The integration of Artificial Intelligence (AI), automation, and data analytics into the revenue cycle management (RCM) of healthcare facilities marks a transformative leap toward operational excellence. In an era where financial sustainability is as crucial as clinical outcomes, these technologies are pivotal in optimizing processes from patient intake to final billing, ensuring that healthcare providers not only survive but thrive in a competitive market.

At our infectious disease lab, the implementation of AI and data analytics has revolutionized how we manage our revenue cycle. By automating routine tasks, we have freed up valuable time for our staff to focus on more complex, value-added activities. Automation of data entry and claims processing reduces the likelihood of errors and speeds up the turnaround time, directly impacting our cash flow and reducing the days in accounts receivable.

One of the most significant advantages of using AI is its ability to analyze vast amounts of data to identify trends and patterns that would be impossible for a human to discern. This capability allows us to anticipate issues before they become problematic, such as identifying which claims are likely to be denied based on historical data. With predictive analytics, we are proactive rather than reactive, which not only increases our revenue but also reduces the stress on our staff and improves our relationships with patients and insurers.

AI transforms data into actionable insights, enhancing efficiency and profitability in healthcare.

Moreover, machine learning (ML) models within our AI systems continuously learn from new data. As they become more sophisticated, they offer increasingly accurate forecasts and deeper insights into our lab’s financial operations. This ongoing learning process is crucial for adapting to the ever-changing landscape of healthcare regulations and insurance policies.

Our organization has also capitalized on data analytics to fine-tune our pricing strategies and to ensure compliance with billing regulations. By analyzing the outcomes of thousands of past transactions, we can set competitive prices that maximize our revenue without compromising patient care. Furthermore, compliance monitoring through AI-driven systems ensures we adhere to all billing regulations, reducing the risk of costly penalties and legal issues.

The integration of these technologies extends beyond internal operations to enhance patient interactions. Our patient portal, powered by AI, offers personalized experiences where patients can easily access their billing information, understand their payment options, and communicate with billing representatives seamlessly. This not only improves patient satisfaction but also expedites payments, positively affecting our cash flow.

In addition to these operational improvements, AI and data analytics significantly enhance our strategic decision-making capabilities. With access to real-time data and advanced analytical tools, our management team can make informed decisions quickly, addressing potential financial discrepancies and optimizing overall financial health.

Furthermore, the ability of AI to integrate with other technological advancements, such as electronic health records (EHRs), further streamlines our operations. This integration ensures that all patient data is synchronized across platforms, minimizing the risk of data silos, and ensuring that every department has access to the same accurate and updated information. This seamless integration helps in maintaining consistency in billing practices and patient care services.

Our commitment to leveraging AI extends to training our staff to effectively utilize these tools. By holding regular training sessions and workshops, we ensure that our team is not only comfortable but also proficient in using the latest technologies. This empowerment enables them to contribute actively to our ongoing efforts to refine and improve our revenue cycle processes.

Additionally, AI tools help us manage the complexities of insurance verification and eligibility checks with greater accuracy. By automating these processes, we reduce the instances of claim rejections due to coverage errors. This not only speeds up the billing process but also decreases the burden on our patients, who can be confident that their coverage is correctly verified at the outset of their healthcare journey.

Moreover, AI-driven analytics assist us in identifying inefficiencies in our billing and service delivery models, allowing us to make necessary adjustments. These adjustments are often predictive rather than reactive, positioning us to address potential issues before impacting our operations. This foresight saves time and resources and supports our strategic goals of maintaining financial health and patient satisfaction.

The adoption and continual advancement of these technologies in our revenue cycle processes illustrate a commitment to innovation and excellence in healthcare management. As these tools evolve, so too does our ability to meet the needs of the patients we serve and the staff we support, ensuring a future where healthcare and technology work hand in hand for the betterment of all involved. As we continue to harness these powerful technologies, we not only foresee a more robust financial footing for our lab but also a greater capacity to provide exceptional care to our patients.

Through ongoing investments in AI and data analytics, we not only optimize our current operations but also pave the way for future innovations. These technologies allow us to stay at the forefront of the healthcare industry, continually improving our services and outcomes. By embracing AI and automation, we not only enhance our operational efficiencies but also ensure a higher standard of care, which is the cornerstone of our mission in healthcare.

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The rise of physician advisors has been a transformative development in 21^st century healthcare. Many healthcare systems have adopted an enterprise physician advisor model to streamline workflows and enhance efficiency, moving away from reliance on individual hospital-based advisors. This change allows physician advisors to support multiple facilities and optimize operations. As healthcare systems continue to merge or expand into larger networks, the need for standardized revenue cycle management (RCM) practices becomes increasingly critical.

As physician advisors, our responsibilities include utilization management, denial prevention, and revenue cycle optimization. We take pride in our data-driven decision-making approach, especially in managing the revenue cycle. Collaborating with robust analytics teams, we meticulously track various metrics, such as length of stay per provider or service line, readmissions, peer-to-peer overturn rates, and insurance denials. These examples illustrate the data we use to perform our roles effectively. The implementation of automated bots to handle repetitive tasks and the creation of user-friendly dashboards have allowed staff to focus on more complex and high-value activities.

