Blog, The Hospital Finance Podcast®

How the Attrition of Billing Staff Impacts Both Practices and Billing Services [PODCAST]

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In this episode, we are joined by Susan Kohler, Senior Vice President of Revenue Services at Greenway Health, to discuss staffing challenges in health care and alternatives available to lessen the impact.

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Highlights of this episode include:

  • Staffing challenges
  • Burnout among clinical staff
  • Outsourcing revenue cycle management
  • Automation
  • Long-term advice

Mike Passanante: Hi, this is Mike Passanante and welcome back to the award-winning Hospital Finance Podcast. It’s no secret that labor shortages and rising labor costs are plaguing the healthcare industry right now. Today, I’m joined by Susan Kohler, Senior Vice President of Revenue Services at Greenway Health, to discuss these staffing challenges and alternatives available to lessen their impact. Susan oversees operations for Greenway Revenue Services and Greenway Clearinghouse Services, engaging with clients to understand their needs with a goal to deliver the best revenue cycle experience possible. Susan, welcome to the show.

Susan Kohler: Thank you, Mike. I’m glad to be here today.

Mike: So, as we were chatting offline right before the podcast started, this is a topic that is extremely hot right now and sort of permeating the industry. So…can you talk with us a little bit about the staffing challenges that you’re seeing in healthcare and the impact that’s having on revenue cycle teams?

Susan: Yes, it’s actually a very hot topic with our clients today. Not only are ambulatory practices faced with shortages of clinical staff, they’re also finding challenges with keeping their office staffed to be able to handle the administrative functions of their practices. It seems to be pretty widespread in terms of the challenges that our practices are seeing, I even recently went to my primary doctor and asked them, “How are things going in the office in terms of support funding staff?” and they reiterated the same message I’m hearing across the industry, “We don’t have enough people. We’re working overtime. We previously could never work overtime, but now we’re working more hours, long weekends into the night.” And this is a pretty consistent theme whether you’re talking Ambulatory practice or even in a hospital-based practice.

Mike: And certainly we’re hearing about burnout among clinical staff, right, and after the pandemic and they’re looking for other things to do and maybe in other industries. But are you finding that non-hospital opportunities are draining otherwise qualified staff from billing departments and revenue cycle teams as well?

Susan: Oh, absolutely. We actually see that the people that used to staff the offices are saying, “I don’t want to do that.” One of the interesting challenges we’re seeing as well is many businesses now are saying, “Hey, you can work remote,” which is also a huge challenge for the ambulatory practice market where they want the staff to be sitting in the physical office. And people are saying, “I don’t want to do that anymore. I have too many other opportunities for other jobs in healthcare industry. And using my experience, and I can work remote from home. I can have a more flexible schedule,” which, as you think about office practices, they’re standard what I would call banking hours, 8:00 to 5:00, Monday through Friday. It’s difficult to have some flexibility if you have to take care of personal business, take care of family members, etc., and because of that, we’re seeing staff that would otherwise work in the doctor’s practice are saying, “I’m looking for other alternatives where I can work remote, have a more flexible schedule, but still apply my clinical or healthcare knowledge.”

Mike: Interesting. And certainly there’s a lot of debate about outsourcing revenue cycle management. Susan, how can an outsourced revenue cycle management support facilities that are currently struggling with these types of impacts among the billing staff?

Susan: Well, one of the advantages of being an outsource is that we’re not bound to the 8:00 to 5:00 that we just talked about or even saying you have to be physically in the office to do the work. We have the technology and tools that individuals can literally work globally. So you can tap into a global market for resources. So you’re not simply restricted to your 25 miles radius of the office that you’re working in, you actually can pull in resources. And when I say globally, literally globally where there are resources across the world who understand US healthcare markets, and in an outsourced model, you can manage remote workforce anywhere, anytime. So we can actually tap into those very resources that the practices are having a difficult time hiring.

Mike: Absolutely. And another topic that’s hot in revenue cycle right now is automation and trying to get things done more efficiently through automation. Susan, can you talk to us about how using people in conjunction with automation is benefiting the revenue cycle?

Susan: Yeah. Automation is really hitting on the cusp right now of revenue cycle. And there’s actually two approaches to automation. There’s what they call bots that can do some of the repetitive tasks. But now we’re seeing advances in artificial intelligence where the computer can see patterns before a human being can see patterns. So when you take those two things, combined with a person, you have the most ideal state for improving quality and overall production for your revenue cycle. When I talk about artificial intelligence for things such as let’s say prior authorization services which is really a challenge in the revenue cycle, getting the right documentation to the payer to get prior approval so you can, on the ultimate end, collect against the procedures that you’re performing. Some of the AI technology that’s out there right now understand the patterns of approvals from carriers. They can prepopulate the forms, pull the correct records, and submit that on your behalf to the [pair?] which really significantly reduces time. On the other side, the bots can do some of the repetitive tasks, which means you need fewer people to manage your revenue cycle process. And then you take the people and really focus them on the critical components of revenue cycle, the, “How do you resolve a claim that’s been denied? What is the issue? Do you need to appeal it? Do you need to recode the claim?” So you’re really taking the people, combined with the automation and artificial intelligence to improve quality and overall productivity.

Mike: Got it. Susan, what long-term advice do you recommend to providers that are experiencing billing staff attrition?

Susan: I look at it from a couple of perspectives. One, understanding what is the actual cost that they are seeing in terms of impact, so what are the losses they’re experiencing as a result of attrition, because they are not then getting claims submitted timely, they’re losing revenue. When you think about that compared to then the cost to find recruit train, if as a provider those costs far exceed what you would want to conceivably pay on an ongoing basis, you want to consider other options, looking at another outsourced company, talking to even global vendors that could perform the services for you, but really being able to say, “I’m not a practice who’s in the business of hiring billing staff. I’m in the practice of taking care of patients and really improving health outcomes for them.” So sometimes you need to take a step back and say, “For the cost I’m paying, does it make more sense to let others who are good at this do it on my behalf?”

Mike: Great advice, Susan. And if someone wanted to learn more about Greenway Health and what you do there, where can they go?

Susan: Oh, we have many places to go. We have user exchanges that you could potentially participate in with our staff. You can go to, browse our site, and even chat live with one of our associates.

Mike: Susan Kohler, thanks so much for joining us today on The Hospital Finance Podcast.

Susan: Thank you so much. I really enjoyed the time today.

[music] This concludes today’s episode of the Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit The Hospital Finance Podcast is a production of BESLER, SMART ABOUT REVENUE, TENACIOUS ABOUT RESULTS.


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