It take a lot of hard work behind the scenes to create seamless patient experiences.
In this episode of HL Shorts, Seth Katz, vice president of revenue cycle and HIM at University City, discusses the top challenges health systems encounter when implementing technologies to improve patient acces.
Senate Health, Education, Labor, and Pensions Committee Chairman Bill Cassidy (R-Louisiana) recently released the results of an investigation into the 340B Drug Pricing Program. Here are four key figures from the report.
The 340B Drug Pricing Program has grown significantly since it was esatablished in 1994. In recent years, the program has come under fire from critics who say that participating health systems fail to pass benefits on to low-income patients.
How big has the program grown? A recent report from Senate Health, Education, Labor, and Pensions Committee Chairman Bill Cassidy (R-Louisiana), the result of a two-year-long investigation, revealed how much is spent through the program and how many health systems are benefitting from it.
Check out the infographic below to learn more or read more here.
Senator calls on Congress to increase oversight of the 340B Drug Pricing Program by requiring participating providers to complete annual reports on program savings and revenues.
If your health system participates in the 340B Drug Pricing Program, additional oversight may be coming your way.
A report recently released by Senator Bill Cassidy (R-Louisiana calls on Congress to require participating providers to complete detailed annual reporting on 340B savings and revenues, and how those benefits are passed on to patients. Cassidy, chair of the Senate Health, Education, Labor, and Pensions Committee Chairman, based his recommendations on the results of a two-year-long investigation.
The report also suggests that Congress consider restrictions on fees that contract pharmacies charge through the program and clearer guidelines to ensure that 340B discounts actually benefit patients.
Senate investigators sought information from eight 340B program participants, including health systems, contracted pharmacies, and drug manufacturers, for the report.
Trust vs. accountability in the 340B program
At their core, arguments over the 340B program focus on whether the federal government should trust that health systems are using 340B benefits to help patients or require health systems to specifically account for 340B savings and revenues to ensure they are being passed through to patients.
Bon Secours Mercy Health (BSMH) and Cleveland Clinic told the Senate that the program does not legally require covered entities to directly pass savings on to patients. Instead, savings generated by the 340B Program “subsidize the significant broader costs associated with providing high quality healthcare,” BSMH CEO John Starcher said in a letter.
While BSMH and Cleveland Clinic don’t specifically account for 340B savings or revenue, many participating providers can point to direct benefits for patients stemming from 340B funds.
Around three-fifths of covered entities provided discounts directly to uninsured patients at some or all of their contract pharmacies, according to a 2018 government survey cited in the report. Federal grantees, like federally qualified health centers (FQHCs) and disproportionate share hospitals, were even more likely to pass savings on to their patients.
Sun River Health and Yakima Valley Farm Workers Clinic, both FQHCs, pointed to specific areas where 340B funds were being used to offer discounted drugs to patients.
Sun River, which exclusively uses third-party contract pharmacies to dispense 340B drugs, allows uninsured patients to receive free or low-cost 340B drugs through two separate programs. Meanwhile, Yakima Valley uses a sliding fee scale to discounted 340B drugs to its patients through entity-owned pharmacies.
340B growth invites scrutiny
The 340B program has ballooned in size since it was established in 1994. As of February 2025, there are 60,000 provider organizations participating in the program, an increase of 600% since 2000. In 2023, participating providers spent $66.3 billion on outpatient drugs through the program.
As the program has grown, it has come under increased scrutiny. Earlier this year, the Trump administration issued an Executive Order on prescription drug prices that would significantly impact the 340B program.
The Centers for Medicare & Medicaid Services (CMS), under the first Trump administration, also tried to cut payment rates for 340B drugs. However, the Supreme Court ruled against the reduced rates.
While no changes are set in stone, the writing could be on the wall for the 340B program. Revenue cycle leaders may want to consider contingency plans to account for reduced 340B savings and revenues in the future.
Patients are taking on greater financial responsibilty for their healthcare expenses, but their liabilities often exceed the amount they can afford, according to a new report.
As patients shoulder larger portions of their healthcare costs, health systems may need to begin offering more flexible payment plans.
While the average deductible for a bronze-level marketplace health plan is more than $7,000, the average patient can only afford a medical bill of $2,350 over a 24-month period, according to a recent report from PayZen. However, most health systems that offer in-house payment plans cap their terms at 24 months.
See key figures from the report in the infographic below or read more about the report here.
