With the ability to shut down clinical and revenue cycle operations, delaying care services and payment processes, it's crucial that organizations make cybersecurity a priority and have a plan in place.
Since the Change Healthcare cyberattack in February, cyberttacks have increased in frequency and become more varied in their complexity. With the ability to shut down clinical and revenue cycle operations, delaying care services and payment processes, it's crucial that organizations make cybersecurity a priority and have a plan in place. HealthLeaders recently spoke with Lynn Ansley, vice president of revenue cycle management for Moffitt Cancer Center, about the organization's experience working through the Change Healthcare cyberattack. Take a look at what she had to say.
Moffitt Cancer Center was one of many health systems impacted by the Change Healthcare ransomware attack earlier this year. The organization's VP of RCM operations explains how she navigated the disaster.
In part one of this interview, Lynn Ansley, vice president of revenue cycle management at the Moffitt Cancer Center and a HealthLeaders Exchange member, explains how the health system imitially reacted to the Change Healthcare cyberattack.
In part two, Ansley walks us through the process of manually keying claims, leaning on other leaders and organizations who'd been impacted, and getting their processes back online.
Responses have been edited from their original length for brevity.
HealthLeaders: How many claims would you manually key a day?
Ansley: Our average count was 3000 per day. It took about an hour to see one inpatient claim during this downtime. There were a lot of just initial rejections, so we'd go back, figure out what we did wrong, and rework it.
When you have a new piece of technology, you have months of training and testing, and implementation and refinement. You've got vendors holding your hand through the process. We had none of that. We were going to figure it out on our own, and we did.
HL: Were you able to lean on or share insights with colleagues at other organizations?
Ansley: We made a lot of connections across the country. The healthcare industry--and revenue cycle specifically-- were all in it together, so we're leaning on each other. Some were able to share more than others, but what was evident is no two providers were in the same exact situation, because we just have such a mixed bag of technologies that we normally use.
UnitedHealthcare was trying to triage how bad things were on their side to figure out systems impacted and there wasn't a lot of information that was coming to the providers. Some of that can be expected, but it felt like we were in limbo, and nobody liked that because of the uncertainty.
We reached out to other vendors we partner with to see what solutions they could offer us in the interim. We had some existing vendors that were able to expand services for us and set up other clearinghouses for us to be able to escalate that process.
What really resonates with me during this time is those industry partners that really leaned in to help us when we didn't know which way to go.
HL: When was Moffitt able to get things back online?
Ansley: With us shifting over to a new partner in the technical clearinghouse space, we were back up in a very infant stage around March 13th (roughly three weeks after the cyberattack was discovered).
They were an existing partner for us, so they really leaned in and tried to help providers get into that solution from a patient payment portal perspective. We were actually on an old platform that UnitedHealth had stopped supporting, so we had no solution coming back online in that regard.
We were actually able to flip a switch and give us a less than desirable patient payment solution in the interim.
HL: What are some things you've learned through this experience?
Ansley: It really taught us we need to be ready for the unexpected, to the level that even our board wants to know what our plan is. We're actually running a host of tabletop exercises, looking at the worst-case scenario of similar situations. And we're not just talking about revenue cycle; we're talking about clinical care as well.
The more we do them and the more comfortable we can get with the uncertainty, the more prepared we are for when that time comes. You hear people say, ‘It's not if, it's when,' and I think everybody's a believer in that at this point. It's better to be prepared.
TheHealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
Moffitt Cancer Center was one of many health systems impacted by the Change Healthcare ransomware attack earlier this year. The organization’s VP of revenue cycle managment explains how she navigated the disaster.
Seven months after the Change Healthcare cyberattack, things seem to be back to normal, but healthcare organizations are moving with caution. The ransomware attack was a significant blow to the sector, preventing providers from collecting or receiving payments or checking a patient’s coverage.
Among those affected was the Moffitt Cancer Center in Tampa, Florida. HealthLeaders spoke with Lynn Ansley, vice president of revenue cycle management and a HealthLeaders Exchange member, to discuss how she guided her team and redirected their processes.
HealthLeaders: What was the first sign that something had happened?
Lynn Ansley: Our teams logged in like any other normal day and they were unable to access a lot of our key systems to get our technical claims out the door. Our technical clearinghouse was down, and that’s about 90% of our revenue.
The second piece, which we identified later that day, was that our patient payment platform was down, so patients were also unable to make payments. The system was completely inaccessible to both our patients and our team members to be able to collect payments.
HL: How did you organize your team to move forward?
Ansley: The most important thing that I could do that day was to, first, gather the facts. The scary part for me, and I'm sure for every revenue cycle leader across the country that was impacted, was we didn't have any information. We didn't know if it was an hours-long outage or multiple-day outage.
It didn't take long for us to learn, based on what our cybersecurity team was telling us and what they were hearing from others in the industry, that this was going to be a substantial outage and we needed to act.
