More on Revenue Cycle Management

Riverside Health System calls 2020 one of its most improved revenue cycle years to date

The system made no furloughs as a result of COVID-19, was able to give bonuses and raises, and is on track to meet its financial baseline.

Mallory Hackett, Associate Editor

Photo courtesy of Riverside Health SystemPhoto courtesy of Riverside Health System

Newport News, Virginia-based Riverside Health System is coming out of 2020 able to say that it had one of its most improved collection, performance and revenue cycle years to date.

The health system, which runs five acute care hospitals, one behavioral health hospital and two specialty hospitals, made no furloughs as a result of COVID-19. It was able to give out regularly scheduled bonuses and raises and is on track to meet its financial baseline, according to Charlie Graham, the vice president of Revenue Cycle at Riverside Health System.

"Now of course this is not the best year we've ever had, because we lost so much revenue when the elective [procedures were canceled]," Graham told Healthcare Finance News. "But as far as revenue cycle itself showing improvement, it has been one of our biggest years of improvement."

HIMSS20 Digital

Learn on-demand, earn credit, find products and solutions. Get Started >>


At the beginning of the pandemic, Riverside's leaders made a commitment to its staff that, instead of getting rid of positions, the system would prioritize repurposing roles. So when certain positions were left less-impacted than others, Riverside moved people into positions that would best enhance the revenue cycle.

"Our theme, in general, was protecting our workforce, because we knew there was going to be a surge and that we wanted everybody to be in a good place, well taken care of and ready to go. And now it's happening," Graham said.

The system's success this year goes beyond reconfiguring its personnel. A major focus has been creating customer satisfaction throughout the care journey.

"We want to be sure that patients get the same level of service and compassion from their billing experience as they do on the clinical side," Graham said. "And that's a difficult thing to achieve these days."

One of the biggest obstacles to this is the shift of patients having high-deductible health plans, according to Graham.

Enrollment in high deductible plans has increased over the past five years, going from 24% of covered employees in 2015 to 31% in 2020, according to the Kaiser Family Foundation.

Graham says this has led to more patients not expecting to need clinical care and then struggling to pay their self-responsible balances, especially during the pandemic.

"We saw seven-digit totals of increases year-over-year of how much patients owed after insurance paid. It's very significant," he said.

One of the biggest undertakings his revenue cycle team took this year was around price transparency.

The system now has more than 420 services and procedures that patients can view to help them shop around for care, another major trend of the past year, Graham said.

Riverside uses Epic to compare its price estimates to the actual price of the service and also to the system's peers.

All of this goes into how the system communicates with its patients on the price of a service. It is working to find a balance between sharing possible unforeseen costs during a procedure with the base estimate.

"We're trying to figure out exactly how to manage that because we don't want to scare a patient, but we also don't want them to be surprised by something that came true that was different than what we talked about," Graham said.

To manage this, Riverside recently partnered with Visitpay to personalize the patient billing experience.

"That actually customizes an offer to a patient based on their wherewithal to pay," Graham said. "Because really what we want to do is meet a patient where they are, not tell them what our payment plan is."

An additional aspect of meeting a patient where they are has been shifting more towards online communications.

"You have patients that have an increased desire to deal with us electronically," Graham said. "They want to deal with us on their smartphone. They don't want to get a paper statement. They want to deal with it online."


As many other financial leaders, Graham is looking for ways to implement automation into Riverside's revenue cycle.

"We have tens of thousands of transactions that are relatively low dollar, and where you have to do relatively the same thing to fix them," he said. "And so that is a perfect space for AI."

There can be as much as $200 billion in administrative waste in the American healthcare system due to inefficient revenue cycle practices, according to a HIMSS20 Digital presentation.

Data shows that implementing artificial intelligence into revenue cycle management can increase productivity, reduce low-value inputs and open up time for more meaningful activities and special projects.

Robotic process automation saved Moffitt Cancer Center in Tampa, Florida about 27,000 hours a month in work hours, which correlates to around $500,000, according to Lynn Ansley, senior director for Revenue Cycle. Automation and AI in the revenue cycle is where most hospitals are headed, though getting there requires a great deal of investment.

"But the thing of it is finding a tool and standing up the resources to do it and developing a team. It takes time," Graham said. "And frankly I believe we're a little behind the curve on that, but it's a big land of opportunity."

He said that the system is currently in talks with vendors to get AI implemented into Riverside's revenue cycle in the future.

"We're just focused on the consumer and trying to improve their experience. We want to make sure that finances don't get in the way of healing. If the finance piece of it is keeping them from getting needed service, or if it's creating surprises and stressors that are interfering with the healing, we just haven't done the best job we could."

Twitter: @HackettMallory
Email the writer:

Taking Stock of Progress and Looking Ahead

This December, we look back at a challenging year – and forward to what we hope is a better, stronger, more connected and resilient healthcare ecosystem.