From Shortages to Strength: How to Overcome RCM Workforce Challenges

Now.

Are you short staffed, maybe feeling a little bit overwhelmed, constantly looking for those efficiency gains, or is that just me?

You're not alone. Organizations everywhere are being pushed to find more innovative ways to manage costs and optimize revenue streams despite all the challenges that we face, like, you know, declining reimbursements and workforce shortages.

Revenue cycle workforce shortages are real, but they are also very solvable.

The solution isn't just adding more people and hiring. It's really about smarter workforce management, and that's why we're thrilled to have some experts today who can help us to recognize those opportunities to optimize roles, leverage technology, and upskill and cross train teams for more long term success.

So let's look at our presenters here today.

Rae Marie Jimenez has just about every certification offered and over thirty years of experience in the health care industry.

She currently serves as a coding liaison to the AMA CPT editorial panel, and she's also AAPC's president of membership and content, leading the development of certification exams and exam preparation materials.

She leads member value and their operational program departments. And then we also have miss Jessica Miller Dobbs with us today. Jessica is a distinguished health care professional with a commitment to health care revenue cycle and over two decades of industry expertise.

As the director of coding operations at Datavant, she leverages her extensive experience across various medical coding domains, including proficoding and billing, FQHC, RHC, CAHs, and more. Jessica also serves on AAPC's national advisory board, helping to guide and support the value that AAPC professionals bring to health care businesses across the globe. A lot to cover for some really awesome experts today, so I'm going to let, our experts take the floor. Jessica, it's all yours.

Great. Thank you so much. So hi, everybody. Happy to join today. So the first thing we're gonna talk about is that medical coder shortage.

We're all seeing that across the board. It's a huge concern in the industry right now. The American Medical Association reported a thirty percent gap in this workforce.

This shortfalls extends beyond just those clinical roles. We're seeing it in billing, rev cycle.

We're also seeing it in clinical denials, things like that as well. In fact, in a survey by the HFMA, it highlighted fifty percent of CFOs find it increasingly challenged to fee to fill these essential roles in our current labor market.

So by recruiting, we all know there's challenges there, finding the right candidates. Sometimes candidates apply to multiple positions at the same organization. We also see extremely high turnover rates that considerably consist, throughout that high industry.

It serves definitely serves our deserves our attention.

So I have a question for you guys to answer real quick. So we have a hundred percent of revenue cycle reader leaders agree that the workforce shortage impacts their ability to get paid. But the question is, do you know what percentage of health care centers are currently operating on a negative margin? And I'll give you guys four different answers. So an a, b, or c, or a d. A, is it twenty three percent? B, is it thirty three percent?

D, is it forty three percent? Or d, is it over fifty three percent?

We'll give everybody a few minute a few seconds to answer.

Thirty three percent is coming out strong. Got some forty three percents.

Oh, fifty three higher than fifty three percent.

So the answer is actually thirty three percent of those operating systems are operating at a negative margin. What that's meaning for anyone newer to leadership is they are operating every day at a loss, so we need to do everything we can to both nurture and optimize the talent and revenue cycle. There's all different ways to do that.

We can see, health care executives as well, are adding to the revenue cycle teams. We're seeing a lot more people dive in deeper to value based, ways to supplement that as well their revenue and entering into partnerships that are implementing technology as a difference maker this next year.

In the industry that I'm on on the side that I'm on, I'm actually seeing this a lot more, especially in your academic health centers, your critical care access, your FQHCs, and even RHCs are also getting into this value based care and looking how they can leverage those partnerships, across the board with their vendors.

As always, many different organizations are looking for more ways to do more with the less amount of people.

One of our revenue cycle leaderships at Common Spirit said in twenty twenty five, they're going to be strengthening their revenue capture capabilities and optimizing billing processes, including corrections, and fostering stronger relationships with their payers.

What we see on the vendor side where I'm currently at is ways to help educate their staff. Cross training is huge right now.

In addition to looking at CDI, where are their gaps in their documentation? Where do their physicians and health care organization partners need that education in order to get paid better?

We saw that increase significantly with the E and M changes that happened back in twenty twenty one. And then, again, recently, especially with split shared. It is surprising how often we see questions in regards to that and and documenting that stuff appropriately so they're not seeing denials on the back end. We're also seeing, workforce shortages are directly impacting several areas of health care operations from revenue cycle.

