Revenue cycle management includes financial activities like billing, coding, insurance checks, collections, and following up on payments. Hospitals and clinics often have problems such as slow claim processing, low insurance verification rates, poor charge capture, and trouble working with insurance contracts. Many of them used outsourcing partners to handle these tasks. Outsourcing can cause communication problems, reduce control over money matters, and delay payments after services are given.
Connecticut Children’s Medical Center (CCMC) in Connecticut is a 187-bed children’s hospital and a main teaching hospital for the University of Connecticut’s Department of Pediatrics. In the past, CCMC outsourced much of its revenue cycle work. But the leaders wanted to take these jobs back in-house to improve patient financial services, make staff more productive, and better connect billing with clinical work.
CCMC worked with Huron, a healthcare consulting company, to bring all revenue cycle management back inside the hospital. They wanted a clear, internally handled revenue cycle backed by new technology, including a new electronic health record (EHR) system. The EHR helped connect clinical documents with billing, making work smoother and communication faster between teams.
Key parts of CCMC’s plan included:
By bringing revenue cycle tasks inside and adding the EHR, CCMC gained several financial benefits:
Staff productivity rose by 80%, letting CCMC do patient access work further ahead of time. They also created new jobs equal to 2.5 full-time employees for follow-up work to keep revenue strong.
With faster and more accurate revenue cycle work, 98% of insurance checks were correct. This led to fewer payment denials. Improvements in charge capture made sure all emergency and observation services were correctly recorded and billed.
Technology played a big role in CCMC’s revenue cycle improvements. Using the EHR system helped clinical and financial data move freely, removing blockages caused by separate systems. Special reporting and workflow tools let managers track staff work, patient access, and financial results nearly in real time.
The EHR was not just for documents. It was an operation center where billing triggers were automatically set based on finished clinical visits. This helped CCMC’s revenue cycle stay stable after switching to the new EHR, avoiding common problems that happen to other hospitals during such changes.
Artificial intelligence (AI) and automation tools are quickly becoming common in healthcare revenue cycle management. These tools help with front-office jobs, patient communication, and claim handling. For example, Simbo AI offers phone automation and answering services using AI, which can improve how clinics handle patient calls and admin tasks.
AI helps by:
Healthcare leaders in the U.S. who use AI tools like Simbo AI together with EHR and revenue cycle tech can improve front-office work, lower costs, and offer better financial services to patients.
The CCMC case shows that using EHR with changes to revenue cycle operations can lead to better financial results. Practice managers and IT leaders should think about adding AI to front-office work. When EHR systems work with AI automation tools, benefits include:
By blending these tools, healthcare groups can use fewer manual processes that often slow down billing and collections and cause errors.
CCMC’s choice to bring revenue cycle jobs back inside and use a new EHR shows a trend in U.S. healthcare. Outsourcing some financial services might seem easier at first, but handling these jobs internally lets hospitals keep better quality, respond faster to problems, and better connect clinical care with money matters.
This is important especially for children’s hospitals and medical practices. Accurate billing linked to actual care can directly affect income. Better charge capture and quick insurance verification reduce lost money and make sure claims meet payer rules.
Hospitals and clinics should consider working with consultants and technology vendors who know both clinical and financial work. These partners can help design revenue cycle systems that fit well with EHRs and change with healthcare rules.
Healthcare leaders in charge of revenue cycles can take these points from CCMC’s experience:
This mix of technology and internal process change offers a good example for medical centers and clinics in the U.S. trying to improve their revenue cycle systems.
By learning from CCMC and using EHR and AI together, healthcare groups in the U.S. can improve revenue cycle results, offer better financial services to patients, and keep their finances strong over time.
CCMC historically outsourced a significant portion of its revenue cycle functions and aimed to bring more of these activities in-house while implementing a new electronic health record (EHR).
Huron collaborated with CCMC to design and implement an infrastructure that allowed for efficient insourcing of revenue cycle processes, ensuring seamless integration with the new EHR platform.
$4.7 million in annual recurring benefits, $5.6 million from renegotiated managed care contracts over three years, and $3.1 million in cash acceleration.
By implementing a new revenue cycle operating structure with clear benchmarks and productivity standards, Huron achieved an 80% increase in productivity and allowed staff to work five days ahead of service.
CCMC increased its insurance verification rate to 98% of insured patients, enhancing the documentation of notification, verification, and authorization of benefits.
Charge capture practices in the emergency department and observation services were improved through nursing education and step-by-step management of renegotiated managed care contracts.
Huron worked closely with CCMC and the EHR vendor to ensure that revenue cycle tools integrated seamlessly with the new system, stabilizing operations post-conversion.
Connecticut Children’s Medical Center is a nationally recognized, 187-bed not-for-profit children’s hospital and serves as the primary teaching hospital for the University of Connecticut School of Medicine Department of Pediatrics.
CCMC insourced all patient financial services, including billing and accounts receivable follow-up, which led to improved tracking of patient access performance outcomes.
Technology played a crucial role by providing proprietary reporting solutions and workflow technology to track performance outcomes and facilitate integration with the EHR system.
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