Finding the team members to staff a physician coding educaiton prgram can be a challenge, according to Abeni Lee, director of physician revenue cycle at Grady Health System.
In this episode of HL Shorts, Abeni Lee says that staffing is one of the biggest hurdles to building a physician coding education program. Lee, director of physician revenue cycle for Grady Health System, recently spoke with HealthLeaders about her framework for success to building effective coding education programs.
Watch the short clip below or read more from her full interview.
See what revenue cycle leaders had to say during the April 2025 Revenue Cycle NOW Online Summit, a 2-part webinar series focused on prior authorization and patient engagement.
Last month, HealthLeaders hosted a Revenue Cycle NOW Online Summit. The event featured candid discussion among revenue cycle leaders over the course of two webinars, with one focused on prior authorization and one focused on patient engagement.
During the first webinar, "Key Strategies for Improving Patient Engagement," sponsored by Waystar, Shannon Ducat, associate vice president of patient access at ProMedica; Seth Katz, vice president of revenue cycle and HIM at University Health Kansas City; and Katie Onorato, Solution Strategist at Waystar discussed ways health systems are using digital tools to create more consumer-friendly healthcare experiences.
During the second webinar, "Technology & Strategies for Improving Patient Engagement," sponsored by Optum, Savanah Arceneaux, director of pre-service & financial clearance at Ochsner Health, Christine Migliaro, vice president of front-end revenue cycle operations at Northwell Health, and Samantha Wyld, partner and senior director at Optum Advisory,
Check out some quotes from event participants in the infographic below, or follow the links to read more or watch the full webinsar.
Technology hurdles, particularly lack of standardization and interoperability, often hinder the prior authorization process. Robust communication strategies can address those problems.
Prior authorization (PA) is a persistent source of frustration and administrative burden for health systems. While technology can streamline the process, challenges around interoperability and lack of standardization across payers often limit effectiveness.
Savanah Arceneaux, director of pre-service & financial clearance at Ochsner Health, Christine Migliaro, vice president of front-end revenue cycle operations at Northwell Health, and Samantha Wyld, partner and senior director at Optum Advisory, shared their thoughts on the PA process during last month’s HealthLeaders Revenue Cycle NOW Online Summit, sponsored by Optum.
Interoperability woes hinder PA authorization automation
The lack of standardization in the PA process was a popular topic.
Each payer has its own processes for PA, and some still rely on fax machines and phone calls. While technology can make the process easier, it can still require multiple logins for the various digital payer portals.
Those payer portals lose their utility if the payer technology can’t communicate with the provider technology.
“Even if we find the right solution out there,” Migliaro observed, “can it talk to all the different systems that we are utilizing and be able to leverage that data?”
Challenges associated with too many technologies are more apparent when PA is done at the practice level, according to Migliaro.
Centralized teams dedicated to PA can effectively manage multiple technologies and processes. However, this becomes more difficult for a practice-level administrative assistant who is primarily responsible for answering phones and greeting patients.
Interoperability issues arise even for technologies with significant market share. Ochsner, like so many other health systems, uses the Epic EHR. While Epic offers a payer platform, too few payers are using it to significantly impact efficiency, according to Arceneaux.
Ochsner has automated some components of the PA process, like claims status processing, giving staff time to work on higher value activities, according to Arceneaux. However, a lack of standardization across payers has limited benefits to technology in the prior authorization space.
“We’re not able to connect this way to all of the payers and see that big volume that we would like,” Arceneaux said.
Bridging communication gaps in the PA process
Currently, PA technology platforms are more of a partial fix than a panacea. Where it is difficult for those technologies to communicate with each other, RCM staff need to step in. Maintaining open lines of communication with both payers and providers is one key to minimizing frustration, according to both Arceneaux and Migliaro.
Within a system like Ochsner, where pre-service and financial clearance teams have been centralized, there is significant opportunity to standardize communication among all PA players.
Staff dedicated to PA work within specific service lines, allowing them to develop deep knowledge of PA requirements. A separate team dedicated to denials identifies areas for improvement, while another team tracks changes to PA requirements and payer policies. Changes are communicated to the appropriate providers through the appropriate channels, all of which helps to inform continuous process improvement.
While joint operating committees offer opportunities for routine communication between health systems and payers, “dedicated payer contacts are really crucial to your success,” Arceneaux said.
At Northwell, which does not have a dedicated PA team, there is less of a top-down approach to communication.
