Beware of Large Egos

Beware of Large Egos

When hiring consultants or compliance or legal professionals, ego, often insecurity in disguise, can cause big trouble. People who feel a strong need to prove themselves right or look smart will often forget to prioritize the needs of their clients/employers. 

Let me be clear: this is not a broad indictment of consultants. I’m a strong advocate of engaging consultants and counsel to improve your compliance and billing processes. Outside eyes can spot mistakes, teach you about rules you are not familiar with, and provide useful process tips. 

Many of the cases I am in are won by a smart consultant, not by lawyering. In short, you want to engage outside consultants and attorneys. But I’ve seen far, far too many situations in which a consultant’s report is poorly worded, resulting in a product that can be used as a bludgeon to hurt you. 

Sometimes the poor wording is a product of carelessness or incompetence, but often I fear it is a consequence of the consultant’s attempt to show off. While it’s entirely acceptable when a peacock chooses to preen, it’s not behavior you want in either an external or an internal reviewer. 

Let’s look at a concrete example.

Say a report offers the direct criticism “the codes you selected were wrong.” It also offers some detail: “we changed an incorrect PEDX to a cancer code for specificity, changed a mistaken observation to inpatient admission, and added codes to correct your mistakes.” 

Compare that with “we would suggest you consider different codes on several of the claims.” Perhaps those two sentences sound substantially similar.

In both cases they are offering thoughts, but there’s an important distinction. The use of the word “suggest” completely transforms that second sentence. It is so much softer, and acknowledges grounds for disagreement. 

In most situations in life, I advocate for very direct communication. But critical consultant reports are an exception. I want the criticism presented, but I don’t want it to be worded in a way that destroys your defenses if the topic becomes part of a government investigation.

Imagine if the report began with “coding is often more art than science. People may disagree about particular codes. We are offering the following recommendation, though we acknowledge people may disagree.” Adding that little bit of humility (or more accurately, acknowledgement of reality!) makes it much more difficult for the government to use the consultant’s report as a roadmap to accuse you of fraud.

My point is that a gentle “I might word that slightly differently” is far superior to “that code was incorrect.” In a chart providing data, softer headings like “we agree with your code” or “we would recommend a new code” are far superior to shorter, blunter labels like “code is correct/code is incorrect.”

An expert’s purported confidence may cause you to initially conclude that they are more knowledgeable and expert than you. But truly confident people are comfortable acknowledging uncertainty. 

And perhaps more importantly, good consultants and lawyers will work hard to make sure they’re making you look better without exposing you to unnecessary risk. When you’re getting reports from consultants or lawyers, make sure that they’re wording their advice in a way that won’t be used against you. A blunt “you are wrong” is NOT helpful. 

One final story.

I recently had a situation in which we called a state department of health to confirm that a transaction wasn’t a “change in ownership” requiring a report. The state agreed. Another lawyer on the deal, who had told his client it WAS a change in ownership, had a bruised ego. So he called the state and argued with them, trying to convince the state to flip their position and require ours to go through additional review.

That lawyer, in order to prove himself right, was willing to hurt his client. That’s crazy, but I wouldn’t call it rare.

Not everyone is willing to, dare I say, “leggo their ego.” 

Print Friendly, PDF & Email

David M. Glaser, Esq.

David M. Glaser is a shareholder in Fredrikson & Byron's Health Law Group. David assists clinics, hospitals, and other health care entities negotiate the maze of healthcare regulations, providing advice about risk management, reimbursement, and business planning issues. He has considerable experience in healthcare regulation and litigation, including compliance, criminal and civil fraud investigations, and reimbursement disputes. David's goal is to explain the government's enforcement position, and to analyze whether this position is supported by the law or represents government overreaching. David is a member of the RACmonitor editorial board and is a popular guest on Monitor Mondays.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

2024 Observation Services Billing: How to Get It Right

2024 Observation Services Billing: How to Get It Right

Dr. Ronald Hirsch presents an essential “A to Z” review of Observation, including proper use for Medicare, Medicare Advantage, and commercial payers. He addresses the correct use of Observation in medical patients and surgical patients, and how to deal with the billing of unnecessary Observation services, professional fee billing, and more.

March 21, 2024
Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Explore the top-10 federal audit targets for 2024 in our webcast, “Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets,” featuring Certified Compliance Officer Michael G. Calahan, PA, MBA. Gain insights and best practices to proactively address risks, enhance compliance, and ensure financial well-being for your healthcare facility or practice. Join us for a comprehensive guide to successfully navigating the federal audit landscape.

February 22, 2024
Mastering Healthcare Refunds: Navigating Compliance with Confidence

Mastering Healthcare Refunds: Navigating Compliance with Confidence

Join healthcare attorney David Glaser, as he debunks refund myths, clarifies compliance essentials, and empowers healthcare professionals to safeguard facility finances. Uncover the secrets behind when to refund and why it matters. Don’t miss this crucial insight into strategic refund management.

February 29, 2024
Mastering Medicare Notices: Your Essential Guide to the MOON and Beyond

Mastering Medicare Notices: Your Essential Guide to the MOON and Beyond

Hospital staff continue to grapple with the complexities of Medicare notices.  In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, will present the latest requirements for preparation and delivery of CMS-mandated forms, including the Advance Beneficiary Notice (ABN), Hospital-Issued Notices of Noncoverage (HINNs), Important Message from Medicare (IMM) and Medicare Outpatient Observation Notice (MOON), and practical solutions through foolproof workflows and compliance auditing.

January 25, 2024
OBGYN ICD-10-CM/PCS Coding: Mastering Complex Guidelines and Compliance

OBGYN ICD-10-CM/PCS Coding: Mastering Complex Guidelines and Compliance

Dive into the complexities of Obstetrics and Gynecology coding, addressing challenges from antepartum to postpartum care. Learn to decode intricate guidelines, tackle claim denials, and safeguard your practice’s financial health. Uncover the secrets to compliant coding, reducing errors, and optimizing reimbursement. With practical exercises and expert insights, this webcast empowers coders, auditors, and healthcare professionals to elevate their OBGYN coding prowess.

February 28, 2024
Unlocking Clinical Documentation Excellence: Empowering CDISs & Coders

Unlocking Clinical Documentation Excellence: How to Engage the Provider

Uncover effective techniques to foster provider understanding of CDI, empower CDISs and coders to customize their queries for enhanced effectiveness, and learn to engage adult learners, leveraging their experiences for superior learning outcomes. Elevate your CDI expertise, leading to fewer coding errors, reduced claim denials, and minimized audit issues.

December 14, 2023
Coding for Spinal Procedures: A 2-Part Webcast Series

Coding for Spinal Procedures: A 2-Part Webcast Series

This exclusive ICD10monitor webcast series will help you acquire the critical knowledge you need to completely and accurately assign ICD-10-PCS and CPT® codes for spinal fusion and other common spinal procedures.

October 26, 2023

Trending News

It’s Heart Month! Use code HEART24 at checkout to receive 20% off your cardiology products. Click here to view our suite of Cardiology products!