The following is a profile of just one of the thousands of revenue cycle leaders at healthcare providers across the U.S. I'd like to thank Amy Bigbee for generously offering her time to provide her insights. If you are a revenue cycle professional at a healthcare organization and would like to participate in a profile like this, please contact me. I would love to hear from you.
What's your name, organization & position?
Amy Bigbee, Innovative Practice Services, McKesson Specialty Health
What’s your role at McKesson Specialty Health?
I solve revenue cycle issues for our customers in specialty medical practices like oncology, gastroenterology, neurology and rheumatology as a part of our consulting group, Innovative Practice Services. My work centers on revenue cycle, but we also have billing and coding specialists, payer negotiation experts and experts on payer initiatives like the Merit-based Incentive Payment System (MIPS), the Oncology Care Model (OCM), the Medicare Access and CHIP Reauthorization Act (MACRA) and others.
How did you land in the revenue cycle world?
I fell into it, as many do. I worked for a dentist, and loved the revenue cycle aspect of my job. I transitioned to medical revenue cycle. I’ve been doing this for about 20 years, and I love it. I’ve worked within practices, and with a large multi-specialty organization with practices all over the nation with various specialties. I’ve been with McKesson Specialty Health’s Innovative Practice Services for almost two years. The culture here is incredible.
What would you say drives your work?
I’m a cancer survivor, so it’s really an honor to support oncology practices.
I’m also very interested in the puzzle of the revenue cycle. Patient collections is a critically important piece of this puzzle. With so much government change underway, and high deductible plans gaining in popularity, we absolutely must address what this all may mean for medical practices. We have to get better at customer service, not just collections. Physicians don’t want to ask for money, but they do want to continue to treat patients, so they need to optimize their flow of revenue. It’s a fine line to walk. Then, there is the advent of value-based care. A portion of value-based care is patient satisfaction. These surveys, in the future, will affect physician reimbursement. We see this phenomenon far and wide today: People love their physicians, and they dislike dealing with the physician’s staff. This isn’t just something to observe and shake off, because it can affect the bottom line of a practice. As an industry, we have to address what’s missing in customer service and find processes and protocols to make patients happy with the whole experience. It’s part of this idea that we’re providing continuity of care, and this will need to also extend to the revenue cycle. It’s an idea that has to penetrate the healthcare collections industry as well.
What role is McKesson Specialty Health playing in this evolution?
We’re a drug distributor at heart, and that access gives us a panoramic view of the hospital and physician practice space that is valuable. Of course, we see the obvious: Practices are making slimmer and slimmer margins, but they’re seeing the same number of patients. In my role at McKesson Specialty Health, I come in to look at ways these practices can improve their current processes to make them more efficient. We offer this service that’s ancillary to the distribution of the medication, but it’s important work because when practices function well and work smart, it’s good for everyone.
We’re bringing best practice intelligence to the table every day, including methodologies like Lean Six Sigma. We look to clear roadblocks. I go into the practice and audit it. I walk through the practice exactly as a patient would, and I sit with staff at each moment of the revenue cycle to identify ways to streamline, identify meaningful benchmarks and enhance what’s there with best practices.
Can you share your “greatest hits” in terms of healthcare revenue cycle best practices?
With pleasure! I’d say virtually any practice can benefit from these guidelines:
- Verify patient demographics. If you don’t have the capability, get it through a vendor relationship.
- Verify patient insurance before the appointment. Do this 48-72 hours before the appointment, so that if there is a problem, an error or a missing referral, it can be resolved before the patient arrives.
- Examine your “days to bill.” How long does it take you from the date of service until a clean claim can be filed? Aim for 24-48 hours after the encounter. Decreasing your days to bill can have a huge impact on working capital.
- Spend the money on a financial counselor. The value financial counselors bring easily offsets the extra salary on the payroll. With physician practices, most don’t want to turn patients to collections, so we recommend having a financial counselor in the practice to start working with the patient before treatment starts. Let physicians worry about medication toxicity, and financial counselors can address the financial toxicity of the clinical experience, which can be equally detrimental. Part of a financial counselor’s work is education, and part of it is determining eligibility. The goal is to capture money up front, or else solidify a payment arrangement. Patients have a better experience when they know what to expect. They don’t need anxiety over the financial aspect, and neither does the medical practice.
- Partner with a patient finance vendor. Most practices still keep the risk of non-payment in house. Very few offer patient financing options to bridge the pay gap. But with drug reimbursements down, and patient responsibility accounting for 18-35% of the specialty practice revenue, we need to be better at getting patient money in the door. The good old days when you could make an attempt to collect and then say “Oh it’s patient money, we’ll just write it off…” are long gone, and they’re never coming back. You can’t afford to write off patient revenue if you want to still treat patients.
- Don’t be afraid to work with a collection agency, but find a good one. If you only want soft collections, be sure your agency of choice understands what that means to you. Practices need to consider some dicey situations, like, if a patient goes to collections, are they discharged from the practice? Or do they still keep coming for treatment, incurring more debt? These issues are much more complex and delicate than collecting on a bad car loan or a credit card. Not every collections agency understands the nuance in practice.
What’s your revenue cycle goal with every practice you visit?
I’m there to get the revenue cycle as tight and clean as possible so that there is ultimately no need to send anyone to collections. Accounts receivable over 90 should be zero---that’s the ultimate goal. Realistically, I’m looking for:
1. Days to bill: 2 or less
2. Days to payment: 20 or less
3. A/R over 120: 9% or less
4. Auto charge capture rate: 99%
5. Clean claim rate: greater than 95%
I want money in the door and a healthy stream of working capital, so that the practice can continue to treat patients and get them well.
If you weren’t doing this, what would be doing?
I love helping people, so it would have to be something in healthcare.
What do you love beyond the revenue cycle?
I’m a Texas girl, so I like to shoot at the gun range. I also have two nieces and a nephew whom I adore. The oldest is a flight attendant, and I have the goal of being a passenger on one of her flights. My nephew is at Texas A&M, and my youngest niece is a high school student, and she’s passionate about FFA (Future Farmers of America). She is all about the heifers right now.
Anyone you’d call your biggest influence?
Gabe Torres, the director of Innovative Practice Services, has been an awesome mentor. He helped me stretch out of my comfort zone. He’s brilliant and lets me bounce ideas off of him.