With the abundance of big data, selecting the right data to create the most significant impact is crucial. It is easy to become overwhelmed by extensive tables with countless rows and columns. The key is determining which data should be utilized and which should be set aside. Online dashboards, which enable instant data review and sorting as needed, have greatly simplified this process for users.

We can deliver high-quality care while maintaining financial stability by leveraging advanced analytics and standardizing processes across expanding healthcare networks.

A core function of physician advisors is denial management. A comprehensive dashboard that tracks denial cases selected for peer-to-peer review and appeal, along with their outcomes, enables a more efficient and balanced workflow. Both payers and hospitals can use the dashboard to dissect data, identify trends, and monitor expected versus actual reimbursement. This valuable information can pinpoint denial categories and their root causes, leading to educational opportunities to improved documentation and adherence to evidence-based medicine, ultimately reducing the administrative burden on providers and payers.

Utilization management benefits significantly from dashboards that assist with status management and identify areas for improvement, such as incorrect status selection on admission, which can lead to denials and compliance issues, especially in short-stay cases. Accurate status selection ensures better revenue and avoids unnecessary denials and out-of-pocket patient costs. Additionally, these dashboards monitor denials by location and payer, identifying trends and patterns among payers with high denial rates. This facilitates discussions between providers and payers about high denial rates and their causes compared to similar payers, encouraging process improvements such as data exchange method with payers.

A Resource Utilization dashboard identifies how services are used across hospitals, departments, nursing units, or outpatient facilities, helping control utilization and direct resources to areas with higher demand. This improves resource management and reduces costs. Physician advisors often lead utilization management committees and conduct discussions to optimize resource utilization.

Care management dashboards facilitate discharge planning. A dashboard that tracks the number of patients discharged home with and without home care versus post-acute facilities provides a better understanding of post-acute denials, streamlining discharge distribution, or improving documentation to support the need for such services. The dashboard also allows monitoring of precertification times and designing process improvement plans to reduce these times. Physician advisors play a crucial role in supporting care management, especially with complex discharges.

Observation of patients is increasingly attractive to health systems, given the growing frequency and the ability to manage some patients in outpatient settings with appropriate resources. Established benchmarks for observation cases are lacking, especially since each facility may have different case types, making it challenging to create standard and reliable benchmarks. Several metrics can be included in an observation dashboard, such as cost per case including direct and indirect cost, length of stay, number of consults per case, conversion rate, ancillary services performed, relevance to the acute presentation, and how quickly they were performed. Data can be reviewed by payer, diagnosis, location, and provider, helping improve efficiency and identify outliers. This data also supports the case for observation units and monitors their effectiveness and productivity.

A Medical Staff Scorecard/dashboard is a valuable tool for providing feedback to providers, including physicians and advanced practice practitioners. Many providers lack access to performance data. A dashboard that displays the length of stay, procedure times, time to round, and ancillary requests provides valuable insights for physicians to understand their performance and compare it to their peers using risk-adjusted data. The scorecard helps reduce inappropriate utilization and enhances success in value-based programs. The quality section of the dashboards can include the number of preventive services, medications used, chronic disease management, and vaccinations, enabling physicians to practice better population health management and prioritize care for those who need it most. The scorecard can also include readmission data, helping providers identify opportunities, create mitigation plans, increase access, and collaborate with other services such as care coordination.

The potential for utilizing data is limitless. Dashboards allow administrators, caregivers, and medical staff to monitor outcomes and make necessary adjustments without missing opportunities. This reduces costs, waste, and administrative burden while increasing efficiency and access to healthcare. A data-driven approach and commitment to continuous improvement ensure an enhanced revenue cycle and reduce denials and controllable loss. We can deliver high-quality care while maintaining financial stability by leveraging advanced analytics and standardizing processes across expanding healthcare networks. Physician advisors involved in these tasks cannot emphasize enough the value of having this data available and updated instantaneously.

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Healthcare is a business unlike any other. Many economists describe healthcare as an imperfect market, where the consumer is not the one paying for the goods and services; they have limited knowledge on what they are buying, and they have little to no ability to shop for a deal in many scenarios. Healthcare has similar imperfections on the provider side in terms of reimbursement. From service line directors to physicians, many do not fully understand what they are or are not getting paid for. Providers are continuously dealing with multiple nebulous policies across several different payers that can have a material impact.

Currently, nearly every provider in the country is experiencing a similar top-down directive to decrease costs and increase revenue with the ultimate goal of increasing cash in the door. Once again, the idea of an imperfect market in healthcare appears. How can these clinical leaders improve cash flow if their primary source of truth is a revenue and usage report?  

There is value in the collaboration of revenue cycle staff in many committees and initiatives, given the current strain of hospital finances.

Since 2011, when incentives appeared promoting the adoption of electronic health record (EHR) systems, the ability to acquire detailed data has improved significantly. One can extract virtually any clinical or financial data point from these systems, and business intelligence (BI) tools can visualize the data. This financial data has not always been readily available, shared, or interpreted by clinical stakeholders for a multitude of reasons. First, it could simply be company culture, keeping reimbursement and money talk away from clinical practice. Secondly, it could be the fact that reimbursement data can be difficult to interpret and there may be significant manual lifting to get it in comprehensible format for clinicians; as electronic remittance info can make little sense and payers make it intentionally confusing. Because of this, the Revenue Cycle (or their data) may have been siloed from project management and clinical decision-making. 

