Confluence Health’s Kaci Ramsey discusses how embedding clinical roles into the revenue cycle protected millions in revenue and bridged the divide between finance and care.
Before beginning a new career in revenue cycle management, Kaci Ramsey spent more than 20 years practicing as a registered nurse.
As a service line director, she struggled to get clear answers on denials and reimbursement from a siloed finance department. This frustration motivated her to shift to the revenue cycle department seven years ago.
Now serving as the Vice President of Revenue Cycle at Confluence Health, a health system serving patients across 12,000 square miles of central Washington, Ramsey is leveraging her clinical background to build bridges from the revenue cycle department.
The ROI of Clinical Collaboration
Before Ramsey’s move away from nursing, the divide between clinical and revenue cycle operations was absolute.
"There was literally not one clinical person that worked in revenue cycle when I started seven years ago," she says.
Recognizing that administrative staff lacked the credentials to effectively fight medical necessity denials, one of Ramsey’s first moves was to hire a nurse specifically to write appeals. She sold the idea to leadership by assuring them that the role would pay for itself.
Confluence Health subsequently added a pharmacist to the revenue cycle team to review drug reimbursements and 340B compliance. The ROI was immediate: Within the first few months, the pharmacist identified a high-volume payer that was reimbursing drugs below acquisition cost, which was costing the health system about $750,000 per year. Confluence Health was able to renegotiate the contract to boost revenue.
Having a pharmacist on the revenue cycle team also proved valuable when it came to reversing denials. In one year alone, this employee was able to identify nearly $1 million in inappropriate denials, proving yet again that clinical collaboration in the revenue cycle leads to results.
"We've gotten a lot more credibility now that we have clinical staff integrated into revenue cycle," Ramsey says.
AI in Project Management
Like many health systems committed to the Epic platform, Confluence Health relies heavily on the EHR giant’s roadmap for automation. However, with technological updates occurring at such a rapid pace, the focus for revenue cycle leadership has shifted.
“We feel like we’re doing more project management now than ever before,” Ramsey says.
While each upgrade comes with technical challenges to implementation, Ramsey says that these have become secondary in many ways to the human element. Effective change management helps to address the job insecurity staff feel when automation is introduced. At Confluence Health, a team of internal champions passionate about emerging technologies pilot new tools and demonstrate their value more broadly.
While the system prioritizes native Epic tools, Ramsey maintains a pragmatic stance toward third-party vendors. Confluence Health turns to these vendors when Epic functionality falls short.
Why Departmental Culture Matters
When Ramsey was appointed Vice President of Revenue Cycle, she says she realized that she needed to address the departmental culture before Confluence Health could begin improving on its KPIs.
Her background in nursing leadership and management influenced decision-making in this area, and Ramsey replaced around 80% of the managers reporting to her, with the goal of creating an environment that was both more supportive and more accountable.
The results are apparent in the metrics. For instance, the department has reduced days in A/R by about a week despite working with fewer staff.
The Bottom Line
Revenue cycle needs to be a clinical partner, not a back-office function, to be effective, according to Ramsey. By integrating clinicians into the revenue cycle team and demanding more accountability from leadership, Confluence Health has established a more resilient revenue cycle.
“These roles pay for themselves,” Ramsey says. “There's so much value and they'll reduce downstream work on our team, but also help get reimbursement in the door quicker."
Luke Gale is the revenue cycle editor for HealthLeaders.
KEY TAKEAWAYS
Integrating clinicians into the revenue cycle delivered significant ROI, with one new role accounting for around $750,000 in new annual revenue.
Due to the rapid pace of technological updates, the daily work of revenue cycle leadership has fundamentally shifted toward project management.
Confluence Health replaced nearly 80% of its revenue cycle management team to improve culture, resulting in a reduction of A/R days despite operating with fewer staff.