Clinically driven revenue cycle helps increase charges by $39.6 million

St. Joseph’s Health, one of New Jersey’s largest safety-net health systems, faced revenue cycle challenges stemming from fragmented tools and outdated processes.

“Our revenue cycle was not closely tied to care or documentation,” says Mike Alwell, vice president, revenue cycle. “We wanted to connect the entire system and create a true clinically driven revenue cycle.”

Leaders knew they’d need support from physicians whose clinical work and documentation would be a primary source of revenue cycle input.

As the academic health system transitioned to Oracle Health revenue cycle and clinical solutions in December 2018, leaders developed a cross-functional Revenue Cycle Collaborative team that included physician leaders as well as representatives from information technology and physician billing.

“Our goal was to empower physicians to know how their work directly affects revenue,” says Beth Kushner, DO, chief medical information officer. “Medical coding is complicated, and it’s critical that we get it right. Small differences in the accuracy of documentation can create huge differences in reimbursement.”

All physicians received education on the importance of complete, accurate, and detailed charting. Newly employed providers heard presentations from colleagues representing each step of the revenue cycle process—from certified coders to the CMIO. Residents and fellows also learned how components of medical documentation contribute to billing.

“This education is a critical part of the Accreditation Council for Graduate Medical Education curriculum,” says Sonia Restrepo, director, physician financial services. “Allowing residents to propose charge orders helps them become competent physicians.”

Established physicians also reviewed key performance metrics as part of their departmental meetings.

“I’ve seen physicians have ‘lightbulb’ moments during these meetings. When they visualize the entire revenue cycle, the financial implications of their documentation become tangible. Many physicians appreciate that transparency,” says Restrepo.

Project teams created autotext templates for common procedures, all pre-verified by coders to meet billing requirements. Additional autotext entries help attendings quickly attest to their residents’ work—a requirement for proper billing.

Using Oracle Health clinical and revenue cycle solutions to help improve charge capture, correct fragmented processes, and educate providers, St. Joseph’s Health increased charges by $39.6 million, or 19.7%, from 2018 to 2019.[1]

“As a safety net hospital, it’s vital that we charge accurately for the care we provide,” says Alwell. “Focusing on our financial health helps us continue to provide care for people who couldn’t otherwise afford it.”

The organization’s revenue cycle improvements helped patients in other ways, too.

Eligibility checking functionality, built into Oracle Health revenue cycle solutions, help staff determine whether ambulatory patients’ insurance will cover their care, before scheduling an appointment. The functionality expedites scheduling and, in many cases, allows staff to inform patients of their copay and other charges before they arrive.

“When we reduce friction associated with billing and paying for services, it allows us to focus on what’s most important—supporting the health of our community and delivering the best possible care to our patients,” says Kushner.