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4 Myths About Revenue Cycle Telecommuting

Analysis  |  By Alexandra Wilson Pecci  
   July 23, 2019

Increasingly, revenue cycle leaders are recognizing the need for flexible work options to save money and to recruit and retain their workforce. 

Revenue cycle leaders are faced with a paradox: They're under pressure to reduce costs while also needing to recruit and retain top talent for more specialized work.

One tactic that leaders are using to tackle these competing needs is offering employees the option to work from home, an action that could save the organization money and give employees a better work experience.

Allowing revenue cycle employees to work at home is not only doable, it's becoming a necessity, says Joshua Welch, revenue cycle executive director for John Muir Health in California.

That's why it's worthwhile to examine—and debunk—the myths that make revenue cycle leaders question whether their organization should allow employees to work from home. 

Welch says for health systems in medium- to high-cost markets, remote employment could save health organizations money as well as increase employee productivity and engagement, which is critical as margins increasingly tighten.

Moreover, it could help revenue cycle leaders attract top talent. To recruit and retain the best workforce, hospitals and health systems must be ready to offer employees not only great salaries, benefits, and a satisfying career ladder, but also a flexible work environment, revenue cycle leaders tell HealthLeaders.

"Flexibility is key," says Jessica Johnson, middle revenue cycle director at Hennepin Healthcare in Minneapolis.

According to a survey from FlexJobs, 61% of various professionals have left or considered leaving a job because it did not have work flexibility. Among 80% of respondents, telecommuting is the most in-demand type of flexible work arrangement.

In addition, 28% of respondents said they would take a pay cut in exchange for the option to telecommute, and 76% said they would be more loyal to their employers if they had flexible work options.

"Our employees have been asking for this for some time and it was a big win," says Welch. "In many areas, we have seen increased productivity and that is almost an expectation at this point."

Making working from home work

Revenue cycle leaders who have allowed their employees to work from home have reported good results so far.

Since implementing its work-from-home program in 2017, John Muir Health has seen benefits, says Welch. For instance, the organization has seen increases in employee engagement scores (they improved in the employee domain from 4.06 to 4.11 over two years) and it is saving around $3,700 per staffer annually in real estate and overhead costs.

There are also other savings, such as not having to provide parking as staffing needs increase, as well as employee savings, like commuting expenses.

Despite success stories, many revenue cycle leaders remain skeptical about implementing work-from-home programs in their organizations, and it was a topic of lively discussion among executives at HealthLeaders Revenue Cycle Exchange in March.

For some leaders, the thought of allowing anyone but coders to work from home may seem infeasible. After all, setting up revenue cycle employees for telecommuting isn't as easy as giving the staff members a laptop and VPN access. There are a host of things to consider, from handling sensitive patient information to monitoring employee productivity.

Employees at John Muir must meet certain requirements to be eligible for telecommuting, which include having a clean, distraction-free workstation at home (including not caring for family members during work hours); no disciplinary issues; their initial employee probationary period has ended; and they have their manager's approval. They also must meet productivity requirements and be self-directed, Welch says.

To help revenue cycle leaders decide whether to incorporate remote work options at their organizations, HealthLeaders takes a look at four myths about revenue cycle employees working from home.

Myth 1: Only coders can effectively work remotely.

At Ochsner Health System in New Orleans, both "hospital and professional coders work from home full time with the option to work inhouse," says Vicki Kaplan, RHIA, MPH, vice president of coding and HIM. And the work-at-home program is expanding.

"We originally started the home program many years ago for employee retention and recruitment," Kaplan says. "However, we realized as the system continued to grow, there was a need for more clinical space and this shift made even more sense that we extended the work-from-home option to our CDI nurses."

She's not alone. Johnson says Hennepin's coders, coding educators, coding auditors, coding support specialists, coding coordinators, and transcriptionists are fully remote, but they also extend the telecommute option to revenue cycle business analysts, revenue integrity analysts and specialists, and clinical documentation specialists.

