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.
Health systems should explore flexible payment plans and focus on pre-service patient engagement to improve revenue cycles, according to a recent PayZen report.
Patients are being asked to take on greater portions of their medical bills at a time when healthcare costs continue to skyrocket. While these diverging trends could spell trouble for revenue cycle managers, they also shed light on opportunities to enhance pre- and post-service collections, mitigate bad debt, and deliver more positive financial experiences for patients.
That’s the takeaway from a new report from PayZen, based on a survey of 213 revenue cycle leaders conducted in partnership with the HFMA. It complements a 2024 PayZen report on healthcare affordability, which was based on a survey of roughly 1,000 patients who had experienced a hospital visit in the previous two years.
High deductibles health plans create an affordability gap
Patient collections are roughly one-quarter of total patient billings, according to the report. One factor influencing patient debt is the increasing prevalence of high-deductible health plans. Just under one-quarter of working-age adults were considered underinsured in 2024, compared with 16% in 2010.
Deductibles vary significantly from one health plan to the next. While the average deductible for employer-sponsored coverage in 2024 was $1,787, average deductibles for marketplace plans ranged from $1,430 for a gold plan to $7,258 for a bronze plan.
With roughly one-half of Americans living paycheck-to-paycheck, amounts owed by patients with high-deductible health plans is often out of reach.
Strategies to address unpaid balances, bad debt
“Hospitals don’t want to be in the business of lending, yet many are left with little choice,” Tobias Mezger, chief revenue officer at PayZen, said in a statement.
Buy Now, Pay Later (BNPL) financing services offered in retail settings could serve as a model for health systems looking to reverse rising levels of unpaid balances and bad debt, according to PayZen. Roughly 40% of American adults use at least one BNPL service, and the market is expected to exceed $122 billion in 2025.
Most health systems already offer in-house payment plans, but these could benefit by allowing additional flexibility to patients or through partnerships with third-party financing partners.
The average patient can only pay $97 per month for medical expenses, while 21% can only afford up to $15 to $30 per month, according to the report. This means that, for the average patient, a 12-month payment plan would only be affordable for medical bills up to $1,200, and 24-month plans would only be affordable up to amounts of $2,350. These figures are well below the amounts many patients could potentially owe under high-deductible health plans.
Despite this math, 58% of health systems cap payment plans at 24 months and 28% cap payment plans at 12 months. An additional 7% do not offer in-house payment plans at all.
Three-quarters of patients shared that they would be more likely to pay their healthcare bills over extended periods of time, according to PayZen.
Alternatively, improving pre-service collections can have a significant positive impact on financial stability, according to the report. Health systems that require or encourage pre-service payments, or require a payment method on file, have a 20% higher overall collection rate.
During a recent HealthLeaders Revenue Cycle NOW Online Summit event, Shannon Ducat, associate vice president of patient access at ProMedica, said her health system has seen an increase in pre-service collections since implementing new scheduling processes that included the creation of a pre-registration team.
Before selecting a vendor to aid in prior authorization management, health systems should conduct their own "needs assesment," according to Christine Migliaro, VP of front-end revenue cycle operations for physician partners at Northwell Health.
Prior authorizations are an increasingly significant challenge for revenue cycle leaders. Technology vendors offer solutions to ease the process and reduce payer-provider friction, but there can also be a tendency to overpromise and underdeliver.
In this episode of HL Shorts, Christine Migliaro, vice president of front-end revenue cycle operations for physician partners at Northwell Health, shares her tips for success in the vendor selection process.
Revenue cycle leaders from ProMedica and University Health Kansas City joined HealthLeaders for a candid talk on their strategies for improving patient engagement.
Health systems are being forced to rethink patient engagement whether they like it or not. Patients are demanding more consumer-friendly, tech-based tools, while government regulations like the No Surprises Act require more transparency around prices. What strategies are revenue cycle leaders exploring to improve patient engagement without sacrificing operational efficiency?
“Patients want their healthcare experience to be as seamless and as convenient as online shopping and online banking,” Ducat said. “So, for strategic initiatives, we’re focused on expanding those self-service tools.”
One patient engagement initiative at ProMedica established automated workflows that give patients greater control over scheduling.
Less than two years ago, the centralized scheduling team at ProMedica was a wholly outbound operation. It felt like the team was chasing patients, often calling while they were at work or otherwise unavailable, Ducat said.
Today, ProMedica is using technology to automatically call and text patients the day after a provider places an order.
Patients have the option of connecting at that time, or at a future time of their choosing. They also receive self-registration links and cost estimates via online portal ahead of their visits. The automated system makes five attempts to contact patients over 90 days.
“We kind of turned our scheduling center around and went from a completely outbound call center to a completely inbound call center,” Ducat said.
At University Health Kansas City, investments in new payment systems mean patients now have additional payment options, like Apple Pay and Google Pay. The academic medical center has also invested in technology to enable accurate cost estimates.
Investing in consumer-friendly digital tools and in-demand tech goes beyond meeting regulations like those in the No Surprises Act, however.
“It’s a key strategy to grow and to retain your patients,” Katz said. “Hospitals that don’t lean into that mode and that idea are going to be left.”
Benefits to patient engagement initiatives outweigh drawbacks
As part of its patient access redesign, ProMedica established a fully remote pre-registration team that calls patients five to ten days before their appointments to complete most tasks typically done day-of-service.
While the approach streamlines patient visits, there has been some resistance to the change. For instance, patients used to traditional patient access models may be reluctant to share personal health or payment information over the phone.
“It’s something new,” Ducat said. “I think some patients have a little bit of a trust issue with just the legitimacy of the phone call.”
