Many healthcare providers face operational and financial challenges, often acting as "subprime lenders" by absorbing the credit risk of unpaid patient balances. This dynamic leads to increased prices, aging accounts receivable (A/R), and cash flow constraints. Streamlining revenue cycle management is essential for improving efficiency, reducing costs, and enhancing cash flow. At St. Mary’s Healthcare (Amsterdam, NY), we’ve strengthened our operations and delivered positive financial outcomes by simplifying our processes.
Understanding revenue cycle pain points
When healthcare organizations lack integration and have limited access to actionable data, it often causes reduced reimbursement rates and increased denials. In the past, we faced several bottlenecks such as statements being sent with unresolved insurance balances, inefficient remittance processing, and outdated tasking systems.
To overcome these challenges, we refocused our efforts around three key pillars: ease of access, ease of data entry, and ease of payment. Transitioning to an intelligent EHR gave us the proper technology to modernize our healthcare delivery, specifically eliminating manual processes that would make it easier to reduce errors and delays.
Leveraging integration, predictive workflows, and automation
Integration and predictive workflows have played a vital role in enhancing our revenue cycle efficiency. By improving follow-up protocols and automating collector processes, we significantly reduced the volume of aging accounts over 180 days. Strategies we’ve implemented to benefit from automation include:
- Automating the change of collector process, which allows accounts receivable to work remittance more effectively, ensuring smoother operations before statement printing.
- Adopting integrated task management has streamlined operations, which now include tasking based on predicted payment timelines.
- Enhancing communication channels and tracked dispute escalations with patients has led to better engagement and quicker resolution of billing issues.
Automation is also a powerful tool for streamlining cash collection and improving patient communication. For example, creating .txt files for automated private pay posting has expedited payment processing and reduced errors. By automating these processes, we have improved efficiency and enhanced financial accuracy.
Improving financial assistance and reducing reimbursement issues
Financial assistance is crucial for supporting eligible patients and reducing bad debt accounts. However, challenges such as non-responsive outreach and high costs associated with processing applications can hinder the effectiveness of financial assistance programs.
Predictive models can be used to estimate household income and poverty levels, improving workflow processes and speeding up the merit of financial assistance. But in order to leverage predictive models, we needed to reduce the complexity of both billing and patient statements. What used to take hours is now manageable by making the following improvements:
- Making self-pay the easier option: Simplifying the self-pay process to encourage timely payments.
- Providing engaging and easy access: Ensuring the payment system is user-friendly and easily accessible for all patients.
- Enabling 2-click payment options: Streamlining the online payment process to be completed within just two clicks.
- Offering competitive self-pay pricing: Offering competitive pricing for self-pay options to attract and retain patients.
This approach has helped deliver a positive impact on key metrics, including a 148% growth in self-pay collection (between November 2023 and November 2024) and a decline from 33% to 3% in AR over 180 days from January 2024 to February 2025.
Key takeaways for sustainable cash flow improvement
At St. Mary’s Healthcare, we have learned from our past roadblocks. Knowledge discrepancies in our billing teams and not tracking key metrics previously led to high suspense days. By avoiding working in silos and moving to data-driven claims processing, we now have faster account resolution, improved cash flow, and optimized resource allocation.
We also believe in the power of routine processes delivering long-term success. Our denials committee conducts daily and weekly reviews, which ensures alignment on key issues and allows us to promptly resolve workflow issues.
All healthcare providers will tell you: we don’t need more systems, we need smarter systems. Simplifying the revenue cycle isn’t just about reducing workload — it’s about creating sustainable operations, happier patients, and healthier bottom lines. Based on our experience as a local, independent hospital, we’ve developed a list of takeaways that have made a strong difference in improving fiscal health:
- Create internal scorecards: Develop and maintain clear definitions of data, including AR over 90, 180, and 365 days.
- Supplement account checks: Implement business rules and overrides for account checks.
- Automate everything: Emphasize the importance of automation in streamlining processes and improving efficiency.
- Review processes regularly: Establish daily, weekly, and monthly reviews of denials and AR to identify and address issues promptly.
- Simplify workflows: Streamline workflows to stay on top of AR, ensuring that cash is collected quickly for the hospital.
- Enhance cash collection: Implement strategies to improve cash collection speed, reducing the time it takes to receive payments.
From streamlining claims to improving financial assistance processes, small changes can lead to massive improvements in cash flow and operational efficiency. By simplifying workflows, leveraging automation, and focusing on patient-friendly processes, healthcare organizations of all sizes can accelerate cash collections, reduce A/R days, and improve overall financial health.
Read our eBook to learn about supporting your frontline and strengthening your bottom line with strategic revenue cycle management.