We're seeing it even on patient care. Patient volumes are expected to grow nearly fifteen percent over the next few years, and staffing shortages are leading to longer wait times. I myself have been in a doctor's office where I waited over an hour and I left. That eventually affects those practices because those wait times are becoming increasingly as well.

We're also seeing operational efficiencies are affected by shortages.

Health care organizations are missing, performance goals due to staff and sported over underages. We're seeing inefficiency in the processes.

This is also leading to negative margins as well.

This is where your partners can help, as well with that. And then financial pressures, we're seeing rising costs due to twenty four twenty one percent over four years with salary increases ranging at twenty five point seven over the same period and even higher depending on the role.

We're seeing increased, temporary cost and overtime pay. And then just in November of twenty twenty four, one of the CPI increases just for revenue cycle services was actually three point seven percent. So that's on top of any additional increases that you might have.

Most operational facilities are operating on KPIs, such as gross margin, things like that. So this is all affects those margins. And with your labor rates going up and your costs going down, it it's it does cost. It does affect everybody.

Jessica, a few things that you just mentioned that I that that we're seeing as well. One of the things that you mentioned was the cross training and the importance of that. I think when you what we we see this particularly in large organizations where you have teams working in silos and not sharing information across teams to understand what their role does to the overall success or health of the success or health of the revenue cycle. Right? It's surprising to me going into larger organizations where you'll have a coding team and a billing team, and information's not being shared across both teams that could have a significant impact on the efficiencies of what you're able to get accomplished.

Another thing that you that you mentioned is, you know, just the cost of everything.

You know, now we're dealing with, costs of medical supplies and medications going up. So we're being hit from every angle in the revenue cycle of cost, you know, salaries of clinical employees going up, and there's only so much that you have. And for thirty three percent to be operating in a negative, that's significant. You know, there's only so much money to go around, and we're we're looking at ways to be more efficient with the staff that we have because we don't have the luxury of adding headcount.

And then another really important thing that I thought that you touched on, was the patient care.

You know, the just like your situation waiting so long and getting frustrated and leaving, that's gonna impact our patient satisfaction scores. So all of these things are coming together almost like a perfect storm, that we have to resolve.

Exactly.

And we're not even discussing the payer cuts where they're cutting what they're gonna pay. So that's going to affect everything as well.

You know, cross training, I can't promote that enough. We talked to somebody this morning where they said, oh, we have a biller doing our coding. She knows what has to be done to get paid, but then she didn't realize all the risk on the back end. She did some looking into it and, yeah, they're actually having denials on the back end. So it's the time now is to get the education to your people, look at your cost margins, things like that, and and look at ways to kind of expand from that.

Yep.

So I know, if you wanted to go to the next slide.

On the strategic responsibilities, this one?

Yes, ma'am. Thank you. Okay. Uh-huh. So the health care landscape has increasingly become complex as we all know.

It's putting so much pressure on that revenue cycle staff. If we dig into understanding those core challenges, there are several key factors that play into this. And the first one, which, you know, I actually find to be the biggest challenge, is those increasing complexity of the health care reimbursement. We're seeing constant changes in payer policies and increasing administrative expenses.

All of these are contributing to the financial pressures on these health care organizations.

Health care differs from other businesses due the difficulty in accurately determining cost of patient care, which complicates the billing process.

A great example of this and staying on top of this is in the GI world. For those of you that come to HealthCon, you know I speak mostly about GI.

They a lot of organizations did not know preauthorizations were required on certain procedures.

They could not understand why they were seeing such a high rate in their denials when they were meeting those screening or those diagnostic reasons.

And it was just they didn't know that that specific payer required them yet.

CPT code changes in cardiology.

We see CPT code changes every year. It is surprising to see how many organizations by March and April still get denials for the incorrect CPT codes because they're denied.

Encoders can help with this.

AAPC is codified. It's great.

I don't know if we should share products, but it's one of my favorites.

Claims scrubber is my team's best friend, along with, you know, being able to stay on that, but then there's education tips in there that you can share with your physicians or your practices, and that can help kind of minimize those complexity of those reimbursements because you're looking at those guidelines efficiently and you're staying on top of those changes.

We also see growing patient financial responsibility.