With these silos in place, service line directors are placed in a poor position to succeed under the direction of increasing cash. Not understanding concepts like the impact of payer mix has enormous strategic implications. Shifts in the payer mix as small as one percent can mean missing revenue targets for the department or for the facility. 

Capital requests for new, high-tech equipment to complete procedures, tests, or treatments have billing implications that should be stamped by the revenue cycle. The pro formas that can be driven by vendor information should be confirmed by revenue integrity for accuracy. Payer policy and national/local coverage determinations should be confirmed by patient financial services. Not understanding the payer policy and billing requirements can utterly derail any value gained by the capital request.

Medicare is the largest payer for many facilities. With Medicare comes the diagnosis-related group payment, and with bundled payments comes the need to manage length of stay (LOS). While moving LOS is multi-faceted, there are ways to quantify the metric. Imagine the impact on physician and case management leadership if you can report how much impact 0.1-day improvement in LOS has on the bottom line. Expected payment-to-charge ratios, cost data, or contractual expected reimbursement can be applied to LOS metrics to drive home the importance of throughput. 

Many bedside and clinical staff have little understanding of the back-end impact of the work they complete on a daily basis. Processes like registration and prior authorization have significant impacts down the line. Meetings with ancillary outpatient departments and clinics to review preventable denials create a sense of value in the work these registration teams complete. The processes in these satellite areas are harder to keep reigns on. Providing this simple data can add allies to your initiatives which improve margins and reduce revenue leakage through denials. 

While not applicable to all facilities, the revenue cycle staff typically have strong knowledge of payer contracts which again can provide valuable insights. Many health systems closely guard what is in their managed care contracts and the rates they contain. It may not be great to share these with all clinicians, but understanding the impacts these agreements could have on operations and reimbursement can be beneficial.

Finally, if clinicians understand their charges, reimbursement, and revenue, they can escalate if a process breaks down or the EHR misbehaves.

There is value in the collaboration of revenue cycle staff in many committees and initiatives, given the current strain of hospital finances. The financial and clinical data is there. It should be time to consider merging this data, as the value may be surprising.

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The healthcare industry faces continuous challenges in maintaining efficient RCM, which is essential for the sustainability and operational success of healthcare providers. A particularly challenging aspect of RCM is the management of denials and appeals, a process fraught with complexities that can significantly impact the financial health of medical institutions. As healthcare providers strive to minimize these financial disruptions, a deeper understanding of the causes and effective management strategies is vital. This piece delves into the intricacies of why denials occur, the consequential effects they have on healthcare operations, and the strategic measures that can be adopted to mitigate their impact.

Understanding Denials in Healthcare

Denials are a critical pain point in the revenue cycle, representing instances where a payer, such as an insurance company, refuses to pay for a service that has been provided, citing various reasons. These reasons can range from coding errors, for example, mismatches between provided services and billing codes, to administrative oversights like incomplete patient information or lack of prior authorization. Each denial has to be reviewed, corrected, and resubmitted, which is time-consuming and costly.

The reasons behind denials are manifold and often interlinked, requiring a multi-faceted approach to understanding and addressing them. For instance, a common cause of denials is failing to verify a patient’s insurance coverage before providing services. This can lead to claims for services not covered under a patient’s current policy, resulting in a denial that could have been avoided with proper insurance verification. Similarly, inaccuracies in coding, whether due to human error or misunderstanding of the latest coding standards, can lead to claims that payers will refuse to reimburse.

Effective denial and appeal management is crucial for the financial viability of healthcare providers.

The Impact of Denials

Denials not only delay payments but also require significant administrative effort to rectify, which can strain resources and reduce overall efficiency. AHIMA published an article on a step-by-step approach to resolving claims denials that reports the average denial rate across the healthcare industry can reach 20%, with each denial costing $25 to $181 to rework depending on the patient setting. When multiplied by the volume of denials a typical healthcare facility faces, the total cost can quickly escalate. This financial strain underscores the importance of implementing strategies aimed at reducing the occurrence of denials.

Strategies for Managing Denials

1. Preventative Measures: The cornerstone of effective denial management is robust front-end processing. This includes meticulous collection of patient data, thorough verification of insurance details, and strict adherence to coding protocols. Regular training for administrative staff, coupled with periodic audits, can enhance the accuracy and efficiency of these processes.
2. Technology Integration: Modern RCM solutions employ sophisticated software that can preemptively identify potential errors in claims through processes known as claim scrubbing. These solutions integrate seamlessly with electronic health records (EHRs), ensuring that claims are accurate before submission, thus reducing the likelihood of denials.
3. Data Analytics: Advanced data analytics tools play a crucial role in identifying trends and patterns in past denials. By analyzing this data, healthcare providers can pinpoint common pitfalls in their billing processes and implement targeted improvements to prevent future denials.

The Appeals Process

Following a denial, healthcare providers can initiate an appeals process, which involves challenging the payer’s decision and providing additional documentation to justify the claim. This process is critical in overturning unjustified denials and recovering revenues that are rightfully due.

