After initiating one solution in her practice's revenue cycle, one leader is eager to expand, but with careful consideration.
Despite fluctuating levels of satisfaction and cybersecurity fears, which many revenue cycle executives share, Sherri Lewis maintains that she’s excited to see how rev tech evolves and hopefully makes operations more efficient and alleviate some strain on staff.
When she joined the BoulderCentre for Orthopedics & Spine two years ago as director of revenue cycle, the practice had recently invested in an accounts received platform with Rivet. However, her predecessor had yet to implement or train staff on the software, making it her first task in her new role.
The practice tried to supplement the AR platform with a highly recommended prior authorization software but issues with its interface have left them with a predominately manual process, albeit managed by one staff member. Since the AR platform’s implementation in September 2022, it’s brought in $1.1 million in pre-collections.
“We’re actually looking at [additional solutions] right now, but [what we’re looking for] is return on investment,” Lewis told HealthLeaders.
“Scalability, are [vendors] going to be flexible with us? What’s the training? Do they have good references? Are they interfaced with the same software we’re using?”
Despite the setback, Lewis has embraced the rev tech boom with a cautious, yet optimistic enthusiasm, and doing her own research. Having recently demoed a transcription solution for medical coding, she questioned where the data was going and what was done with it.
“My doctors are nervous about it, and I would love it if it worked well,” she said. “I don’t want to take people’s jobs away, but there is so much they could do on the other side of it, like collecting our outstanding accounts receivable.”
The billing department receives around 40 phone calls a day, which are time consuming for front desk staff to handle, so it has also looked at a vendor that uses bots to manage phone lines.
There’s a misconception that when a health system or provider begins implementing technology into its revenue cycle, that they’re replacing staff, but according to Lewis, this isn’t the case. The misconception itself comes from a lack of transparency and communication between executives to revenue cycle staff.
“I think every practice has their own culture and our culture here in Boulder is very much a ‘buy-in culture,’” she explained. “I think we’re doing some good team building to try to get our employees to see the benefit as a whole.”
User-friendly payment methods also helped drive the AR platform’s pre-collection success. Patients can view and pay their bills through their patient portal, and Lewis was able to institute card on file payments, which the practice didn’t have previously.
Going forward, she hopes to see revenue cycle staff expand their knowledge of rev tech for their own growth and to keep up with the evolving solutions.
“I’d like to see it as an adjunct to our practice, not to replace people,” Lewis said. “I’d like consistency with it if it could be that way.”
As technology continues to evolve, revenue cycle staff are always a reliable solution.
Organization’s success with revenue cycle management solutions has, at best, been largely varied. Leaders are beginning to shift away from outsourcing operations to refocusing on workforce and upskilling staff, while others are bringing them to the table as decision makers when considering investing in a new solution.
Here are three HealthLeaders stories that reflect the irreplaceable presence of revenue cycle staff.
One Exec’s 3-Pronged Approach to Technology Alignment
With many health systems shifting away from using vendors, VHC Health announcing its 15-Year revenue cycle management partnership goes against grain. The system’s senior vice president, chief financial officer, and chief strategy officer, John Zabrowski has high hopes for the partnership based on the foundation laid in the decision-making process.
In addition to C-suite leaders from both VHC Health and the vendor, revenue cycle team leads are also included in the partnership’s governance council, which will regularly meet to evaluate its productivity and key performance indicators.
How Ann & Robert H. Lurie Children’s Hospital Boosted Its Patient Portal Access
Ravi Patel, vice president of digital health, was able to increase patient portal utilization from 27% to 83% using point-of-service staff. Through the Every Patient, Every Time initiative, staff would offer patients access to the portal during each interaction.
“What we found was purely telling them about it…was enough to get them activated,” Patel previously told HealthLeaders. “So we started to see a steep increase with performance management.”
Could IT Specialists Be the Key to Rev Tech Success?
As revenue cycle management solutions continue to evolve and become more commonplace in the revenue cycle, information technology specialists are poised to be invaluable resources in healthcare.
Jeanne Stokes, director of revenue management at Ironwood Cancer and Research Centers, emphasized the importance of IT specialists and how they should be included in decision making conversations involving rev tech.
“I think with [IT specialists] we don’t have enough,” She previously told HealthLeaders. “We traditionally don’t hire huge amounts of IT folk. We hire just enough to get through.”