I'm sure many of us on this call have, taken on more of a financial responsibility when it comes to our procedures because our plans are paying less or we've had to switch from a PPO plan or to a HSA plan, being able to budget for those appropriately, that does put a strain on organizations as well because now you were relying on the patients, versus the the straight payments from the insurance payers. We're now counting on beneficiaries and things like that to make their payments. Looking from a facility point of view, you're looking at that case mix index.

You'll see that the payer mixes the majority of them are commercial followed by patient and other payers before Medicare and Medicaid.

That affects everybody's bottom line. So hospitals need to be able to realize this and offer, personalized payment plans, automated payment reminders.

Digital finance options are out there as well to help reduce those bad debts that they're having to write off, turn over to collections, and or improve their collection rate internally and not have to have that additional cost that has to go to a hospital for having to send that to a collection agency.

We also see technology adoption barriers.

AI is here. It is here to come in and help.

Providers need to have those advanced technologies, not only to streamline their manual processes, but you can do that for prior authorizations.

There's forensic denials, for example, that can help get your low hanging fruit, that we call it. It's your high volume, low dollar, but that amount adds up. So if you think about it, that may seem small to write off as a small balance. But if you can collect that over a year, your numbers can add up to there. So transitioning to newer technology is gonna not only upscale your teams to work with these AI products, but it's also going to require investment in in your training and development as well.

We're also seeing competition among skilled professionals. The demand for revenue cycle professionals outpaces any other one right now. According to the there will be a critical sort shortage of three point two million health care providers by the end of twenty twenty six. Health care organizations are gonna struggle with recruiting and retaining these skill sets with many of them unable to even be able to compete with the competitive salaries and allocation of resources for ongoing training.

You're also seeing a shortage of these experienced professionals are leading to errors, slower claim rates, and even delayed reimbursements.

Another thing that I'm seeing a lot, especially lately on LinkedIn, is everyone wants a remote job.

And it may not be something that an organization can offer right now, but there's other smaller hospitals, critical care that could just as much use your your expertise if you end up finding looking for a new position.

Cross training is huge here as well.

We're also seeing the impact of that transition where the resistance to work on-site, is creating many challenges for traditional staffing models. That's where you're gonna see positions go hybrid.

You're also gonna have both advantages and disadvantages to that. It's requiring organizations to adopt their workforce strategies, and the transition has led to a need for stronger system security as well, which is then another added increase for security.

I think I went ahead go ahead. You're okay. I think I went ahead of you, Jess.

So, no. It's okay. We've got the workflow assessment and optimization.

That's where you're creating processes and identifying those bottlenecks.

You're looking at your optimization mapping. One thing to to do that I've recently been doing as well in my role is process mapping.

You may not think of that domino effect if you may remove or change one piece. And while it may make sense for one area, if you look at that, entire model down the road, it's gonna be like a domino effect. And so being able to see the bigger picture rather than, like Rae was saying earlier, siloed, that's gonna enhance your abilities to look more at where you can see.

We're also seeing creating detailed flowcharts from patient scheduling to final posting.

Breaking those steps out will also utilize those to learn how to affect that for affect your workflows, but also pinpoint your potential blockages.

There's also change management styles out there such as McKinsey seven s. Whenever you're going to start something new, you're always gonna have that resistance, and there's all different programs out there. There's Lewin. There's Kotter. There's McKinsey.

And then there's different types of diagrams and flowcharts you can use as well. But the biggest thing you wanna do out of all of these strategies is you wanna conduct regular workflow audits.

While something may work temporarily, you may get something that breaks down the road and therefore will cause issues with meeting your metrics.

One of the things my role is I have to do what's called a proforma.

I spent three and a half weeks, and I broke the thing every way possible over eighty times, and it it didn't it wasn't something that our leadership had thought of because they're not in that day to day. And so by breaking it as many times as we did, we were able to not only improve the form that everyone needed to use, but we were able to see where our bottlenecks and our potential issues within that specific form for a new workflow stream.

Yeah. And I think that's really important, Jessica, what you touched on. Because sometimes when you're when you're at the leadership level or administrator level, what sounds like a really great idea in principle doesn't end up translating down. And I think that, you know, by doing that process mapping and that auditing and that flow, you really get to interact with the people in the trenches doing the job that can tell you all the ways that what you are wanting to accomplish is gonna be difficult.