Key Steps in the Appeals Process:

1. Review and Response: It starts with thoroughly reviewing the denial notice to understand the payer’s reasons for rejection. This understanding guides the collection of necessary documentation and evidence to construct a robust appeal.
2. Timely Filing: Adherence to the payer-specified timelines is crucial. Failure to file an appeal within the designated timeframe can permanently impact the provider’s ability to recover the funds.
3. Follow-Up: Persistent follow-up is essential to keep the appeal moving through the process. This includes regular communications with the payer to ensure the appeal is being considered and to submit any additional information required swiftly.

The Critical Role of RCM in Government-Dominated Payor Environments

Given the financial intricacies of healthcare institutions with a predominant payor base consisting of governmental entities, where approximately 85% of revenue comes from Medicare, Medicaid, and other government-funded programs, the importance of meticulous RCM cannot be overstated. For these institutions, every dollar is crucial not just for operational sustainability but also for fulfilling their fundamental mission to deliver quality healthcare. Governmental payors often have strict reimbursement criteria and complex billing protocols, making the management of denials and appeals even more critical.

Institutions with a high proportion of government payors frequently operate under tight financial constraints, often running at negative margins. This economic environment amplifies the significance of every claim processed and requires a heightened focus on the accuracy and timeliness of billing and coding practices. Efficient management of denials and appeals in these settings is not just about financial survival; it is about ensuring that resources are available to continue providing essential healthcare services to the community. Through strategic improvements in denial management and the thoughtful integration of technology, these healthcare providers can significantly enhance their operational efficiencies, reduce financial waste, and, more importantly, uphold their mission to deliver exceptional care.

Effective denial and appeal management is crucial for the financial viability of healthcare providers. Through a comprehensive understanding of denial causes, strategic process implementation, and the adoption of advanced technologies, providers can enhance their RCM processes, reduce the impact of denials, and ensure robust financial health. As healthcare landscape continues to evolve, staying informed and agile will be key to success in RCM.

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Healthcare relies on audits to ensure they remain compliant and assist with identifying potential risks. Is your organization prepared?

Audits occur on many different levels and have different areas of focus. External audits can be performed by many different teams. The following are the most identifiable audits within healthcare:

• Commercial Payer Audits
• Federal Government Audits
• Third-Party Expert Audits
• Compliance Audits
• Coding and Documentation Audits
• Quality Assurance Audits
• Privacy and Security Audits
• Pharmacy Audits
• Internal Audits

Audits are performed by evaluating comprehensive transactions. This is a great way to discover areas of opportunity. Processing these requests can seem daunting due to the complexity and volume of requests. Preparing your team to meet the expectations before starting the audit is highly impactful.

It takes a village to satisfy all of the requirements of an audit. Specific areas with revenue streams are typically the primary focus during an audit. This can include supplies, adjustments, cash posting, pharmacy, capital, and real estate, to name a few. Many areas within your organization will be called upon.

The first step in completing an audit successfully is identifying the champion at your organization. This person will be the primary contact for receiving and submitting requests from the audit team. This will decrease confusion and promote consistency when reporting back to the auditors.

Keeping a working spreadsheet to track outstanding items and document completed tasks is pivotal to your team’s success. This document should be a view only for all team members but should only be edited by your champion. Once again, creating consistency in this process will allow for a more strategic approach.

As documentation is sent and received by the champion, it is important to ensure the request is fully understood before submitting the response. Do not be afraid to ask clarifying questions. Providing too much information can lead to more scrutiny and additional requests. Timely responses are necessary because this could potentially disrupt the end result.

After receiving your final scores, it is imperative to create action plans to improve in the areas with low scores. During this reconciliation, it is essential to communicate with the teams that were affected by the “needs improvement” scoring. Training and education are often the correct discipline to reconcile these deficiencies. Developing policies and procedures post audit will give the organization guidelines on properly adhering to the corrective action. Constructive feedback can provide the team with tools to develop standardization and quality metrics. Consistent follow-up and tracking of the remediation plans will provide employees with measurable results.

Audits can assist revenue cycle management (RCM) in finding discrepancies in workflow. Understanding that the audits are done using random accounts for specific timeframes will provide valuable data and greater optimization.

Publishing the results of an audit can provide patients with transparency with quantitative results and projected resolution. This forward-thinking can build trust within the community. Increasing positive patient experience can be driven by audit results.

Audits will allow the team to create compliance with regulatory requirements. Audits help healthcare facilities stay aligned with industry standards and ultimately mitigate risk.

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Navigating revenue cycle challenges, from billing errors to insurance denials and patient collections, requires diligent effort and strategic approaches. Automation has proven invaluable in streamlining processes and reducing errors, supported by continuous staff training to ensure regulatory compliance and billing proficiency. Harnessing data analytics optimizes performance by identifying trends and enhancing operational efficiency.

Our commitment to patient satisfaction drives engagement through flexible payment options and seamless experiences, facilitated by interoperable systems that foster departmental collaboration and minimize errors. Upholding ethical and legal standards is integral, with comprehensive training ensuring adherence to regulatory requirements from patient interactions to billing.

By leveraging advanced technology and proactive analytics, we anticipate regulatory changes and implement preemptive measures, thereby mitigating risks and enhancing patient care and stakeholder trust. Embracing innovation ensures financial stability while delivering quality care, underscoring our leadership in healthcare excellence through unwavering compliance and continuous improvement.

