages which can make your changes more effective. However, you still need to pay attention to the remaining stages. Only focusing on one aspect of your organization is known as sub-optimization. Sub-optimization could negatively impact your results and hinder the changes you want to make.
What causes Progress Note Float?
While every agency is different, there are a few obstacles that consistently cause Progress Note Float:
- Over-scheduled clinicians
Clinicians who are overscheduled do not have enough time to complete their progress notes. They’re struggling to just fit in all the clients they need to see. Or maybe they’re in a leadership role and those duties take up any free time they might have to complete progress notes. As your team struggles to complete all the large tasks, documentation often falls to the wayside.
- Supervisors suffering from alert fatigue
Progress notes need signatures from supervisors before they’re considered complete and the process of a billable claim can move forward. When multiple people need to find the time to sign progress notes, it slows down the progress note’s completion. Supervisors often experience “alert fatigue” when they receive too many alerts or messages to sign a progress note. Since there are so many, they may ignore them in favor of completing other work.
- No official rule or process
If there is no deadline enforced, many clinicians won’t complete their progress notes in a timely fashion. This doesn’t mean that the clinicians are lazy – without an understood deadline or a supervisor enforcing a deadline, tasks are reprioritized so that documentation is at the bottom.
- Lack of technology
A lack of technology makes progress note float more likely to occur. Shuffling papers back and forth between clinicians and supervisors who only meet periodically limits their communication and increases the likelihood of delays. Progress notes are more likely to be lost if they’re on paper – it’s much easier to lose a piece of paper than a searchable electronic document.
Any combination of these obstacles could cause Progress Note Float in an agency.
But, don’t get discouraged!
There is a lot your agency can do to prevent Progress Note Float and streamline your billable claim process.
Measure and track your progress note float at the clinician level. Once you know who is struggling to complete their progress notes on time, you know who you need to focus on. Consider the graph below:
This graph shows each clinician and the average number of days it takes each of them to complete their progress notes. The goal for each clinician is to have their progress notes completed within one day of the appointment. The clinicians below the goal line of one day (orange) are meeting this standard. The clinicians above the goal line (maroon) are not.
From a supervisor’s perspective, you now know what you need to do. The clinicians represented by the orange bars don’t need any guidance. Commend them for completing their progress notes on time and ask them what their process is. Something they’re doing might be helpful for the other clinicians.
You need to have conversations with the clinicians represented by the maroon bars. Don’t immediately approach the situation from a disciplinary perspective – just because they’re struggling doesn’t mean that they’re lazy or don’t care about their job. They may not fully understand the process of submitting their progress notes; you’ll want to revisit their training and revitalize your training program.
Or the clinicians represented by the maroon bars may be reprioritizing their documentation to the bottom of their list because deadlines aren’t enforced. You can’t blame them for not adhering to it – especially when they have so many other tasks that want their attention.
If you don’t have a policy, create one! Best practice is for progress notes to be completed within 24 hours of the appointment. Communicate the policy with all your clinicians. From this point forward, if deadlines aren’t followed then there will be a consequence. Once you all have the same understanding, you can impart consequences if clinicians still aren’t adhering to deadlines.
Taking the time to measure and track your progress note float by clinician can help ensure that your agency won’t fall victim to progress note float…and if you’ve already fallen victim, it will help save you.
I may still be late, but not with my progress notes
If you commit the time to changing and enforcing your policies, you can conquer progress note float and the rest of the billable claim stages and improve your agency. I better run now – I think I’m late for my dinner plans…