Sometimes, let's say we implement a new tool. We don't realize the, rework or double work that we're causing employees to do based on implementing that new tool. It sounds like it's a great idea, but then when you try to operationalize it, that's where all of the things that could go wrong come out. So you're you're absolutely right at reevaluating and and and monitoring to see if that if that progress is sustainable, or is it just a temporary win that breaks down in the long run?

So I think that's great what you guys are doing.

Yeah. And that's actually a good point too is, on the next slide, we're actually kinda doing into that was eliminating those redundant task and unnecessary handoffs. The amount of handoffs and approvals that we had on our form, it it was holding up sometimes two and three weeks because people are on vacation, and this person is the only one that could approve that. So those were definitely focuses and things that we found during that process that we were able to shift and streamline.

So implementing automation, you know, you've got tools that are best that are aligned with best practices, not only for medical coding, but even patient communications and billing. The amount of handoffs could significantly increase your manual errors and your critical task, is by reducing that redundancy.

If well, whoever has your in your role for whatever reason it is, you're seen as that subject matter expert. And so you your leadership is counting on you to kinda know these steps and being able to to create better roles.

And then also creating those role definitions and responsibilities.

That clear delineation of roles is critical for an efficient RCM process.

You not only want to have an established qualified manager or director to see the program, but you also want somebody that's gonna work with the front end and the back end. So like Rae was saying earlier, there's not those siloed. It's that bigger picture you've gotta look at. And clarifying the specific responsibilities within that from patient registration to collections is crucial in order to have that workflow that works for everyone.

It also helps then your staff know what their role is and how it interacts with everybody else, but it gives them a bigger picture as well of that entire cohesive process and how they affect if they cause an error or if something doesn't work right, what domino effect that's gonna cause.

Okay. Okay.

Yep. I will turn it over to you.

Thanks. Sorry. Okay. So when, we look at at AAPC and we're supporting our membership as well as our partners, in some of these challenges, so some of the best practices that we identify is through the work that we do with our partners. So we're able to support and align in a few areas.

So best practices and timeline, and guidelines to frameworks.

We believe in the optimization of the RCM space. And and how we're supporting this on the AAPC side is by offering comprehensive guidelines on contract management, fee schedule reviews, and payer billing rules. It's always amazing to us when we're working with our, clients how many of them haven't been renegotiating fee schedules.

Some have been on fee schedules multiple years before asking for an increase. So that's one area where we've been able to help, organizations.

Also, providing self assessment checklists for health care organizations to evaluate their RCM process.

Because we have insight across our very broad membership, we're able to gather these insights from our members and our clients and help share those best practices across our membership base.

So also sharing industry benchmarks and performance metrics. A lot of the questions that we'll get is, you know, we're setting up production standards for the first time.

How many, let's say, charts should a coder be able to get through in a day in order to maintain those industry standards, for example?

Also, process improvement methodologies.

AAPC supports the implementation of proven process employment, improvement techniques, by promoting the use of six sigma, for example, in order to look at systematically tasks that are, maybe causing some of the more complex RCM problems that we have.

We also encourage the adoption of these lean principles to eliminate waste in our Centimeters processes, similar to what Jessica was talking about, looking for those redundancies and in better ways and more efficient ways to do things rather than this is always the way that we've done it. Is there a better way to do it?

Also, advocating for continuous process improvement strategies, including regular audits and, employee suggestion systems.

A lot of times, employees that are doing the work might have a great idea on how to do it better, and they might just not be bringing it to your attention because maybe you haven't opened up that, open line for them to bring suggestions.

Sometimes we've seen that people have very great ideas.

They just figure that, well, leadership's smarter than me, so they must have already thought of this. Why bring it forward? So really empowering your employees to bring suggestions and efficiencies to the table. You'll be surprised at what you learn from opening that dialogue with them.

Also, you know, it also comes down to appropriate training and job skill validation.

And that's one thing that we've done a lot of here at AAPC with our certifications is being able to showcase job competency by the different credentials that people may hold.

We're known for our CPC certification for our certified, professional coders, but we've also, created certifications for, the billing job competency with our certified professional biller credential.

And our newly released credential that we're super excited about is the revenue cycle management specialist.

This new certification is not talking about the management of people, but more the management of process and trying to find those areas of breakdown to be more efficient. We know that this is an important role and one that organizations are investing in to be able to follow the entirety of the revenue cycle and find where break downs are for you to focus on those efficiencies.

So by focusing on these areas, health care organizations can strategically realign responsibilities in their revenue cycle. They can lead to improved deficiencies, help reduce errors, and ultimately have a healthier financial position.