Harnessing Technology: Enhancing the Revenue Cycle through Integration and Transition Strategies

Integrating new technologies has ushered in a transformative era for our institution’s revenue cycle, enhancing efficiency and elevating patient care delivery. Our approach centers on thoroughly assessing current processes, collaborative decision-making with key stakeholders, and prioritizing comprehensive training to empower our staff. Through meticulous pilot testing and a commitment to continuous improvement, we ensure seamless implementation and optimize performance metrics. This strategic deployment of technology not only improves financial outcomes but also reinforces our commitment to delivering exceptional healthcare.

Driving Efficiency: Artificial Intelligence (AI), Automation, and Data Analytics in Revenue Cycle Optimization

AI, automation, and data analytics are pivotal in transforming organizations’ financial operations, reshaping revenue cycle management. At our organization, these technologies drive transformation. AI algorithms harness data for actionable insights, anticipating trends and enhancing financial performance. Automation streamlines billing and claims, reducing errors, boosting operational efficiency and prioritizing patient care. Data analytics clarify performance indicators, drive decisions, and maximize revenue and operational effectiveness. Integrating these technologies has made our revenue cycle agile and responsive, optimizing financial performance and patient care. Moving forward, we remain committed to leveraging technology for innovative, high-quality revenue cycle management.

Strategic Evaluation and Successful Implementation of Technology for Revenue Cycle Improvement

Integrating advanced technologies is essential for optimizing the revenue cycle within our organization. This begins with thorough prioritization and evaluation to align solutions with our organizational goals and address specific needs such as billing accuracy and claims processing efficiency. We carefully assess our revenue cycle processes to identify areas for improvement, focusing on reducing errors and enhancing operational efficiencies. Additionally, we conduct comprehensive market research and vendor evaluations to select technologies that seamlessly integrate and promise tangible benefits. Pilot testing and proof of concept are pivotal phases, allowing us to observe technology performance firsthand. Adopting an AI-powered claims & coding processing system has significantly streamlined operations, reduced errors, and enhanced revenue streams.

Navigating Regulatory Shifts: Ensuring Compliance and Efficiency in Revenue Cycle Operations

Managing healthcare regulations at our organization requires a careful balance between compliance and operational efficiency. These regulations significantly influence our revenue cycle practices, necessitating constant vigilance and adaptability. Our dedicated compliance teams diligently track updates and ensure our policies align seamlessly with current standards. Comprehensive staff training equips our team with the necessary skills to navigate these complexities effectively. Efficiency is paramount. We utilize advanced technology, including specialized software and robust revenue cycle systems, to streamline operations while maintaining strict compliance. Regular audits and monitoring programs further reinforce our commitment to compliance, identifying areas for improvement and ensuring continuous enhancement of our services with a focus on patient care excellence.

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One of the simple truths is that “none of us is as smart as all of us.” This rings especially true as IT and revenue cycle teams seek to establish a more symbiotic relationship in defining a strategy that meets the organization’s cost reduction and technological advancement needs. The revenue cycle plays a pivotal role in ensuring the financial health of an organization while IT provides the necessary technological infrastructure and support to run it. Finding synergy between these two departments is critical, yet often fraught with challenges as both teams feel overburdened by pressures to adopt new technologies at excessive speeds.

The expectation of the modern revenue cycle leader to stay in tune with emerging technologies and navigate pressures to adopt new solutions – amid payer challenges and diminishing margins – is founded on realizing that our challenges can no longer be solved with people. It is also making us some of the most desperate for advancements in driving modernization into our operations; however, revenue cycle priorities to implement high-impact solutions rarely come with low-effort commitment. Meanwhile, IT is facing some of their biggest challenges to provide a robust and reliable technical solution while also having to protect, constantly upgrade, and completely reimagine it. Both roles are becoming more complex, diverting further from how they have been typically defined in the past, and will continue to require more collaboration to be successful.

Revenue cycle and IT teams should develop shared performance metrics that reflect the objectives of both departments to help align their efforts.

The distinct capabilities of each team that have historically allowed them to operate in silos have become the same qualities that make it a perfect alliance. IT departments prioritize system stability and security whereas revenue cycles are focused on immediate financial outcomes and process efficiencies. IT teams don’t necessarily understand the processes that need to be supported, and revenue cycle teams don’t typically have the ability to create or implement the solution themselves. Balancing these priorities requires careful coordination since both areas are so specialized, and neither team has the excess capacity to become experts in solutions that present as too complex to learn into.

Revenue cycle success is so dependent on the execution tactics and timeliness of IT – a department that has limited resources and competing priorities – but increasing financial risk may not allow for prioritization among in-flight or pipeline initiatives. With revenue cycle outsourcing becoming more common in recent years, we must consider the overwhelming requirement to explore, manage, and integrate multiple technologies as a contributing factor. An organization must commit to accommodating these trends internally or support seeking out alternative solutions. Meanwhile, organizations are becoming more skeptical of vendor overpromises and the non-delivery of solutions that lack proof of concept and further remove us from the patient experience. An established IT partnership can explore these options as strategic developments rather than evaluate them at a critical decision point.

