In 2016, reimbursement and general market changes had Birmingham, Alabama-based UAB Medicine facing multiple revenue cycle management (RCM) challenges at both the hospital and physician level, including the following:
A lack of communication and integration led to higher-than-desired initial denials and write-offs.
Hospital leaders were challenged with accurately measuring and tracking revenue cycle performance.
While revenue cycle key performance indicators (KPIs) were reported, additional analytical views were needed to use the data to improve performance.
Although UAB Medicine had a high-performing revenue cycle, leaders knew continued performance improvement would require a comprehensive focus on RCM enhancement. It would also depend on heightened collaboration between hospital and physician operations within UAB Medicine.
UAB Medicine expanded its partnership with Guidehouse through a comprehensive RCM initiative to improve hospital and physician revenue cycle operations and performance. The goal of this seven-year collaboration was to streamline all functions related to processing and payment of medical claims and promote greater collaboration, transparency, and consistency.
The initiative went live on Oct. 1, 2016. The initial phase included UAB Hospital and UAB’s faculty practice plan comprising more than 1,000 physicians across the state.
For UAB Medicine, one of the first steps in achieving financial improvements was to break down silos — not only between hospital and physician revenue cycle operations, but also within each segment. To address this, UAB Medicine established a new RCM governance structure composed of:
An executive committee responsible for setting and reviewing strategy, operations, and any fundamental changes in governance structure.
A program committee of key stakeholders throughout the system that reviews ongoing operations, with subcommittees focused on specific areas of opportunity.
A revenue cycle committee responsible for problem awareness, action plans and monitoring, idea sharing and generation, benchmark monitoring, goal setting, and more.