So some of our resources and certifications play a vital role in helping that, you are successful in this.

Many aren't aware, but on our website, you can find many free resources that are published by our experts.

So we have a few, areas that you can tap into, for resources.

That is the pulse, which is a podcast that we talk about industry topics. We also have videos, case studies.

These are all driven by experts through thought leadership that's available through our membership and available for you as well as to to share with your teams on, some effective and efficient, strategies and successes that we're seeing others experience.

So when you're out among us, we are not only at AEPC events, but we've also spent time at other organizations' conferences as well.

So always, love the exchange that we get from our members and clients when we're at other industry events like RISE, HFMA, and MGMA, just to name a few.

Now we're gonna transition over to effective task delegation and workflow distribution.

So some of the things that we're seeing on on our side are effective task delegation and workflow distribution that can strengthen your revenue cycle management.

So for modern delegation strategies, we see that, there are structured cross, structured task allocation across revenue cycle. So looking at, do you have the right person in the right seat? So for highly complex tasks like coding, auditing, denials, and appeals, do you have the appropriate staff assigned to it? One thing that always surprised me, in going into multiple clients is the lack of resources dedicated to denials and appeals.

It was always an afterthought. Like, a lot of organizations will put a lot of priority on time to get the bill out the door, but they don't really look at the back end to see, you know, is that speed really helping you on the back end? How many times do you have to touch that claim because, you might be experiencing a high volume of denials.

It is shocking to see how many organizations just write off or don't go through the process of appeal. You're setting a a a standard with your payer by doing that. When you go through the appeals process and validate that you were right in how you submitted the information, when you have a high success of appeals, that's something that payers look at on their side. Like, you know, we've denied these claims and all of them, they've been able to support, that particular coding, scenario.

That's not something that we need to keep denying them for. We know that they've shown success in the past in overturning having When you're looking at categorizing those denials and having the right people dedicated to working on them, you'll find one error that can be applied across multiple patients, and now you have a quicker rate of return and, clean claims being processed.

When we look at mid level tasks, such as insurance verification or claims scrubbing, having dedicated trained billing specialists to understand the importance of those roles and those, tasks that are part of it. And then when you look at more entry level roles, what are some of the routine tasks that are being done, that you can hire someone at at an entry level, like a CPCA, for example. Or it's also a great way if you have staffing adding externs as as a way to supplement your workforce. And we'll we'll talk about that, in a few minutes as well.

Also looking at team based workflow implementation, and this goes, this supports what Jessica was talking about with that cross training as well as cross functional teams handling distinct RCM phases, but also collaborating and sharing those insights with each other.

If people don't understand the importance of what their role is and the efficiencies that they bring, if you're just thinking about the task and not the outcome, it's, it may limit your ability to be as efficient as possible. So collaborative workflows between your coders and billers as well as your clinicians to be able to resolve any documentation gaps.

When we've seen really strong relationships between your coders, auditors, CDI with your providers, you know, providing that information to providers on what might be missing in the documentation, they're thinking it from a purely clinical perspective.

Having that dialogue between other, members of the team help providers understand why something is important to be included in the documentation so that you can, let's say, prevent medical necessity denials or a prior auth denial. So having them understand from a coding or reimbursement ex expectation how their documentation not only aligns to patient care, which is the number one priority, but also supplements and making sure we're getting, appropriate payment. And then can't say enough about cross training and ability ability to assess your teams. One of the tools that we have here at AEPC to help assess the skills of your coders is Practicode by AEPC.

It helps you identify any skill gaps that there might be, our our coding of cases that might be more difficult.

Organizations have also implemented to do cross training. Let's say that you have a very strong cardiology coder, for example, and now you're taking on a new line of business.

Having them practice on those new types of cases that you're gonna be transitioning to helps you cross train a very strong coder in one specialty to be able to cross train them in others.

And then another thing to look at, and I know Jessica and her organization has done a lot, in this particular, aspect is leveraging AI and automation for those routine tasks.

Things that are very repetitive that can be done through automation frees up your team's time on that more difficult type of job like denials that I was talking about that seemed to be an afterthought.

If we can take the, more routine items or tasks that they're doing and repurpose them for more complex things, it will also help with your efficiencies.

So just to get some insights from the audience, would love for you to share in the chat if your organization is using AI or automation in any way. And where are you guys finding success?