Any revenue cycle solution requires significant expertise in claims, reimbursement, payer behavior, and policy. An advanced level of technical expertise may not exist at all levels of the revenue cycle as it does in IT, but the deep understanding of financial workflows, patient interactions, and billing processes provides critical insights into the practical application of existing and proposed technical solutions. Some revenue cycle departments have dedicated analytics functions and citizen development capabilities established within their department to cater to ongoing and specialized revenue cycle technology support needs. This model can work well, but will need to avoid the silo and remain well aligned with an organization’s overall innovation strategy. Integrating IT staff into the day-to-day operations of a revenue cycle can provide them with operational knowledge to suggest automation opportunities or exception-based workflows and avoid bolt-on solutions where untapped capabilities may already exist. Traditional revenue cycle leaders are also still developing experience in managing an automated workforce, in which it is more challenging to attribute performance and quality issues to technology, and where results and processes aren’t as easily traceable to defects. Revenue cycles also have a giant cyber security target on its back, so IT is becoming more aware of the need to understand and contribute to solutions, especially when they are not the ones delivering them. Technical solutions identified by only one party are also more likely to result in tech debt or unintended consequences. Many other industries that have already solved these challenges are ones that fully understand the user experience.

Revenue cycle and IT teams should develop shared performance metrics that reflect the objectives of both departments to help align their efforts. The impact of IT initiatives on revenue cycle efficiency or an operational team’s contribution to quality assurance can measure the benefits of collaboration and promote shared commitment.

Revenue cycle leaders are uniquely positioned to meaningfully contribute to the digital transformation of the human experience. The collaboration between revenue cycle and IT departments is not just beneficial, but essential. It requires intentional effort to evade the give-and-take mindset that our own balancing acts create. When the great minds of revenue cycle and IT come together, it not only produces a more realistic and impactful technology roadmap, but enables us to innovate better, and faster.

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Aligning professional development and succession planning within revenue cycle management (RCM) begins with getting the right people on “the Bus.” This enhances operational efficiency and accuracy, increases team member engagement, and optimizes revenue capture. Continuous learning and engagement boost employee retention, while effective succession planning ensures leadership continuity and organizational stability. By staying current with regulatory changes, leadership best practices, and technological advancements through curated learning experiences, Moffitt Cancer Center fosters sustainability, innovation, and financial stewardship. 

Advantages of Continuous Learning

The dynamic nature of the healthcare finance industry requires a commitment to continuous learning and improvement. With technological advancements, evolving payer requirements, and a multigenerational workforce, staying informed is crucial for optimizing reimbursement. By staying engaged, our teams quickly adapt to shifting demands while delivering superior service.

Effective talent development and succession planning positively impact revenue cycle management.

The benefits of upskilling existing employees cannot be overstated. It enhances their ability to navigate complex processes with confidence and efficiency. Upskilling fosters a culture of empowerment and engagement, boosting morale and retention. When team members are upskilled, they contribute to improved revenue capture and reduced denials. Overall, investing in the development of existing talent not only strengthens individual competencies but also drives organizational excellence.

Bill Arneson, Director of revenue cycle process and systems support, states, “As Moffitt leaders, we are responsible for building the best team possible… I go beyond resumes and identify internal staff who have the technical acumen and interest to thrive in IT roles. Think of it as the NFL draft. Who are the people with raw talent you can coach and grow into a player who can help your team? There are multiple paths to a successful IT career… I love to encourage staff with operational knowledge and interest to learn technical skills and start a new career path for themselves… Currently, six of my team members were operational staff in a different Moffitt department and are now thriving in IT roles…”

Importance of Succession Planning

Succession planning is crucial for maintaining continuity and expertise within an organization. As experienced professionals move on, organizations risk losing institutional knowledge. Succession planning ensures a smooth transition by identifying and developing internal talent to fill critical roles. By proactively preparing successors, organizations mitigate disruptions, maintain efficiency, and uphold high standards of service delivery. Moreover, succession planning fosters a culture of growth and development, motivating employees to excel in their current roles with an eye toward future advancement.

Succession strategies are integrated with our professional development programs to ensure a holistic approach to talent management. First, we provide development opportunities tailored to the needs of the organization. We, then, identify high-potential individuals through performance evaluations and informal assessments rooted in relationships. Once identified, high-potential individuals are offered opportunities, including mentorship initiatives, cross-functional projects, and committee assignments, aligning individual career aspirations within the organizational context. Additionally, discussions occur regularly to track progress, address gaps, and adjust development plans. By aligning succession planning with professional development, we ensure a pipeline of qualified talent ready to assume leadership roles and drive continued success within Moffitt’s revenue cycle.

Cultivating Talent

Cultivating talent involves intentional practices that nurture employees, preparing them to meet current and future challenges. Our approach encompasses several initiatives and partnerships designed to recognize potential, foster growth, and provide continuous development opportunities.

Our methods involve Super Skip Level meetings, a career ladder system, and an IDEAs Committee. With Super Skip Levels, senior leaders engage directly with employees several levels below them, helping identify and support high-potential individuals who might not be on upper management’s radar. The career ladder system offers opportunities for project-based assignments that are progressively challenging, further assessing skills and leadership potential. The IDEAs Committee allows employees to present innovative solutions to challenges, highlighting their problem-solving abilities and nurturing a culture of continuous improvement.

