Outsourcing accounts receivable is a common default in hospital revenue cycle management. It’s a way to reduce administrative complexity, offload staffing decisions and let a specialist vendor handle collections. Felicia Kimble, director of revenue cycle at Rawlins, Wyo.-based Memorial Hospital of Carbon County and former director of billing operations at Billings Clinic, a closer look at what that arrangement was actually delivering changed the calculation.
While she was at Billings Clinic, Ms. Kimble conducted a comprehensive assessment of costs, performance and patient experience. She concluded that building and managing an internal self-pay AR team would improve both the financial results and the quality of care patients received through the billing process. She decided to make the switch and bring the function back in house.
“Using Lean Six Sigma principles, we mapped existing workflows, identified inefficiencies and waste, analyzed root causes of performance gaps, and redesigned processes to improve productivity and accountability,” she said. “The project required careful planning and execution, including workflow redesign, staff recruitment and training, development of key performance indicators, and a structured transition plan to ensure continuity of operations and cash flow throughout the conversion.”
The transition was designed specifically to protect cash flow during the shift, a concern that typically shapes how ambitiously hospitals pursue insourcing. The structured plan kept collections moving as the new team came online.
The financial results validated the bet. The initiative generated approximately $700,000 in savings during the first year, with projected cumulative savings exceeding $3.4 million over five years. Collections performance also improved, driven by greater operational visibility and stronger oversight of accounts receivable.
But the outcome that mattered most was not on a spreadsheet; it was the personal connection patients forged with team members at the hospital.
“Patients appreciated speaking with local representatives who understood the community and could provide personalized, compassionate assistance with billing questions and payment options,” she said. “This increased trust, improved patient satisfaction, and reinforced our commitment to delivering exceptional service throughout the revenue cycle.”
Revenue cycle leaders are often pressed to choose between cost reduction and patient experience, but the two aren’t mutually exclusive.
“This initiative demonstrated that revenue cycle transformation is most successful when operational excellence, financial stewardship, and patient-centered care are aligned,” she said. “By applying Lean Six Sigma methodologies and empowering a dedicated internal team, we achieved measurable financial results while enhancing the experience of the patients we serve.”
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