What things have you been successful in transitioning over to more of an AI utilization or automation?

Okay.

Some other ways that AEPC is trying to support in this endeavor is supplemental trainings and material programs, that can help health care organizations optimize the revenue cycle management by equipping staff with necessary skills and knowledge.

We offer customized training, for the RCM space, including denials management, provider education, and post audit education.

And then we also have many resources, as I mentioned before, that will help you bring tools, to your organization to help with those efficiencies.

Jessica mentioned one of the tools that we have, which is codified by AAPC.

There is not just a code lookup component to this, but it's also a very excellent research tool and helps, with educational support to understand complex things. So there's a lot in that, that software. If you aren't familiar with it, you can sign up for a free trial to check it out for yourself. Denials and appeals, and I'm gonna turn it back over to Jessica.

Thank you. So my second favorite place in the world, denials.

Like you said earlier, so many organizations are seeing challenges with their denials management, amid the workforce shortages, but also just because the lack of knowledge.

It is incredibly and time sensitive to do this.

To do them properly, you need the right staff to do this. So there are different strategies that you can do specifically to be more effectively managing them, with your constrained staffing resources.

Biggest one, which we talked about before, was automation and technology.

There are different organizations that have technology that can help with the forensic denials that we kinda touched on earlier. That's, you know, your high volume, low dollar amount.

There are products out here now that can also help write some of your appeal letters based on the criteria, for DRG denials and clinical validation.

One of the biggest challenges that I see on the inpatient side in DRG is in regards to sepsis. As we know, there are so many different roles with sepsis and that your payers also differ.

That if you have the staffing challenge or not having the right person in that role, you're gonna see more denials on that because they're not effectively appealing those. So you really wanna implement a denial prediction, to identify claims that are likely gonna deny beforehand.

If you're using an EMR, for example, such as Epic, you can write your own edits based off your denials.

When I was in the hospital setting, we did that. We watched our denials. We tracked and trend. We knew certain things were gonna need a clinical trial number. If that was left off, we'd have an edit on the front end. So those coders knew to check that documentation for it, ensure that they had that.

Same thing with verifications.

Not running your verifications for insurance on the front end can really hurt you on the back end.

Those are just basic appeal things that you can do on the front end that will help your back end. And then also, you can also deploy robotic processes or RPAs RPAs to find repetitive tasks for your claim checks. How many times do you have, in your office, your people are trying to work their denials, and they're checking the same ones over and over and over. You're never getting to those newer ones, or you're not getting enough of them.

You can use intelligent workflow solutions that will automatically route denials to appropriate specialist. There's a tool out there such as AutoPro. It's a great tool for using something along lines that to manage all of your denials in one spot so you can route them appropriately.

You're looking also at your processes for optimization.

You wanna per work your denials, not only on volume, but the dollar amount. What ones are you're more likely to overturn positively?

And then have your staff focus on those high value, high probability appeals while you can have something, whether it's not going to affect your denials. You can establish specialized denial teams, whether it's by certain specialty or by certain payers rather than generalists trying to remember all the rules for all the payers.

You can also do your implement root cause analysis for protocols to address any system issues.

You know, modifier twenty five is a huge one. I can't tell you how many times we're working denials to see billers just added a twenty five without checking to see if it was supported.

We also see unbundling a lot. These are things that with the right staff on the front end, it could have been caught, and you wouldn't have somebody just systematically adding those on.

You can create, strategic workforce management. What I mean by that is creating a tiered staffing model where your junior staff could handle routine denials and your more experienced ones are looking at your surgeries, your neurosurgeries, your spinal, your ortho trauma, things like that, and kinda dividing up the work that way.

You can implement, flexible or work remote options to expand your talent pool beyond your geographical.

Now I know there are some states, and we run into this too a lot, where they can only hire within a certain few states. But if you're limited, for example, Texas has one where they will only look at Georgia, Tennessee, Texas, and areas. But if they only had Texas, they're only gonna get those pools. By opening them up to those additional areas, you're able to get more effective pool and talent. And so you don't know who you're not you're who you're missing out on, essentially.

And then another great one is establishing your relationships with your payers.

When you sign up for insurances or hospitals or private practices do, you get a payer liaison or a a a management rep. Building that relationship will help you immensely, especially if you're seeing a lot of denials, for the same thing when your contract may state something different.

