Leaders at Carolina Community Health share their experiences on outsourcing revenue cycle management processes to ensure the success of the organization.
Among the top concerns for chief financial officers (CFOs) and vice presidents (VPs) of revenue cycle these days are labor shortages, increasing costs, insufficient capacity causing care delays, and recession. Creating and running an effective revenue cycle takes a village. That is why leaders at Carolina Community Health in North Carolina knew they had to outsource some of its revenue cycle processes to ensure the success of their organization.
In a recent survey of 205 CFOs and VPs conducted by R1 RCM, results revealed that over 90% of respondents said they believe the return to routine healthcare post-COVID will put additional strain on their departments.
There are several areas within the revenue cycle that could benefit from streamlining, from better patient access processes to fewer coding denials, but one area of focus most important to Carolina Community’s Matthew Ury, COO and Humi Maytoyama, interim CFO that is becoming more common is the need to reduce accounts receivable days in the billing department. Outstanding accounts receivable in healthcare directly affect a hospital’s bottom line.
Some common healthcare accounts receivable days benchmarks are:
- High performing: 30 days or less
- Average performing: 40 to 50 days
- Below average: 60 days or more
As the accounts receivable days for Carolina Community Health were below average for the last six months, hospital leaders knew the organization needed to reduce these days and rework the management of denied claims and additional inefficiencies, to climb out of the ashes and thrive.
After drafting many possible solutions, their team realized that partnering with an experienced group of revenue cycle professionals was the best way to handle the complexities of today’s revenue cycle management needs.
Maytoyama and Ury recently spoke about their experiences as leaders at one of the most coordinated, community-oriented, patient-centered health centers in the Carolinas and their two most important lessons learned in enlisting a third-party expert for help with their revenue cycle challenges.
Lesson 1: Enlist a Revenue Cycle Expert
Carolina Community Health is comprised of 65 physicians and 17 specialties including an endoscopy center, urology, cardiology, diagnostic imaging, and orthopedics and sports medicine services.
Despite a strong focus on healthcare excellence for every patient, one issue remained: a lack of an experienced revenue cycle management team that could ensure that basic financial obligations were being met and optimized.
In 2019, after a year of research and phone interviews with third-party payers, Maytoyama and Ury’s board of directors brought on Solutionreach to help with multiple deliverables, including:
- Charge entry
- Denials management
- Accounts receivable follow-up
- Claim edits
- Patient posting
- Physician education
“As key leaders, I felt we need to do a better job of handling revenue and need the right level of technical know-how to do it,” Ury said. “We just couldn’t seem to find our base and stay consistent without their help.”
Once the new revenue cycle management team hit the ground running, positive results ensued quickly across each area.
“In addition to improving the financial stability of accounts receivable, the biggest take away I learned was that we can train a dedicated admin to act as a bridge and share certain responsibilities with the payers. Strengthening these relationships and having a direct communication line in this way has proved extremely effective,” Ury said.
In addition to outsourcing an experienced staff, Carolina Community Health implemented the use of automated revenue management tools to assist with the capture of revenue that would otherwise be missed. The cloud technology is used to assist with closing care gaps and improve patient engagement and communications.
Lesson 2: Patient Experience is Forefront and Center
While having an experienced partner was one side of the equation, the other side that was equally important to Carolina Community Health was the ability to combine the best workflow methods internally while enhancing the patient experience.
Before all processes could be improved, dedicated admins needed to be properly onboarded and trained in conflict resolution and service recovery methods. Ury made it clear to the team that this process should not degrade patient experience or continuity of care in any way. “We need a seamless process,” Ury said.
“One of the great things about bridging the gap between providers and payers is it means a constant strengthening of relationships that not only positively affect the organization but the community as well.”
Carolina Community Health is the primary source of care within three counties, it’s imperative that every patient receives the ultimate in care and experience. Patient experience must be the driving force.
“Having a stable revenue cycle management team doing the heavy lifting in the background getting the bills out the door accurately, completely, and efficiently, and payments are being made timely allows us the freedom to focus on other critical areas concerning direct patient care.
Reiterated Maytoyama, “I feel better knowing our coding, accounts receivable, and posting components are optimized and running efficiently.”
Bringing in a third-party vendor may not be viable for every organization, though, Ury and Maytoyama say that they hope their lessons learned can be applied and help other health executives struggling with similar revenue cycle challenges.
Since outsourcing its revenue cycle management processes, Carolina Community Health has seen a reduction in accounts receivable days from 60 to 46, thus reducing the time it receives payments from insurance carriers. Aged accounts receivable days greater than 120 days have been reduced by 13%.
“Processes we had in place before partnering with our vendor were poor and we just couldn’t get the needle to move significantly,” said Maytoyama. “We still have a long way to go in reducing our AR days but with the significant improvements we have put in place regarding reworking denials, reducing accounts receivable days, streamlining our charge entry process, and having a dedicated representative to work with our payers and share the duties, we are well on our way to navigating the complexities of healthcare a little easier.”
- Evans, C. (2022). Survey: These are healthcare CFOs biggest fears. https://www.fiercehealthcare.com/payers/report-health-cfos-fear-recession-staff-shortages-patient-strain
- Maytoyama, H. (2022, July 28). Personal communication [phone].
- Ury, M. (2022, July 29). Personal communication [phone].
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