However, even at systems where working from home is becoming more common, there are still in-office employees. At John Muir Health, those include patient-facing roles; while at Hennepin, Johnson says HIM operations team members and managers work in the office.

Myth 2: It's too hard to safely process credit cards or handle PHI remotely.

John Muir Health's IT team created work-from-home staff workstations that allow employees to take credit card payments, and there are expectations around dedicated work-at-home workspaces to protect PHI and avoid risk, Welch says.

For instance, he points to specific technologies to facilitate security, such as virtual desktops (i.e., virtual desktop infrastructure, or VDI, technology) and telephony technology that maintain PHI compliance for credit card information.

In addition, he says, "all of our employees handle PHI," and those who work from home must follow HIPAA guidelines, just as they would in the office. However, there are several PHI-related tasks employees aren't permitted to do at home, such as printing PHI.

Instead, the employees print PHI only when they visit the office or ask people who work in the office to do it for them. It's a situation that Welch admits "is not ideal," but they're working on a better solution.

"It creates inequity in roles/responsibilities (i.e., who would want to be the printer/envelope person?), so we are exploring administrative support to leverage for this," he says.

"All PHI must stay in the office," says Lisa Sander, John Muir Heath's single business office director. "[Employees] are not allowed to bring any home. This is part of our HIPAA training."

For instance, Sander says the team that prepares and processes refunds can do all the work to initiate the refund at home, but they must go to the office to get the checks, attach/validate any attachments, and put them in the mail.

Myth 3: You can't monitor or communicate effectively with remote employees.

There are ways to monitor productivity and communicate effectively with remote revenue cycle employees, Kaplan says.

When Ochsner started allowing its CDI nurses to work from home, it "initiated an interactive SharePoint site for employees to communicate day-to-day items such as days off, requests for second look at accounts, supply requests, productivity, and quality status," Kaplan says. "While we have great engagement, we still have to manage this, especially with our employees who are out-of-state."

John Muir Health requires that employees have daily check-ins with their supervisors and are accessible by phone, email, or Skype during work hours. Welch also notes that the organization's Epic system has employee dashboards to monitor their work times and volumes.

"There are some areas that are more troublesome than others to monitor or review productivity. Those are particularly challenging, but we have made progress toward better reporting and monitoring capabilities," Welch says.

Among those harder-to-monitor areas are ones that work outside of Epic, such as cash posting and cash reconciliation, Sander says.

"Quality reviews are critical to this process, even more so probably than on-site staff," Welch says. "We have also become adept at using Skype to help monitor who is online."

Myth 4: Remote employees aren't engaged.

"Staff engagement is one of our key priorities," Johnson says. "We listen to every idea that is presented, we shadow our staff—even remotely—and we promote a positive environment."

Leaders at Hennepin also work to make sure revenue cycle employees feel like they're part of the team.

"We insert fun [through] competitions, team-building events, photo contests, guessing games, and portal scavenger hunts," Johnson says.

John Muir Health requires monthly in-person staff meeting attendance, and also invites all remote employees to events such as office potlucks.

The success of the remote worker program depends on more than monitoring and engagement, of course. To set employees up for success, John Muir sends IT staff to employee homes to set up their workstations, ensures that employee home internet connections and phone lines are reliable, and provides on-site work stations for when remote employees come to the office.

Innovative healthcare organizations are proving that work-at-home programs for revenue cycle employees can be successful, even as they figure out processes as they go along.

"It's progress over perfection," Johnson says. "As long as we continue to make our people our first priority, I believe we'll continue to move the needle in a positive direction."

Alexandra Wilson Pecci is an editor for HealthLeaders.


As revenue cycle jobs become more specialized, health systems should consider offering work-from-home options to attract and retain the best workforce.

Robust technology that supports taking credit card payments, as well as implementing clear expectations and productivity monitoring can help revenue cycle employees work at home effectively.

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