“One of the biggest things that we have to do is make sure that we learn and share from all the individual practice operations,” Migliaro said.
Migliaro also stressed the importance of strong relationships with payers. Maintaining open lines of communication with payers can allow revenue cycle leaders to learn why denial rates are high or why turnaround times are long.
Despite the negative mood surrounding PA, revenue cycle leaders should recognize the silver linings, Migliaro said.
“We always talk about the stuff that isn’t working, but I also think it’s really important to give people feedback on stuff that does work and to celebrate the wins.”
Watch a recording of the webinar below or visit the HealthLeaders YouTube channel for more content.
Grady Health System's director of physician revenue discusses the impact of organizational culture on physician coding education.
In this episode of HL Shorts, Abeni Lee shares her thoughts on organizational culture and physician coding education programs. Lee, director of physician revenue cycle for Grady Health System, recently spoke with HealthLeaders about her framework for success to building effective coding education programs.
Watch the short clip below or read more from her full interview.
Grady Health System's director of physician revenue cycle shares a framework for creating effective physician coding education programs that improve compliance and performance against quality metrics.
Providers understand the importance of medical coding. While promoting the financial well-being of health systems, it can deliver better clinical outcomes through the accurate documentation of information that improves care coordination and reduces gaps in care.
Despite this, the administrative toll that coding takes on clinicians is well documented. However, provider coding education programs can help organizations meet compliance and quality metric goals without significantly increasing burdens on clinical resources, according to Abeni Lee, director of physician revenue cycle for the Grady Health System.
While not quite as easy as 1-2-3, Lee shared her framework for success in the development or redesign of coding education programs.
Understand the needs of your entity and providers
The first step to building an effective coding education program, Lee says, is identifying the necessary behavioral and cultural changes.
"You really have to, first, understand your entity," she says. "Every entity is different. And once you understand that, then you can build what it looks like."
A solid understanding of organizational culture and goals for a coding education program will aid revenue cycle leaders as they:
Assess the educational needs of providers to inform the development of training material.
Establish a pathway via pre-AR coding review, coding denial rates, or compliance audits to identify providers who are candidates for education.
Develop modes of provider coding education.
Build a coding education team and develop training material
Now comes the hard part.
"Developing the team is probably going to be your biggest hurdle," Lee says. "You have to identify coding educators that are really specialty specific. If you have a large cardiology program, you want to make sure you get some of your specialty-specific coders that are really good with guidelines that represent cardiology."
Training materials should also be specialty-specific and specific to providers' educational needs, while complying with clinical billing standards and relevant government regulations.
With a coding education team and training material in place, there needs to be a process for onboarding providers into the program. Grady Health has established three separate pathways for new and existing providers.
All new providers are enrolled in specialty-specific education programs to bring them up to speed on coding expectations at Grady Health. These training sessions are typically more robust than sessions for existing providers.
For existing providers, training is delivered upon request and can be tailored to a degree based on the coding issue providers are experiencing. Grady Health also requires that any providers scoring 80% or lower on compliance audits receive additional training.
Communication is key
"Communication is imperative," says Lee.
To streamline requests for training, Grady Health has implemented a shared group e-mail. The coding education team also uses an IT-like ticketing system to categorize training requests and ensure that providers receive training appropriate to their specialty and the specific coding issue they are facing.
Training itself usually occurs "elbow-to-elbow," Lee says. Coding educators meet with providers in their clinics and provide real-time feedback as charting occurs. This arrangement limits any added burden on providers and ensures that they don't need to go searching through their e-mails or files for training materials.
Once training is complete, providers receive an e-mail with a training summary and feedback on coding practices within 72 hours. Additionally, providers are asked to complete a survey on the training so that the coding education team can identify areas for improvement and ensure that training material meets providers' needs.
It is important to remember, Lee notes, "Our customer in the coding education program is the provider."
The heavily scrutinized 340B Drug Pricing Program is back in the spotlight as the Trump administration targets drug costs in a recent Executive Order.
The 340B Drug Pricing Program has received a lot of attention in recent years. In 2018, the Centers for Medicare & Medicaid Services sought to reduce reimbursement to participating provider organizations for 340B drugs. However, those new rates were rejected by the Supreme Court last year.
Now, a recent Executive Order has revived attention on the program that was establised in 1992 with the intention of improving care for low-income and vulnerable patient populations.
Check out the infographic below, or read the full HealthLeaders coverage here.