I looked at it like this: We needed to find a way to be able to pay our team members. So that first day, we're not just trying to get claims out the door; we're trying to be able to make sure that we can get cash in the door so we can pay our 9500 team members.
Last year, we rolled out like our new organizational purpose, which is framed around positivity and John Gordon's The Energy Bus. I think the universe gave us a little bit of a gift in this, because we really took that positive momentum and we just charged forward.
That took me as the leader, making sure that other areas in the organization were leaning in to help, but also that I was willing to do the work. Willing to roll up my sleeves and really be in the trenches with my team to figure out what those interim solutions were going to be and just maintaining that ‘we can do this’ attitude.
HL: How long did the outage last for Moffitt?
Ansley: We were using an alternate clearinghouse about three weeks later, and [we were] able to set up our new solution and then mature and refine it over time. But during that three-week period, we really got creative.
We were down in terms of having a clearinghouse or an interim solution. We started manually keying in claims about a week and a half later, going into direct data entry and key-stroking in an inpatient claim, which can take about an hour on average.
We had managers, supervisors, and team leads going into these systems that they haven't used for this sort of work in many years, relearning the system overnight, and coming up with ways to prioritize the work so we could at least get some claims out the door.
Parallel to that, we had our operational IT team and revenue cycle systems IT team looking at other solutions.
We were doing a lot of trial and error to try to figure out how to get more than one claim through at a time. Even though we could get claims out the door, we had to get the remittances in the door and figure out how to post the cash because we didn't have our traditional workflows for getting our electronic remittance advice—which tells us what they're paying for and what patients they're paying for.
This is part one of a two part story.
TheHealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
AI has immense potential to save organizations time and money by optimizing their revenue cycle processes.
While technology has revolutionized revenue cycle management in the healthcare sector, it’s AI that has leaders really excited.
One area in particular in which RCM leaders are eager to implement AI is medical coding. Coding has largely been managed by certified medical coders, but in 2023 the American Medical Association reported a 30% shortage in that position, leading healthcare executives to look to technology for help.
Detroit-based Henry Ford Health saw some success in integrating AI into their beside procedures to assist with medical coding. Bedside services are one of the system’s highest volume specialties, making up 20% of overall coding costs.
The solution automatically codes the simple procedures, referring to procedure notes that closely match ICD codes.
“It does this by bringing together all the complex information required to identify, understand, and code a bedside professional charge,” Joann Ferguson, vice president of revenue cycle, said. “It then predicts and assigns charges and diagnosis codes, automating cases directly to billing.”
The solution has also improved workflow efficiency by reducing errors, missed charges, billing backlogs, and denials. As it gets more familiar with the patient journey from the data it uses, it can also identify potential charge gaps—which can make up around 8% of previously unbilled revenue.
In addition to improving financial and operational performance, Ferguson said the solution has also helped improve coders’ job satisfaction by reducing their workload.
“We find we can get around some of the roadblocks and hesitation that come with using new technology by taking time to highlight the short-term and long-term benefits to employees’ everyday workloads, while also laying out how it helps the organization as a whole,” she explained.
Denials management
Providers spend a significant amount of time going back and forth with payers, appealing denied claims. By using AI to predict and track denial trends, RCM staff are able to work with payers to reduce denials.
California’s Sierra View Medical Center began using an AI solution to help with its appeals process, having seen an increase in denials due to lack of medical necessity.
“Our [utilization review] department now reports to finance and will be focusing on education related to documentation to avoid medical necessity denials,” said Julie Franer, administrative director for revenue cycle.
An AI solution West Tennessee Healthcare implemented to help with patient care planning also improved its relationship with payers and reduced delays and appeals. With payers being able to connect to the platform, providers and revenue cycle staff are able to streamline patient care and insurance information.
Debbie Ashworth, executive director for care management, also noted that payer responses are timelier.
“The conversations we have with them are better [because] you’re both getting information that you can share,” she said.
Keep these three things in mind the next time you're shopping different vendors for a new RCM solution.
Revenue cycle management solutions are a substaintial investment for even the largest organizations. When listening to a vendors presentation, it's important that leaders know the issues they're wanting to address in their revenue cycle operations, so that they can discern which vendor has the solution that best suits their needs. Keep these three things in mind going forward.
A new survey finds that three of every four RCM executives are struggling to address a surge in denials. Revenue cycle leaders are seeing an increase in denials and claim errors.
Denials management is a consistent issue within revenue cycle operations but seems to have worsened in recent years.
In a recent survey of 200 RCM executives conducted by Experian, more than 75% said denials are increasing. That’s a sharp increase from a 2022 survey, where 42% of executives acknowledged an increase in denials.
According to the survey, 55 percent of RCM leaders have seen an increase in claim errors, and 75% say payers are making more frequent changes to their policies.