You wanna schedule meetings with those so they can take your issues, to the appropriate people, and they can help with addressing those systematic issues and even appealing case by case.

Many, many moons ago, when the Medicare CAP program was around, I was on a team where a certain insurance payer was constantly denying us.

We, you know, jumped through all the hoops. We reappealed them. We put the claims on a different form. We were then told submitted as a project, and we submitted hundreds of spreadsheets.

It ended up towards the end of that, appeals process, we ended up having to get the payer rep involved, and they were able to help us get the claims paid because it was something that was written in the contract.

So that's where they can have that collaborative approach and having and using your resources, and you're connected to them, and they're assigned to you for that reason. But they can also help, if you've identified denial patterns and reduce your unnecessary denials, which, of course, then, again, will help on the front end.

Right? Okay. Yep. Okay. So for, essential RCM technology staff that is focused on workforce productivity, We look to AI powered auditing.

For example, a product that we have is Symantec by AAPC that does DRG validation, to make sure that you've captured the correct d I DRG and you don't have opportunity improvement.

Denial management systems.

That's one way that people will use Codify to do the crane the claim scrubbing to prevent those denials from occurring or using information from within to help support an appeals letter.

Also, performance analytics and benchmarking of teams and and their skills through the use of Practicode.

So using an assessment tool like PractiCode, like I mentioned earlier, can help with cross training, determining accuracy, and then putting in a performance plan for them.

Some of the things that we like to recommend is, proactively monitoring trends to determine a corrective action. What are you monitoring?

When you find a deficiency on performance, how are you going to build that corrective action plan? Whether it's doing internal and external audits on, the efficiencies of the coding and billing pieces, or is it with patterns of documentation improvement with your providers?

So, being able to predict impacts on the revenue cycle will help you, resolve issues and, and, prevent them from occurring.

The other thing that we are very big believers in is education and support.

Things are constantly changing in our industry. And it is it is hard to keep up on everything that's going on when you're talking about regulatory changes, different payer requirements.

There's a ton of things that we need to stay on top of outside of just the day to day.

If you're not staying on top of these changes, it might take too long to realize it's a problem until you get that denial. An example that Jessica shared earlier was, you know, organizations still getting denials as late as March on a code change that went into effect in January.

And that's where AAPC spends a lot of our time is monitoring those industry changes and putting that information out to our members either through, education at the local chapter level, webinars and workshops that we hold on our, at the AAPC, as well as conferences.

Another thing that we're trying to really, help the industry understand is new technology and how to adopt it.

Not being intimidated by it, understanding how we might successfully use automation and AI, and then integration of resources across roles.

Your software vendors will also have training on resources that you can draw from to better use the technology that you already have. I find that this happens often at different organizations where you'll have multiple tools, and you might not be using them to their full potential because you just don't know how to use it properly.

So these are other areas that we help support as well as the vendors that you are already partnered with.

So building out a versatile work force, essential cross training areas, again, using an assessment tool, pairing that education with areas that you find that your that your coders or billers may struggle, that's where customized training really, really helps. If you are going to invest in education for your teams, we recommend a custom approach to be able to hit and improve the pain points that you're experiencing within your organization.

So that's a really important thing to do.

Another thing that we recommend is, the utilization of externs. We have a project extern that we have implemented here at AAPC, and that helps with support of staff. These are newly certified members who have proven that they have the knowledge and understand the principles, the guidelines, how, coding is supposed to be done. So putting them on projects that you might have areas where you're understaffed can be extremely successful, not only for your organization, but for this individual who is new to the field and just looking to get more exposure to what the real world work environment looks like.

We've seen organizations use externs effectively in some of that research I was talking about. You know, staying on top of, a policy or payer changes, doing that research, and providing that information to your teams is a great learning experience for them and an area that we know that people don't have time to dedicate to, as much as they would like to.

Also, AAPC has a mentorship program to help mentor individuals. Let's say that you are, in a a place where you're considering a leadership role, and you just haven't had the skills of a leader yet. Having someone mentor you on how to attain and develop those skills that you might not have access to develop in your current role. So take advantage of that as well for those of you that are on the line that might be interested in that. And then, continuing education opportunities, there is many options available to you through different aspects of the AAPC community.

And then, you know, one thing that is extremely important is when you have the right team, you want to keep them. So if you're lucky enough to have the right resources on your team, it's important to recognize a strategy for retaining these people.