Two programs support engaged and cooperative learning: Revenue Cycle Energy Bus and the Revenue Cycle Leadership Academy (RCLA). The Revenue Cycle Energy Bus bridges gaps and enhances existing competencies with power skills like resiliency, focus, drive, and positivity, supporting teams holistically. Participants learn best practices in areas including human resources, payer strategies, and more. RCLA further engages existing leaders through formal training, mentorship, and interactive workshops, ensuring a robust pipeline of qualified talent ready to assume leadership roles.

Measuring Success

It all comes down to the Cost to Collect, the metric we use to gauge the realization of optimizing reimbursement to find a cure faster. The lower the Cost to Collect, the more money is invested back into cancer research. Intentional education ensures that every revenue cycle team member understands how their work contributes to Cost to Collect and Moffitt’s mission. By fostering a culture of continuous improvement, Moffitt ensures its RCM team remains focused on reducing costs and enhancing revenue capture, directly contributing to the center’s mission of finding a cure faster.

Overcoming Challenges

Every new leader faces a “storm-form-norm-perform” cycle, highlighting the challenges of leadership transitions. Creating networking opportunities and authentic connections among leaders provides support for these challenges, especially in a remote setting. Collaboration with human resources (HR) on our Energy Bus ensures alignment with business needs.

Continuous improvement is a culture we lean into at Moffitt. We approach everything with a “what could be” attitude, even when we have tenured leaders who are occasionally wary of leaning into the uncomfortable.  

The people-first approach is more than strategy; it’s the culture that drives our Revenue Cycle Energy Bus. By onboarding the right people and providing continuous development opportunities, we enhance operational efficiency, reduce losses, and optimize revenue capture. Cultivating talent and preparing future leaders ensures seamlessness during leadership change and fosters a culture of innovation. At Moffitt Cancer Center, we believe investing in our people is the key to achieving long-term sustainability and success.

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During a recent leadership meeting with our CFO, we were reminded that as quiet as it is kept, an organization’s revenue cycle acts as bookends for the healthcare delivery experience. In a broader context, a person or process representing a healthcare provider’s revenue cycle is often the first and/or last interaction that the healthcare provider has with a customer. The typical healthcare consumer cannot adequately articulate the functional importance of the revenue cycle. However, undoubtedly, it represents the first and final verse of a progression that should flow melodically and seamlessly. This melody can be, and is often easily disrupted, by the complexity involved with navigating and financing healthcare.

Vacillating between the clinical, financial and emotional aspects of the healthcare delivery process can be stressful for consumers and providers. However, healthcare providers understand this conundrum and are laser-focused on developing solutions for improving the Patient Financial Experience. As a revenue cycle leader for 30+ years, I have had the pleasure of seeing firsthand how a high-functioning revenue cycle can improve clinical and emotional outcomes from a holistic perspective. As such, we in the healthcare delivery industry, specific to the revenue cycle, must unapologetically and unabashedly pursue a “put people first” mentality.

A healthcare provider that does not invest in technology on par with other service-related businesses will struggle to sustain itself.

Train, Recognize, Reward and Repeat

I am an unwavering believer that happy team members result in happier customers. Leaders can make the mistake of focusing solely on the “client perception” and completely miss the need to invest in the individuals that drive the customer perspective. When customers present to healthcare providers with what can be life-altering events, I am not naïve to believe that the revenue cycle can make that experience less unnerving. However, I do believe in setting forth robust continual training, clear accountability metrics, along with thoughtful reward and recognition to revenue cycle team members.

Engaged and empowered team members will advocate for the customer and the provider in a symbiotic manner that will create synergy in a way that is impossible to replicate without their meaningful input.

Transparent Financial Assistance and Clearance Programs

When putting people first, an organization must continually review, update and share their financial clearance and assistance policies to meet the real time needs of the customers they serve. Ensuring that communities, advocates and team members understand that financial support programs exist is pivotal. Equally important to stakeholders is knowing that support programs exist and educating them on how to access and navigate these programs. 

Being clear advocates for the customers they serve will help a healthcare provider be more in sync with the customer’s perception of care. Fair or not, we have all learned the hard way that “perception can be as strong as reality”. As healthcare providers, we should attempt to overshare how and why we support the patient’s financial journey with our team members and customers. Having this level of transparency is mandated in some ways, but clearly, customers have come to expect that healthcare providers will go above and beyond the letter of the law, whenever the opportunity exists to do so.

When healthcare providers do not consistently, proactively and deliberately debunk the notion that “they only care about making more money”, the provider does themselves and their customers a great disservice.

Use Technology as a Differentiator

Another way that healthcare providers can put people first in their efforts to support their team members and customers is through leveraging technology. Technology through an organization’s electronic medical record (EMR) can be a tremendous satisfier. A healthcare provider that does not invest in technology on par with other service-related businesses will struggle to sustain itself. A detrimental symptom of this type of stagnant mindset will be the leakage of talent to organizations and industries that are more receptive to technological enhancements. Some ways healthcare providers can and do utilize technology to improve the patient financial experience include:

• Self-Service Registration
• Self-Service Payment Options (Pre and Post Service)
• Self-Service Financial Assistance Application Filing
• Self-Service Cost of Care Estimates
• Self-Scheduling (for limited modalities)
• Billing Process Information on Provider’s Website
• Self-Service Payment Plan Initial Set-up and Update

I don’t need to lament the fact that healthcare finance is complicated, even for those of that are privileged to have chosen it for a career destination. The truth of the matter is that payment rules constantly change, it is challenging to recruit/retain talent in the revenue cycle space, and, yes, unfortunately, shrinking margins are a real thing. Nevertheless, I am totally optimistic that we as healthcare finance and revenue cycle connoisseurs, will adapt to the ever-changing climate. That is to say in no uncertain terms, we must adapt and continue to transform.

