Revenue Cycle Insider

Aligning a practice’s departments can catch problems early for everyone.

When the various departments involved in patient care, from providers to coders to billers to practice managers, are misaligned, patients are directly impacted, said Charisse Marshall in her AAPC HEALTHCON 2026 presentation “Bridging Clinics and Billing: Leadership Strategies for Revenue Cycle Alignment.”

Practice managers sit at the intersection of people, process, and performance and can help departments understand one another’s work and how it affects the next step in the patient and payment journey. Leadership can bolster business by making revenue cycle alignment one of their responsibilities rather than a billing initiative.

Use Data to Know Where to Make Adjustments

Focusing on building a system alignment where people aren’t constantly fighting and instead are collaborating organically can simplify and better your revenue cycle, she said.

The revenue cycle is built from operational decisions that begin before the visit and continue after the claim is submitted — registration, insurance verification, check-in, treatment, documentation, coding, billing, claim follow-up, and denial management are all interconnected.

Practices can run into problems when departments are siloed and front-desk teams believe denials are caused by payer behavior, billing teams believe the issue is registration accuracy, and providers think the problem is overly technical coding feedback.

Start with listening to what your team members are saying about workflow snags and pitfalls and then look for data — and engage in some direct observation, like shadowing the front desk or discussing barriers in real time, she said.

Look for patterns by payer, location, workflow step, and staff role. If patterns show that denials are concentrated in registration, eligibility, authorizations, or point-of-service collection, then you can problem solve with targeted training and workflow changes instead of broad, unfocused directives.

Marhsall said that her work showed that 50 percent of denials were tied to insurance and registration issues, but because her organization’s main payer was Medicaid and many were immigrants whose first language was Spanish or Somali and who were unfamiliar with the American healthcare system, it seemed like too much responsibility for the front desk to handle.

“We stopped assuming, we started measuring, and we found solutions that supported both our staff and our patients. It wasn’t that people weren’t doing their jobs correctly, it was just about how complex insurance has become,” she said.

Her organization redesigned their system, creating a six-person centralized insurance team that handles the insurance verification for the whole organization and educating front desk on certain insurance processes — changes which dropped the front-end denial rate to 2 percent.

Get Everyone Invested in Documentation

Documentation is one of the clearest examples of where clinical and revenue cycle goals overlap. Incomplete documentation affects coding accuracy, but it also affects referrals, prescriptions, quality reporting, risk capture, continuity of care, and patient access.

In her own work, Marhsall described her efforts to align dozens of clinics and staff within her broader organization. “We realized that when we aligned our language with our mission, collaboration followed, and that actually helped make patient care stronger in the end. But before we even got into documentation, before we got into coding, before we could even talk about moving forward, we had to start listening to the providers,” Marhsall said.

Speak the language of providers, grounded in patient care, because when documentation problems are framed only as billing concerns or couched in terms of risk, specificity, hierarchical condition categories (HCCs), or uniform data system (UDS), providers may see the feedback as administrative rather than clinical, and therefore not in their wheelhouse. Most providers didn’t go into medicine due to a passion for the vagaries of medical billing and regulations!

Practice managers can help reframe the issue by helping providers understand that their documentation is how the practice communicates the full story of the care delivered.

When feedback is still necessary, you can make it more effective by connecting the missing detail to its impact, such as risk not captured, referral delayed, diagnosis unsupported, or complexity understated. Practice managers can work with coding and compliance team members to review chart templates, update problem-list workflows, and focus education on the documentation issues that most often affect reimbursement, quality, and patient care.

Make Alignment a Foundational Element

Practice managers should make sure teams share the same priorities, understand their responsibilities, and see how operational work connects to financial outcomes. Clinical staff may be responsible for accurate access, timely follow-up, complete documentation, and chart closure. Billing and coding may be responsible for education, trend reporting, and feedback loops. Clear role definition reduces confusion and supports shared accountability.

Training should reinforce the interconnectedness of revenue cycle elements and roles from the start. New-hire education should explain how scheduling, registration, documentation, coding, and billing affect one another. Ongoing education should address trends the practice is actually seeing, not just general best practices. Regular leadership check-ins, pattern reviews, and time spent with staff help managers validate what reports are showing, as well as surface barriers that data alone may miss. Plus, visible leadership presence sends an important message that alignment is part of daily operations instead of a side project.

Practice managers do not need to overhaul the entire revenue cycle at once. If you’re seeing siloing and breakdowns in communication and collaboration, start with meaningful measures and a willingness to follow the workflow where it breaks down. Review denial trends, registration errors, chart closure delays, referral issues, and collection patterns. Ask staff where workarounds have become routine. Once you know what’s wrong, you can bring the right people together to fix the system instead of only mitigating the symptom.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Production Editor, AAPC