July 16, 2019 — Today marked my biggest Team Rady visit to date! I headed over to our Copley office to meet with more than 150 members of the seven teams (12 with sub-teams) responsible for all aspects of revenue cycles within Rady Children’s. Sprinkled between Hawaiian-themed décor, each team had set up individual stations with posters, fun visual aids and treats (so many, many treats) to help me learn more about what they do to support the Rady Children’s mission. With Michael Hester, senior director of revenue cycle, acting as my guide, I prepared for my tropical tour of “Copleyland.”
Team 1: Patient Financial Services
Within PFS, there are five sub-teams: customer service, commercial, government, HomeCare and support services. The customer service team handles both inbound and outbound questions and concerns surrounding patient billing, and prides themselves on accountability and teamwork. “We try to do the best that we can with everyone,” one team member said. “We never say, ‘sorry, that’s not my job.’” What a great example of how we can approach complex, often stressful subjects with our patient families.
Commercial team members ensure Rady Children’s is properly reimbursed for services from private insurance providers, and I learned each employee typically handles about 40 accounts. On any given day, team members field upwards of 15 calls each, addressing important issues such as denials and credits. The commercial group also collaborates to automate follow-up systems, which helps to streamline both their job duties and providers’ processes for reimbursement.
The government team has similar responsibilities, but works with very different payors — entities you would expect given their subject area, such as Medi-Cal, Medicare and the VA, and many more you may not, including Aetna, Blue Shield and Kaiser. Team members told me their scope of work reaches far beyond California, spanning the United States and even into other countries! Their number-one goal is achieving what they call “clean claims,” and each person handles between 50 and 60 every day, which is no small feat. No wonder their stamp reads, “In the Government Billing and Reimbursement Team We Trust.” Check out their awesome 3D poster, which a staffer’s talented son helped to create.
On the HomeCare side of operations, employees do everything “for the love of the kiddos” as they handle claims and billing for patient families in Rady Children’s HomeCare programs in San Diego and Orange County. It was amazing to learn how many families these programs help, and encouraging to meet the folks dedicated to making them work behind the scenes. Since HomeCare shifted over to operate under Rady Children’s Health Services, they’ve been staying extra busy, and are hoping to accomplish a HomeCare billing tie-in with Epic in the future.
Last but not least in the PFS family is the support services team. Its seven members lend a hand to the Hospital’s operations by making sure important financial and insurance records make their way into patients’ EMRs in a timely and accurate fashion. Their diligence helps our medical staff provide efficient care, our clinical service or customer service representatives assist families with questions or concerns … the list of essential tasks they help make possible goes on.
Team 2: Central Authorization Unit
The central authorization team oversees Hospital billing for surgeries (with the exception of cardiovascular surgery), transplantation, EEG, inpatient and hematology/oncology services across 17 specialty areas. While team members have myriad responsibilities within their individual roles, they all come together to obtain authorizations for essentially all inpatient services rendered at Rady Children’s, and to make sure claims match up and can close smoothly. I was amazed to hear that in fiscal year 2018/19 alone, they had more than 5,500 authorizations come across their desks. That’s a lot of attention to detail and a lot of kids given care, especially when combined with the work of the outpatient CAU team! I felt like one of the CAU bunch when they gifted me with a team shirt. Got auth?
Team 3: Charge Descriptions Master
At the CDM station, the “queen” and “mayor” of the team (aka Rose Marie Johnson, revenue integrity and CDM specialist, and Tracy Muenz, revenue integrity and CDM manager, respectively) greeted me to walk me through their “territory,” dubbed Revenue Heights. Tracy said of his team, “For a small group of people, we’re doing a great many things.” I couldn’t agree more! CDM staffers are in charge of all of the Hospital’s revenue, and interface with every single revenue-generating department we have. They showed me a sneak peek at a new, daily “rolling report” they will soon start sending out to key leaders, which they aim to use as a tool to immediately pinpoint — and subsequently address — any discrepancies. “Leadership can see right away if there’s an issue,” Tracy explained. I felt pretty special to be one of the first to see this new tool, and impressed by the level of ownership and strategy behind it.
Teams 4 and 5: Quality Assurance and Training
These two teams presented together as “The Twin Cities,” so I thought it was only right to keep the sentiment going here. They told me their shared logo, a bridge (check it out in their stamp below), represents how all members unite to collect, report on and help colleagues learn from key quality data. The QA team reviews about 3,500 patient accounts each month to help safeguard against errors in data that can lead to payor denials and reduce Hospital revenue. The training team then takes important findings and incorporates it into education exercises, both introductory sessions for new staff and ongoing training for existing staff. It was neat to see how they strive to make trainings easily accessible through computer applications, and I even got to try my hand — or should I say, my voice — at recording a mock session intro on their trusty microphone, Snowball. I loved the level of collegiality I saw in just a few minutes with this team.
Team 6: Revenue Cycle Applications
Michael and Chandramouli Pottu, director of revenue cycle applications, stuck with me as I made my way around three revenue cycle application stations.
As I snacked on some incredible homemade fudge at the project management and development team’s table, they filled me in on their main responsibility: “enhancing and sustaining the economic health of Rady Children’s.” They work with more than 20 departments to automate processes for negotiating contracts, posting payments, updating electronic claims and patient portals — and that just scratches the surface. They noted their team excels at jumping in when and where they’re needed, even if it’s not in their day-to-day job description. That seemed to be a common theme I was very happy to hear about again and again during my day with the larger revenue cycle group.
The business application team had a great Avengers theme at their station — because they focus heavily on Epic, they dubbed themselves “The Epic-engers.” I learned these heroes use their superpowers to process incoming PFS and management requests and find a speedy solution that sets a future precedent. “Hopefully, we never have the same issue again!” a team member explained. Before tackling tasks such as addressing charging and billing issues, handling proration, and providing rates and codes for contracts, the team said they start off most days with a quick Nerf Gun battle. All I can I say to that is … when can I stop by?
I then visited the five-member auditing and compliance team. Comprising nurse auditors/medical auditing specialists and billing/compliance specialists, this team works with the Hospital’s clinical departments to screen bills, correct medical coding, research regulations and, of course, conduct audits. They also make themselves available to attend committee meetings and connect with their clinical liaisons in person to keep up a strong rapport. It’s always a pleasure to see teams from all over the organization working together!
Team 7: Underpayment Unit Review and Denials Management
My introduction to this team was “we find the money for the Hospital,” so their interactive “Where’s Waldo?”-inspired display was spot-on. These folks reach out to payors to handle financial challenges such as refunds, contracting issues and denials, and strategize to prevent similar situations in the future. I learned that in fiscal year 2018/19, their efforts recovered more than a million dollars for Rady Children’s! That’s something to celebrate — and celebrate we did, with a custom lei crafted from $1 million in 100 Grand candy bars for me to keep (or eat) as a souvenir.
With 12 stamps and a very full stomach, I waved goodbye to the multitalented revenue cycles team. Thank you for all you do to serve our patients and your colleagues, and for working hard to protect Rady Children’s revenue!