With what I’ve been able to share, I’ll end with this thought: “Our customers depend on healthcare providers, rightfully so I must say, to understand the landscape we operate in. We are, I strongly believe, well positioned, like never before, to lead our customers and cohorts through this most difficult of terrains.”

Making these and many more efforts like this a priority has shown that the financial realities do not necessarily have to add to the stress of the healthcare consumer. We can and should instead make things a little easier and provide the benefit of having one less thing to worry about for those we have the privilege to serve!

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In the post-covid world, revenue cycle teams face unprecedented challenges and opportunities. The industry is evolving rapidly, requiring teams to adapt to changing regulations, technologies, and customer expectations. However, many teams struggle with communication barriers and technological inefficiencies that hinder their performance and innovation. How can revenue cycle teams overcome these obstacles and thrive in the new era?

I’m sharing our journey of discovering a powerful solution: integrated leadership. This strategy involves bringing key personnel from external disciplines, such as IT and operations, into our revenue cycle team. By doing so, we have not only bridged communication gaps but also driven significant improvements in efficiency and shortened the path to innovation.

By combining technical, clinical and operational expertise, we have been able to improve our performance, efficiency, innovation, and customer satisfaction.

The Initial Struggle

Our requests for new features or enhancements often took months to be delivered, as they had to go through multiple layers of approval, testing, and deployment. This meant we were always lagging behind the industry standards and best practices, and missing out on opportunities to optimize our revenue cycle processes.

We often felt that our collaborating IT and Operations teams did not understand our goals, priorities, and pain points, and vice versa. There was a lack of trust and communication between the different disciplines, resulting in silos and conflicts. This made it challenging to coordinate our efforts and achieve our desired outcomes.

Many of the solutions we received from our IT team did not meet our expectations or requirements, as they were based on inaccurate or incomplete information. We frequently encountered errors, bugs, and glitches that affected our workflows and productivity. We also had to deal with frequent system downtimes and maintenance issues that disrupted our operations and customer service.

A New Approach

Recognizing the need for a new approach, we hired an IT analyst and integrated them into our team. This individual would attend all our meetings, gaining a deep understanding of our challenges and providing real-time solutions. The goal was to quickly identify efficiencies and improve communication with the IT team.

The results were immediate and transformative. The embedded analyst quickly uncovered missing context in our IT requests and helped bridge the gap between our needs and the technical solutions. This not only enhanced our team’s expertise but also improved our relationship with the IT department, leading to more efficient builds and higher morale.

We also benefited from having direct access to the analyst’s knowledge and skills. Whenever we encountered a problem or had a question, we could consult the analyst and get an immediate answer or solution. This saved us time and frustration and increased our confidence in using the system. The analyst also helped us optimize our workflows and processes, suggesting best practices and tips that improved our performance and quality.

By hiring an IT analyst and integrating them into our team, we achieved a level of collaboration and alignment that was unprecedented in our organization. We broke down the silos and barriers that had previously hindered our progress and created a culture of trust and mutual support. We were able to deliver better results for our customers and ourselves, thanks to the shared vision and leadership of our team and the analyst.

Expanding the Model

We expanded this model to include hiring a seasoned Operations leader. They helped us bridge the gap between our revenue cycle and clinical teams, creating a more cohesive and collaborative environment. By understanding the needs and challenges of both sides, they facilitated communication and alignment, resulting in smoother workflows and increased customer satisfaction. Their presence also boosted the morale and engagement of our staff, who felt more supported and valued by the organization.

As we integrated the operational leader into our team, we saw a remarkable improvement in our performance and efficiency again. They brought a wealth of clinical knowledge and experience that enabled us to tackle complex issues and devise solutions that met the needs of our customers and stakeholders. They also enhanced our communication and collaboration with the clinical teams, ensuring that our revenue cycle processes were aligned and coordinated with their workflows and objectives.

One of the key benefits of having the operational leader on our team was their ability to foster a culture of innovation and learning. They challenged us to think outside the box and find new ways of improving our revenue cycle processes and outcomes. They also shared their clinical expertise and best practices with us, helping us understand and anticipate the needs and expectations of our customers and partners.

The Benefits of Integrated Leadership

In conclusion, the integrated leadership model has proven to be a valuable asset for our revenue cycle operations. By combining technical, clinical and operational expertise, we have been able to improve our performance, efficiency, innovation, and customer satisfaction. We believe this model is the future of revenue cycle management (RCM) and we look forward to continuing to leverage its benefits. The integrated leadership model has enabled us to achieve remarkable results in our revenue cycle processes. By having leaders with non-traditional skills, we have improved our quality, productivity, creativity, and communication. This model has also enhanced our alignment and collaboration with the external teams, ensuring that we deliver optimal value to our customers and stakeholders. We are confident that this model will help us maintain and strengthen our competitive edge in the market.

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