Billing may be a meticulous process, but sometimes things fall through the cracks.
There’s a long process of medical coding, communicating with payers, and the back and forth of claim denials and appeals before a medical bill reaches a patient. Despite the most meticulous efforts, mistakes are still made.
Recently, Penn State Health voluntarily disclosed that from December 2015 to November 2022, it had submitted claims to Medicare for annual wellness visits that were not supported by medical record. According to a release from the United States Attorney’s Office, the system “took prompt corrective action,” the issue was discovered and has agreed to pay over $11 million.
Similarly, in California, Pomona Valley Hospital Medical Center voluntarily disclosed that from December 2016 through September 2021, it overbilled Medi-Cal for prescription drugs and have agreed to pay over $2 million.
Here are some best practices to avoid improper billing:
Payer strategies
Payer relations was a main topic at HealthLeaders’ 2023 RevTech Exchange, with leaders sharing solutions and insights for alleviating the strain of denials. Jonathan Benton, assistant vice president of Atrium Health, offered the following recommendations to attendees:
Prioritization: use algorithms to score priority based on an accounts likelihood of being recovered or being denied
Automation: automate tasks to reduce work burden on staff and speed up operations
Cultivation: organize work to maximize system automated priority, embedding daily behaviors and techniques
Analysis: keep track of factors impacting key performance indicators
Resilience: Inundate payers with appeals and follow up on automated denial responses
Price transparency
In a previous HealthLeaders story, we mentioned the results of a Patient’s Rights Advocate poll, where 93% of respondent believed hospitals should be required to share the prices—not estimates—for planned care in advance. Individual providers and health systems alike have struggled to adhere to the No Surprises Act and Lower Costs, More Transparency Act, but Tina Barsallo, vice president of revenue cycle operations at Lifepoint Health, believes that collaborating with peers can help with these efforts.
“If possible, pull a team together to create joint ownership and partnership in creation of the tools and to help drive consistency and compliance,” she previously told HealthLeaders.
Lean on your patient portal
Patient communications are now mostly facilitated through a patient’s preferred method, whether it’s by phone, email, text, or messaging via a patient portal. Many portals have capabilities that allow patients to review as well as pay their bills.
However, to ensure patients regularly access and utilize their patient portal, it must be accessible and easy to use.
When the Ann & Robert H. Lurie Children’s Hospital in Chicago began strategizing ways to increase patient portal utilization, it launched the Every Patient, Every Time initiative where at every interaction with a point-of-service staff member, each patient was offered portal access.
“What we found was just purely telling them about it…was enough to get them activated,” Ravi Patel, the hospital’s vice president of digital health, previously told HealthLeaders.
Two Johns Hopkins University professors proposed five metrics for billing quality benchmarking.
With patients paying more out of pocket for their medical services, the billing process has become a source of frustration for providers and patients alike.
Price transparency and cost of service estimates alleviate some issues, but when it comes to making payments, the billing quality of many organizations leaves much to be desired.
“Healthcare billing continues to be a complex process especially since you have the provider, patient, and payer all involved,” Chris Johnson, vice president of revenue cycle at Atrium Health, previously told HealthLeaders.
“Quite frankly, when some patients see an insurer’s use of CPT and ICD-10-CM codes, it can be like a foreign language, and it can cause real confusion.”
In a recent article for JAMA, Simon C. Mathews, MD and Martin A. Makary MD proposed five billing quality metrics providers can use to rate their own practices:
Itemized bills – Are patients given an itemized bill with easy-to-understand language?
Price transparency – Are the prices for elective services available to patients if they ask?
Service quality – Can patients speak with a billing representative promptly about any concerns and if potential accommodations can be made?
Suing patients – Does the institution sue patients for unpaid medical bills?
Surprise bills – Are patients who pay out of pocket expected to pay more than others for the same care?
“In the same way medical complication rates are collected for improvement purposes, and some are available to the public,” the article explained. “Metrics of billing quality could be used to create public accountability for US hospitals.”
HealthLeaders previously reported how patient collections has surpassed denials management and staffing as the biggest concern for revenue cycle leaders. To make the patient financial experience easier, some organizations have begun exploring cash sharing apps like Zelle and Venmo as payment options.
As organizations shift away from outsourcing revenue cycle operations, leaders are making workforce development a priority.