So according to a Gallup state of the global workplace survey, the cost to replace an employee is a half to two times that employee's salary.

That encompasses the direct costs like recruitment, training, as well as your indirect impacts on productivity and team morale.

Providing them with career advancement frameworks will also avoid some of those hidden expenses.

So defining a career pathway, skill development, when you invest in your employees, they feel valued, measuring their performance and giving them that feedback and always rewarding and recognizing good work. People will respond to that.

And then, AEPC membership as career support. There's a few areas that we have focused a lot of time to be able to support this initiative.

Many RCM leaders have recognized AAPC membership as career support because of the things that are included in membership And taking the expense off the employee personally to pay and moving the membership to a corporate membership helps, show the employees that you care about their, their support, and it's an added employee benefit.

Because we include in it in our membership networking opportunities, abilities to, participate with all of the industry insights and keeping on top of industry changes and being able to get that out to membership in a way that they understand how it can be applied will be extremely beneficial to your organization.

So in implementing work, force optimization involving evaluating resources, adapting new strategies like AI for administrative tax tasks, and utilizing software tools to improve your efficiencies and consistencies across all roles.

As next steps, it's a good idea to implement continuous feedback via quarterly workflow audits.

This can help you find areas that can be improved and realize breakdowns that might not be apparent.

Leverage data driven workforce planning, so using predictive analytics to align staffing with claim volume fluctuations, implementing flexible staff models. As Jessica mentioned earlier, a lot are looking for a remote or hybrid work environment.

And then with that, you need to have benchmarks and a way to manage or or review the benchmarks that you have set to make sure that your productivity is where it needs to be, especially when dealing with the remote staff because a lot of people wonder, are they really working? If you have a good way to measure metrics and productivity, then you can trust that the work is getting done.

And then also engage stakeholders strategically from cross functional teams all the way to, your management levels. And then, again, a focus on denial management simulations to see where you can improve your, denial prevention as well as overturning them.

Thank you so much, Rae and Jessica. We're almost out of time, but we did have one question I wanna make sure to address here today. And check the chat because we've we've been attempting to answer some of your questions as as we've we've progressed this as well today, and there's some valuable resources and links in there. But, Rae, somebody's asking about that extern tip an externship program.

How how can you know, can we can you give more information on how to get started?

Yeah. So, I don't know, Desiree, if you can put the link to the page that has the information for externship.

In order to participate with externship, the member would need to be certified. So that's one of the things that employers can take, confidence in. And then you would post that opportunity, just like you would post a job opening, but you tag it as an externship.

And then, members who are looking for that opportunity will contact you directly to learn more about, the scope in which you want to utilize an externship.

And, the arrangement can be anything from volunteer hours to get exposure.

Some employers do pay for the ex externship, but it's not a requirement.

So we really just, have a flexible program so that you can utilize this additional help without it being disruptive.

That sounds amazing. And, also, if anybody, is planning to attend HealthCon this year, which is in a couple weeks in Florida, it's a great opportunity to expose yourself to a lot of different best practices and the community of support that is available through AAPC.

But we are also going to be delivering our extern program for employers guide. So it's actually a a resource that has been put together, to take you step by step through how to do that. It's not as time consuming and difficult as you may think and super duper rewarding.

And as always, AAPC can assist in identifying problems air problem areas that you may have, developing a plan to tackle the issues as well. You might have a situation where you already uncovered what your problems are and you just need, you know, kind of specified help in tackling those problem areas. Well, our experts can assist with training, backlog, staffing support.

Another option is working to get people you already employ certified in those areas of need. Right?

Experts at AAPC can also offer, as Rae mentioned, those prospective and retrospective audits so you can assess those trouble spots and get more confidence in the quality of your submissions.

So if you're interested in connecting with an AAPC expert, you can request outreach through a few quick questions that will appear in your browser as you exit this webinar here today. I know we're just a few minutes over, and we just wanna thank our our experts, Raemarie and Jessica. Your insights have been really valuable, and we appreciate you bringing them to us. We'll soon post a recording of this presentation as a registered attendee. You will receive a notification of that, a copy of the slides, and more information on business and revenue cycle solutions from AAPC.

Thank you once again to our experts for yet another super insightful conversation. Thank everybody for joining us today, and this concludes our webinar.

Thanks, everyone. Thank you.