As physician organizations grow — adding locations, specialties or private equity partners — the revenue cycle processes built for a single site often start to break down. During a recent Becker’s Healthcare webinar sponsored by NextGen Healthcare, Jerri Ivey, vice president of RCM services at NextGen, and John Long, chief operating officer of Fort Bend Rheumatology Associates, discussed how practices can scale their revenue cycle management without ceding oversight, and what one practice’s turnaround looked like in practice.
When growth breaks consistency
Ivey said the first thing to break as an organization scales is consistency. A single site can lean on experienced staff and informal workarounds, but adding volume or locations turns those workarounds into inconsistent registration, authorization and coding practices. Rather than treating outsourcing as all-or-nothing, Ivey encouraged leaders to frame the decision around outcomes and constraints — where performance is below target, and which functions require scarce expertise the organization can’t reliably retain.
A $600,000 turnaround at Fort Bend Rheumatology
Long described the state of his practice’s revenue cycle before he joined in 2023: an internal RCM manager and administrator were collecting well on high-dollar infusion billing but missing smaller E&M codes, referrals and authorizations, adding up to roughly a $600,000 annual deficit. After evaluating several vendors, Long partnered with NextGen RCM services, removed the prior RCM leadership, and rebuilt the function around a partner whose compensation was tied to the revenue it recovered. The results were significant: Long said the practice has grown revenue by roughly 311% over nearly three years, with denial rates near zero and gross collection ratios far above where they started.
Choosing services à la carte, guided by data
Both speakers emphasized that outsourcing doesn’t have to be all-or-nothing. Ivey said NextGen uses function-level data — across coding, authorizations, denials and collections — to identify where a practice has a workflow issue versus an expertise gap, then scopes services accordingly. For Long, the analytics platform was a major draw, giving him visibility into trends like rising denials or underpayment on specific drugs before they became larger problems.
Vetting a partner, and planning for the exit
Ivey advised organizations evaluating RCM partners to look for evidence the vendor understands their specialty, payer mix and growth plans, along with clearly defined KPIs, performance expectations and accountability on both sides. She also flagged terms that are easy to overlook at signing but matter later: who owns the data, how it can be retrieved, and what the transition plan looks like if the relationship ends. “Sometimes I typically see contracts be deficient” on exit terms, he said, leaving organizations without a clear plan for outstanding AR if a partnership unwinds.
Keeping oversight without doing the work in-house
Long said constant dialogue — weekly meetings early on, later shifting to biweekly — combined with an independent auditor reviewing NextGen’s billing and coding, kept him confident in the partnership while treating the vendor as an extension of his own practice. That approach also caught real revenue: identifying missed documentation tied to a new billing code alone added roughly $192,000 in additional revenue last fiscal year. Both speakers agreed that transitions typically bring a short-term cash dip — Long’s practice saw about 40 days — before revenue rebounds and, often, improves beyond baseline.