Managing the revenue cycle workforce comes with a unique set of challenges. Fighting labor shortages and managing remote workers has been plaguing the healthcare industry for years, forcing revenue cycle leaders to reevaluate the way they remedy staff burnout, responsibility, and leadership development.
These combined challenges are putting pressure on revenue cycle leaders, and now is the time to act, especially when it comes to managing remote workers, fostering leadership development, and collaborating on new technology.
These were the main themes of conversation during the HealthLeaders’ 2024 Revenue Cycle Exchange held in Litchfield Park, Arizona, last week. Around 35 revenue cycle leaders from across the nation met to share insights and strategies for how they’ve navigated these workforce pain points within their organizations.
Managing Remote Workers
Although remote work still poses challenges, revenue cycle leaders shared some of the solutions they’ve implemented at their own organizations to maintain productivity, effectiveness, and engagement among their staff.
Patrick Wall, vice president of patient financial services for MedStar Health, emphasized the importance of satisfied and engaged employees. He argued that special attention should be paid to remote workers, as they’re more susceptible to feeling unengaged with the rest of the organization.
Pictured: Lynn Ansley, Vice President, Revenue Cycle Management at Moffitt Cancer Center, attends the 2024 Revenue Cycle Exchange. Photo courtesy of HealthLeaders.
“I think in order to retain our most valuable resources, we’ve got to come up with a solution to make sure that all of our associates across the country feel connected and engaged to the mission of the organization and the communities that we serve,” Wall said.
To this point, Michael Gottesman, associate vice president of revenue cycle front end operations for Northwell Health Physician Partners, suggested ways leaders can get the most out of their remote workforce:
Establish clear remote work policies
Create strong personal connections
Be intentional about team collaboration
Be responsive and available
Provide face-to-face meeting opportunities
Hold regular check-ins
Invest in the right tools
Gottesman also showed leaders how productivity reporting data can drive accountability and identify areas for improvement.
Leadership and Succession Planning
For decades, coming in at entry level and learning on the job was typical for revenue cycle employees, and while this is still commonplace, more revenue cycle leaders are working to formalize the training requirements for workers while placing a heavy focus on leadership development and succession planning.
In fact, a live poll held on the first day of sessions found that workforce development and employee engagement has become a priority. Many leaders also identified succession planning as a priority, but others, while they also agreed, said they didn’t have the time to dedicate to it.
Where to start? Well, employee engagement and workforce development begins with attentive leaders and effective communication, the attendees said.
Using a creative analogy, Lynn Ansley, vice president of revenue cycle management for Moffitt Cancer Center, illustrated the importance of succession planning and nurturing employees’ skills and abilities to encourage their growth within the organization—the “bus”—to help drive success.
An example of fostering this growth is through a ratings system where leaders can assess the employee’s performance by rating elements like strengths and recent growth.
After calculating those ratings, the leaders can share development best practices with the employee and put together an individual development plan and opportunities for the future. Six months after the initial assessment, leadership can meet again to review the employee’s performance, adjusting development plans as needed.
Additional best practices for succession planning were also shared during roundtable discussions:
Making sure to properly train employees on new equipment and policies
Creating a career ladder for patient access staff
Drive accountability to ensure success
Set people and the organization up for success by thoughtfully placing them where they’re needed and where their skills can expand
Collaborating on New Technology
Technology in the revenue cycle is not an if but a when, and leaders are realizing they need to call upon their workforce to drive technology success.
Acknowledging the large presence of revenue cycle technology solutions, Cassi Birnbaum, administrative director of hospital and professional coding for Stanford Health Care, walked attendees through a case study of how the system operationalized technology platforms, highlighting the role its revenue cycle team members played in the efforts.
As administrative director of hospital and professional coding, she had some best practices to share, like the invaluable presence of super users (i.e. resident experts) through the implementation and launch process. Having information technology and coding teams collaborate and meet weekly was also beneficial.
Pictured: Michael Finley, Director of Revenue Cycle at Bellin Health attends the 2024 Revenue Cycle Exchange. Photo courtesy of HealthLeaders.
Change management was an important part of the process as well, and Birnbaum emphasized the importance of effectively communicating the purpose and progress of the rollout to employees to ensure its success.
Sharing these insights, stories, and strategies with peers is helpful, Sarah Hartwig, patient access officer for Avera Health, explained, because leaders can take that information back to their organizations and apply them to their plans for the future.