Sporadic policy updates, along with fixing incorrect CPT codes, take time to address. And that’s putting pressure on RCM teams.
Carle Health has seen a 22% increase in denials year-over-year but has seen some success in addressing the issue with front-end solutions and staff stepping up claim management efforts.
The system’s prior authorization solution has saves specialists 10 minutes per request and where last year it took the system 46 days to appeal a denied prior authorization request, it currently takes them 36.5 days.
When it comes to appeals, the system’s revenue cycle partners are taking a more focused approach, leaning on data analytics to track trends and additional assistance from system executives.
Revenue cycle staff and leaders meet monthly to monitor progress and denial trends, updating system leadership on their findings so that they and the operations teams can assist in resolving them. In tracking denial trends, staff found that policy changes and issues with interoperative CPT codes were the reason for many of them.
However, while payers seem open to addressing the health system’s concerns, according to Aron Klein, vice president of finance operations and supply chain, resolving them takes longer than they would like.
“Payers rely on technology solutions just like we do to manage processes on their side,” Klein previously told HealthLeaders. “Which ultimately, if something [happens] on their side, it takes time to resolve, which ultimately delays processing or receipt of payment on our side.”
"We want to make sure it's worth the effort to implement," one executive said.
There are many advantages to organizations developing revenue cycle management solutions in-house, like being able to keep knowledge within the organization.
However, developing solutions in-house can potentially be more expensive and time consuming than partnering with a vendor. Because of this, it’s important that everyone from revenue staff to executives understand the importance of ROI in an RCM solution.
One Grady, the billing subsidiary for Atlanta-based Grady Health, has a team of seven developers that build its RCM tools. Jacqueline Samuel, director of revenue cycle integrity, strategy, and analytics, says this team is small compared to larger, non-safety net organizations.
In addition to developing and managing One Grady’s RCM solutions, the developers also support the overall health system with data analytics, process improvement, and automation tools.
“We only have so many resources and time available,” Samuel, a participant in the HealthLeaders Mastermind program on AI in RCM and financial operations, said. “We have an excellent team with an excellent skill set, [but] we need them to able to focus on certain things.”
One Grady staff submit proposed RCM solutions for potential development during quarterly meetings. In doing so, they must detail what that solution should be able to do and identify the return on investment.
“We want [staff] to think through ROI because with the resources that have to be dedicated, the time it takes, and the costs of the tool, we want to make sure it’s worth the effort to implement.” Samuel explained.
The suggestions are later reviewed during governance meetings to determine if they should be added to the pipeline of solutions in development. They’ll also consider alternative solutions that may not require as many resources; for example, leaning into tools built into the system’s electronic health record (EHR) and using them to their fullest extent.
The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Mastermind series features ideas, solutions, and insights on excelling AI in revenue cycle.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com
There are many advantages to organizations developing revenue cycle management solutions in-house, like being able to keep knowledge within the organization.
However, developing solutions in-house can potentially be more expensive and time consuming than partnering with a vendor. Because of this, it’s important that everyone from revenue staff to executives understand the importance of ROI in an RCM solution.
One Grady, the billing subsidiary for Atlanta-based Grady Health, has a team of seven developers that build its RCM tools. Jacqueline Samuel, director of revenue cycle integrity, strategy, and analytics, says this team is small compared to larger, non-safety net organizations.
In addition to developing and managing One Grady’s RCM solutions, the developers also support the overall health system with data analytics, process improvement, and automation tools.
“We only have so many resources and time available,” Samuel, a participant in the HealthLeaders Mastermind program on AI in RCM and financial operations, said. “We have an excellent team with an excellent skill set, [but] we need them to able to focus on certain things.”
One Grady staff submit proposed RCM solutions for potential development during quarterly meetings. In doing so, they must detail what that solution should be able to do and identify the return on investment.
“We want [staff] to think through ROI because with the resources that have to be dedicated, the time it takes, and the costs of the tool, we want to make sure it’s worth the effort to implement.” Samuel explained.
The suggestions are later reviewed during governance meetings to determine if they should be added to the pipeline of solutions in development. They’ll also consider alternative solutions that may not require as many resources; for example, leaning into tools built into the system’s electronic health record (EHR) and using them to their fullest extent.
The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights on excelling your virtual nursing program. Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com
Three tips to conisder all different stages of the selection and negotiation process.
Leaders should consider vendor agreements an extension of their business strategy. The contract for an RCM solution lays the foundation for its implementation, and ultimately its success. Here are three tips to consider before selecting a vendor, when signing the agreement, and after implementation.
"We only have so many people that could be allocated to the team."
There are many advantages to developing RCM solutions in-house, like the security of keeping all information within your organization.
As part of our AI/Finance Mastermind series, Jacqueline Samuel (director of revenue cycle quality, strategy, and analytics) for Grady Health walks us through some of the challenges the system's billing subsidiary, One Grady, runs into when developing their solutions.
