The billing team at Tucson Gastroenterology was meeting a bar of excellence, according to Julie Wester, contract administrator at the Arizona-based specialty practice. But that bar was threatened when long-time staff members were starting to retire.
“Some people had been there for a long time, like 19 years, and they were retiring and moving on,” Wester recently told RevCycleIntelligence. “We were losing some key billers that had known the practice and were leaving in 30 days times.”
Staffing, in general, has been a major challenge for healthcare organizations coming out of the COVID-19 pandemic. The stress from addressing a global pandemic has pushed more healthcare professionals to retire or even leave the industry. Meanwhile, significant reductions in patient volumes and therefore revenues forced many organizations to downsize non-essential staff, some temporarily and others permanently.
Moving on from the thick of the pandemic, practices especially are having to reengage not only their patients but their staff. But finding qualified healthcare professionals to manage aspects of healthcare like revenue cycle has always been a challenge, especially for a specialty practice.
“Everything in healthcare is very specialty-driven,” Wester explained. “So we’re pushing through the claims and if you’re not really attuned to your specialty, its coding, and how things are processed, it can fly under the radar.”
Revenue cycle outsourcing, though, has supported practices like Tucson Gastroenterology with maintaining a high-performing revenue cycle without a full team on-site.
“We have a conversation about what kind of partnership we could build,” Wester explained.
Wester had already worked for a practice that had outsourced revenue cycle management to a third-party company, although for a different reason. “In that situation, there was an environment where the internal billing team was not up to excellence standards,” the contract administrator stated.
That experience, though, opened the door to getting help in “not trying to build an internal billing team to meet standards that had been there for so long but to bring in the experts, as well as to take it that off our plate, so that the team on-site could focus on getting all the information more accurately for the billing specialists to make the process more effortless.”
Tucson Gastroenterology tapped its EHR vendor Greenway Health to help to take over processing claims and other revenue cycle management tasks.
“We use that EHR system for our billing aspect, all of our documentation. And they know their system better than we will ever learn their system. That right there is the number one reason why we chose to use [Greenway Health] over another opportunity,” Wester said.
The support available was also a contributing factor. The EHR system is central to the practice’s operations, be it clinical or financial, so being able to tap into the expertise of the EHR vendor has been like “an infinite resource of availability,” Wester said.
“The more that they see us knowing the best practices, using their system including in revenue cycle management, the closer we are to meeting that bar of a hundred percent.”
Achieving a perfect clean claim rate may be a stretch for any practice but revenue cycle outsourcing was the key to getting to that top-tier for Wester.
“People want to strive to be in the top 10 percent, but that’s a pretty wide variable,” Wester said. “Why not be in the top 1 percent?”
Revenue cycle outsourcing is helping Tucson Gastroenterology bridge those extra percentage points by “improving internal operational efficiencies while increasing the transparency into the financial health of the practice,” which has always been a priority but was difficult to execute, Wester explained.
The strategy also leverages experts who specialize in certain areas, which is key to realizing success, according to the contract administrator. “The way you accomplish that extra 10 percent is becoming specialized.”
Revenue cycle outsourcing companies specialize in software and solutions that optimize billing workflows for the best outcomes. So shifting billing to billing experts made sense for Tucson Gastroenterology, which now has more time to do what it specializes in: delivering high-quality GI care.
Since outsourcing billing, the practice had the capacity to improve other aspects, such as front desk check-in processes, while Wester has been able to focus more on the bigger picture as contract administrator.
“It’s like running a well-oiled machine for that one of many areas that an administrator has to keep an eye on,” Wester said.
But revenue cycle outsourcing isn’t a one-and-done implementation process. Wester is still focused on “specializing” by working with the practice’s revenue cycle outsourcing partner to ensure they have staff who understand the nuances of GI billing and revenue cycle management.
“It’s really important that we have an advocate, a specialist, who knows this site and can answer questions because one of the most frustrating things is if a key player can’t answer questions and you get routed to a 1-800 number. To me, that’s the least effective way,” Wester said.
Account managers are critical to overcoming this major challenge of revenue cycle outsourcing. Additionally, communication is important.
The billing team is in frequent communication via email with outsourced billers to resolve accounts. Then, the practice also has weekly calls to catch potential revenue leakage issues early.
At the end of the day, Tucson Gastroenterology may have lost key players on their internal billing team but it has gained new partners to fill those gaps and increase efficiencies. And fostering that relationship, as with any partnership, is key to success.
“It’s about constantly tweaking and reviewing the processes,” Wester said. “But that term partnership is really key.”