“We’re all learning just as fast as new technology, new regulation—that dynamic—as quick as it’s coming at us,” Hartwig said. “I think that having these types of sessions and dialogues is just as important, so it stays relevant. And so, we’re keeping more on top of change together and keeping pace with some of that change.”
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
To inquire about attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
One exec shares three best practices for revenue cycle leaders when looking to partner with a vendor.
The large number of revenue cycle management vendors alone can be overwhelming for organizations when considering potential partnerships. Whether they boast a suite of tools or the ability to tailor solutions to your organization’s needs, it’s important that leaders and decision makers thoroughly weigh their options before making the investment.
Here are three best practices for revenue cycle leaders to keep in mind when looking to partner with a vendor.
Cultural alignment
A people first perspective drove the decision-making process for VHC Health when the system began looking at RCM vendors to partner with. With rev tech constantly evolving, there’s excitement in the newness, but according to John Zabrowski, it must be the right cultural fit.
“It’s fun to be in the middle of creating and leveraging new technology, but I would argue the best practice on the front end is to really understand the culture of the organization you’re working with,” he said.
VHC Health ultimately decided to partner with a vendor they had an already had a relationship with, which Zabrowski previously said "just made a lot of sense."
Presentation vs. performance
Though vendors may claim their solutions can produce certain results, it’s important for executives and other decision makers at the table to take their organizations needs and data into consideration – and make sure the vendors do as well.
“If you’re not comfortable that the people that you’re talking to about such a deep relationship haven’t taken the time to really dig into the data and to understand your AR, your payers, your process,” Zabrowski said. “I would argue that’s a read flag you should be careful of.”
Third party perspective
VHC Health worked with a consultant while they evaluated different vendors, which Zabrowski said gave executives and decision makers a more accurate view of them outside of their presentations.
“Having that sounding board riding shotgun with you on such a big transaction, I think, is an exceptionally good idea,” he said. “Especially if you don't have history with these companies. They all do very similar work and you've got to find the one that is going to actually bring value to your organization.”
There are two key trends that are top of mind for revenue cycle leaders.
The revenue cycle has never been more important, and leaders are working hard to make their organizations shine.
From prioritizing the workforce to discussing payer strategies, revenue cycle leaders from across the country are gathered at the HealthLeaders’ Revenue Cycle Exchange in Litchfield Park, Arizona, this week to learn from one another.
Let’s dig into two major trends that have already emerged.
Workforce
Reviewing the current state of their revenue cycles, many leaders saw succession planning as a priority, while others noted they were unable to allocate time for it. Workforce development, however, was noted as top focus area for leaders.
Patrick Wall, vice president of patient financial services for MedStar Health, emphasized that leading with finesse and activating the people in your corner—whether they’re physician champions or employees—is necessary to meet organizational goals.
Wall placed an emphasis on making sure the workforce is happy and engaged. While he acknowledged the high productivity of remote workers, he also noted that they can often feel unengaged in the organization.
“I think in order to retain our most valuable resources we’ve got to come up with a solution to make sure that all of our associates across the country feel connected and engaged to the mission of the organization and the communities that we serve,” Wall said.
Payers
Payers and provider-payer relationships were also a big topic of discussion, with many leaders voicing their concerns over payers' lack of cooperation with providers.
Leaders discussed different payer negotiation scenarios, sharing and comparing insights and strategies during a roundtable discussion led by Sarah Hartwig, patient access officer for Avera Health. One strategy an executive suggested was making sure to bring physicians into conversations and contract negotiations with payers.
“I love hearing everyone’s perspectives, their stories, and strategies,” Hartwig said. “By sharing, we can take things back to our respective areas and share insights to forge our own plans for steps ahead.”
The HealthLeaders Exchange is an executive community for sharing ideas, solutions, and insights. Please join the community at our LinkedIn page.
How one revenue cycle leader plans for his health system and its RCM partner to work together throughout their partnership.
VHC Health recently announced a 15-year, revenue cycle management partnership that comes at a time when leaders' satisfaction with vendors is largely varied and financially strained systems are hesitant to make the investment.
In a previous HealthLeaders article, John Zabrowski, the system's senior vice president, chief financial officer, and chief strategy officer acknowledges this trend, but suggested that organizations pulling out of vendor agreements may be due to them not aligning with the organizational culture.
