Bellin Health System aims to build revenue cycle knowledge within clinical operations using service line-revenue cycle platform representatives who will act as liaisons to each of the system's service lines.
Kayne Coleman, MBA, revenue cycle director for Bellin Health System in Green Bay, Wisconsin, says that revenue cycle professionals and clinical operation professionals "live in extremely complex worlds."
"Revenue cycle has so many facets in and of itself" that it's a challenge even for seasoned professionals to keep up, she says.
But for service line leaders at her health system, understanding and improving each of those facets became overwhelming. Asking the same question to a revenue cycle or a finance staffer might yield several different answers, and clinicians might not understand why or how their documentation affects—positively or negatively—the revenue cycle.
That's why Bellin has recently instituted a new program that aims to build revenue cycle knowledge within clinical operations, using Service Line Revenue Cycle Platform Representatives (SLRCPR) to act as liaisons to each of the system's service lines.
These representatives "translate" revenue cycle needs to clinicians and also help get to the root of any issues that arise.
"Often when revenue cycle and clinical operations were trying to weed through the complexity, there was a breakdown in communication or a failure to fully understand what was at issue," Colman says. "The SLRCPR concept strives to bring structure, organization, and evidence-based practice to deliver improvement faster."
Each service line leader chose their own representative (some have two) from among current employees. Some representatives are from the business side, whereas others have a clinical background. For instance, the Cardiac, Pulmonary & Vascular service line’s representatives are the team leader from the wound center and the heart, lung, and vascular administration clinical coordinator, who are both registered nurses.
Coleman says she thinks clinical folks are uniquely positioned for a role like this.
"I think it's because they understand what it takes to take care of a patient and they understand that excellent care for the patient is the main objective. Patient care is their passion, that's what they want to do,” she says. "They understand the need to connect the dots between caring for patients and keeping the organization financially viable to continue into the future."
Representatives have started their work by providing education on basic income statement concepts and creating a scorecard for each service line related to revenue cycle performance.
"Eventually I hope to get to the point where when we need support for something in registration, or point-of-service collections, or clinical documentation improvement, the SLRCPR will be our partner in driving the change," Coleman says.
Although it's too early in the program to measure outcomes, Coleman did share anecdotal evidence of improved communication and transparency around everything from avoidable denial and write-off rates to the nuances of documentation and authorizations.
Here are three reasons to tap service line representatives:
- They take some pressure off: "How does a service line leader investigate when revenue looks off?" Coleman asks. Now it's the representative who can begin asking the questions and report back the findings.
- They're revenue cycle advocates: The representatives can help to explain the hows and whys of revenue cycle to clinicians. "We want to try to make it more of a we feeling as opposed to, here comes revenue cycle again, telling us how we did everything wrong," Coleman says. "They can help get into place the things that need to be in place so the back end is cleaner."
- They provide structure: When problems arise, service line leaders have an assigned point person for getting to the bottom of it, while also ensuring that the revenue cycle team fully understands the issue clinicians are having. "We're trying to put some rigor and discipline into how it's been investigated, how it's brought forward to apply resources to it," Coleman says.
Alexandra Wilson Pecci is an editor for HealthLeaders.
Use representatives to create a bridge between clinical and revenue cycle operations.
Establish clear and structured communication channels.
Educate physicians on income statements and documentation.