Of course, resistance to change also comes from internal sources. While many clinicians are excited about the potential to improve patient engagement, some prefer the level of control afforded to them in under traditional models.
The success of patient engagement initiatives depends on buy-in from senior leadership and from physicians.
“It is a culture shift,” Katz said. “That can be a challenge for some organizations or for some people within those organizations.”
While resistance has been a challenge, the benefits to these patient engagement initiatives can’t be denied.
Since implementing new scheduling and pre-registration processes, ProMedica has seen a decrease in eligibility denials and an increase in pre-service collections.
Similarly, University Health Kansas City has been able to improve the accuracy of the data it collects since providing patients with more tools to update their information via online portals and self-serve kiosks. This has reduced friction in the prior authorization process.
“Everything that happens up front has major implications through the rest of your revenue cycle,” Katz said.
A recent Executive Order takes aim at drug pricing, with significant implications for the 340B Drug Pricing Program.
The Trump administration recently issued an Executive Order directing federal agencies to take steps to reduce prescription drug prices. Among the wide-ranging directives are two provisions that would significantly impact the 340B Drug Pricing Program.
One provision would require provider organizations participating in the 340B program to make insulin and injectable epinephrine available at or below the discounted price that they paid for the drugs.
The other provision instructs the Department of Health and Human Services (HHS) to gather data on hospital acquisition costs for outpatient drugs and to propose reimbursement adjustments that align Medicare payment with acquisition costs.
Recent controversy surrounding the 340B program
The 340B program, established in 1992, requires drugmakers to provide outpatient drugs at discounted rates to eligible provider organizations. The program is intended to free up money for hospitals to use elsewhere in ways that support low-income and other underserved patients.
The 340B program has been mired in controversy for the past several years, but multiple revenue cycle leaders have said the discounted rates through the 340B program are essential to their organizations’ financial health.
“Henry Ford Health system and a lot of folks rely on 340B discounts and other mechanisms like disproportionate share payments,” Robin Damschroder, the health system’s CFO, told HealthLeaders in a 2022 interview. “We're a big teaching institution, so a lot of these special payments that we do in order to teach the healthcare leaders of the future or make sure that we can take care of vulnerable patients are extremely important.”
“340B going away would not only be devastating for us but incredibly devastating to our patients because it does fund some other things that we can do in our organization to serve that indigent population,” added Cheryl Sadro, former CFO for UC Davis Health and current CFO for John Hopkins Medicine, told HealthLeaders in a separate 2022 interview.
On the other hand, critics say that the 340B program lacks transparency and that participating provider organizations frequently fail to use savings on the populations that the program is intended to help.
This criticism prompted the formation of a bipartisan group of legislators to explore changes to the 340B program. The Senate 340B working group released a legislative discussion draft last year.
“The 340B drug pricing program is not working as effectively as it should,” Senator Jerry Moran (R-Kansas) said at the time of the group’s formation. “The confusion around its contract pharmacy provisions and lack of transparency and congressional oversight is failing the patients the program exists to help.”
The Supreme Court offered some 340B relief – for now
In 2018, the Centers for Medicare & Medicaid Services (CMS) reduced payment rates for 340B drugs to average sales price minus 22.5%, stating that the formula would more accurately account for actual costs incurred by 340B hospitals.
However, the Supreme Court ruled against these rates in 2022, saying that HHS had not properly surveyed hospitals’ acquisition costs. The decision led to a $9 billion remedy payment for eligible hospitals in 2023.
Healthcare leaders were pleased at the time. However, scrutiny over the 340B is still strong, and both Congress and the White House seem eager to make adjustments to the program. Revenue cycle leaders would be wise to keep contingency plans in their pockets.
Revenue cycle leaders today are tasked with improving patient engagement, while they're facing frustrating prior authorization requirements that lead to skyrocketing denial rates.
Health systems are under pressure to meet patient demands for more consumer-friendly experiences while wrestling with increasingly stringent prior authorization requirements. How are revenue cycle leaders balancing these dual priorities?
This Wednesday, revenue cycle leaders will share their tips for improving patient engagement and strategizing around prior authorizations during the HealthLeaders Revenue Cycle NOW event.
The event is split into two separate webinars:
How to Improve Patient Engagement in Today’s Healthcare Revenue Cycle (10-11 a.m. EDT)
Effective patient engagement is critical to revenue cycle management. However, patients are growing frustrated with a consumer experience that frequently fails to deliver the digital tools and pricing transparency offered by other industries. Some RCM leaders have rethought their approach to deliver both a better experience and improved operational efficiency.
In the opening session, sponsored by Waystar, Shannon Ducat, associate vice president of patient access at ProMedica Health, will join Seth Katz, vice president of revenue cycle and HIM at University Health Kansas City, to discuss the steps they are taking and strategies they are using to reduce patient uncertainty, minimize denials, and decrease friction between patients, providers, and payers.
Revolutionizing Revenue: Technology and Strategic Solutions for Prior Authorization (11:10 a.m.-12:10 p.m. EDT)
Prior authorizations are an ever-present headache for revenue cycle leaders. Unclear prior authorization requirements and shifting payer policies have contributed to skyrocketing claim denial rates, impacting the financial health of hospitals across the country. To help ease the pain, healthcare leadership is exploring new automation technologies and changing the way they interact with payers.
In this session, sponsored by Optum, Christine Migliaro, vice president of front-end revenue cycle operations at Northwell Health, and Savanah Arcenaux, director of pre-service and financial clearance at Ochsner Health, will share the solutions they are exploring to reduce the prior authorization burden.
Interested in joining the webinars? You can register here.