For VHC Health, partnering with a vendor they've worked with for multiple years, reflects they fit into the system's culture. Bringing executives from both entities together, alongside the system's revenue cycle team leads, forming a governance council to oversee the partnership allows them to share accountability, laying a solid foundation.
"The way we've carved it out, we've got a strong three-pronged approach that allows for a strong operational alignment, strategic alignment, and organizational alignment to achieve the goals of this partnership," Zabrowski said.
Prior to their current partnership, the VHC had been utilizing their partnership vendor for ancillary services for five years. Now, over a month into the partnership, the system has found over $13 million of incremental value that is "currently in the process of collection and realization."
Initial goals for the partnership include streamlining their patient registration process and integrating AI into the denials process. According to Zabrowski, integrating more robust physician advisory services into the organization is an area of emphasis as well.
To oversee the partnership's progress and performance, the team created a shared governance council of VHC executives, revenue cycle leads, and vendor representatives.
"There's a weekly touch base where we'll be discussing our [key performance indicators], revenue cycle metrics, how are realization rates looking, what's happening with denial trends," Zabrowski explained.
Key performance indicators include accounts receivable per day, insurance aging, number of accounts held up in billing, and coding accuracy rates.
While these metrics are important to the overall management of RCM activities, Zabrowski said, the target goals for the partnership emphasize improving clinical documentation and the system's overall yield.
For the system's yield, efforts are being made to optimize point of service collections, with tech solutions being deployed to help reduce front end denials.
"From a clinical documentation improvement perspective, extended deployment of related practices, education, auditing, and workflow redesign will serve as the foundation upon which our improvements are built upon," Zabrowski explained.
At a time when revenue cycle leaders are being more conservative with their vendors, one health system is betting big with a 15-year contract.
Editor’s note: The article was updated on 2/2/24.
Revenue cycle leaders have been implementing technology for years, and as some vendor promises are falling short or systems remain incompatible, more leaders are becoming conservative when implementing new tech and signing those long-term contracts.
But not VHC Health.
Earlier this month, VHC Health announced an exclusive, 15-year partnership with Med-Metrix, a revenue cycle management solution provider, for end-to-end coverage of the system’s revenue cycle functions.
As mentioned, the partnership deviates from the current trend of revenue cycle leaders moving away from outsourcing operations, usually due to a lack of results. But, John Zabrowski, senior vice president, chief financial officer, and chief strategy officer at VHC Health believes that there’s a trend “in both directions.”
“Regarding organizations pulling out [of contracts], I would argue the agreement and cultures were not aligned,” he said.
Why such a long contract?
The system had already established a relationship with the vendor for different ancillary services and as they considered different RCM providers, the familiarity and demonstrated reliability set them apart from the rest.
“When we coupled our past experience with a thorough review and understanding of what else we could bring by moving that relationship a little deeper into an end-to-end process, it just made a lot of sense,” Zabrowski said.
Having a 15-year agreement, compared to 10-year agreement, Zabrowski explained, will allow the system to get more value from the partnership. One month into the partnership, the partnership has found over $13 million of incremental value that is “currently in the process of collection and realization.”
“My view is in a 10-year deal, you’re really getting seven years of value and I just don’t find that to be worth the effort,” Zabrowski explained. “If I take those same time frames, I can generate 12 years of value on a 15-year deal and spend a lot more time executing, refining, and driving value for the system.”
As the system begins to implement the partnership, a shared governance council will develop 30- and 60-day plans and identify priorities and high value areas within the system’s revenue cycle.
“The reality of the situation for organizations terminating agreements and pulling back, they most likely forgot the most important part of the equation: people,” Zabrowski said.
Consistent with the system’s “people first” philosophy, in addition to C-suite leaders like the chief information officer and chief operating officer, revenue cycle leads are also part of the shared governance council.
“It’s a very clear open governance structure to make sure that from an overall management perspective, our priorities remain aligned, and we’ve got real clear communication,” Zabrowski said.
HealthLeaders surveyed 87 revenue cycle executives on expanding tech in their operations, staffing, and their priorities for the year. Here's what they said.
Pictured: Lynn Ansley, Vice President, Revenue Cycle Management at Moffitt Cancer Center, attends the 2024 Revenue Cycle Exchange. Photo courtesy of HealthLeaders.
Pictured: Michael Finley, Director of Revenue Cycle at Bellin Health attends the 2024 Revenue Cycle Exchange. Photo courtesy of HealthLeaders.
