Arlington-based Texas Health Resources is shifting its revenue cycle team away from working insurance denials one at a time and toward identifying large-scale payer patterns it can resolve in bulk.
Jamie Williams, associate vice president of professional billing at Texas Health Resources, discussed the shift during a panel on revenue cycle innovation at Becker’s 11th Annual Health IT + Digital Health + RCM Conference.
“I want to change the dynamic of how we’re engaging with denials, truly,” Ms. Williams said. “Gone are the days of the mindless tasking and the transaction … I really want to transform the team into more of like large scale payer trends and large scale appeal projects.”
Rather than working through a queue one denial at a time, her team is shifting toward identifying recurring patterns — the same denial code appearing across dozens or hundreds of claims — and building a single bulk-reprocessing or appeal effort around the pattern instead of relitigating it claim by claim. Ms. Williams said part of that strategy runs through the payer Joint Operating Committee, the periodic governance meeting most health systems hold with major payers: once a pattern is confirmed internally, she wants it raised formally there rather than absorbed quietly by staff.
“They could be a large scale issue we’re just not locking arms on and addressing,” she said, referring to peer health systems in the same network or market that may be sitting on the same unresolved payer issue without realizing it.
The shift traces back to a “build crisis” Texas Health Resources hit about 18 months ago in its Epic system, the accumulated result of patches layered on top of patches since the system’s 2017 go-live. Rather than apply another fix, the team tore down parts of the build and reconstructed it from Epic’s foundation, starting with its follow-up and denials workflows.
“Are we patching it or are we fixing it?” Ms. Williams said. “We had been patching together things for a very long time. In revenue cycle, we’re fixers, we’re results oriented … but are we doing ourselves favors by doing that?”
The rebuild gave her team real visibility into which touches on a denial actually accomplish something, rather than just logging activity — a discipline she calls “invisible accountability.” That visibility, she said, is what now lets her team consider batching denials by pattern instead of working them one at a time.
Texas Health Resources isn’t alone in that push. Matthew Ayinde, system director for CDI and coding at Baltimore-based University of Maryland Medical System, described a similar shift from a different starting point during the same panel. About nine months ago, his team built a revenue cycle “command center” that pulls daily data on 90-day accounts receivable and denial rates directly from Epic.
Alongside it, the team built its own “payer behavior library,” a module that tracks the frequency of specific denial codes, such as CO-50 and CO-197, to identify a payer’s pattern before it compounds into a larger loss.
“We are not really reacting anymore,” Mr. Ayinde said. “We are going upstream using probability, using patterns, using scoring to ensure that we can move our work upstream, and we’re not really spending a lot of time in the downstream.”
Ms. Williams credited part of her team’s bandwidth for that pattern work to how Texas Health Resources structures its offshore staffing. Rather than treat an offshore partner as a traditional vendor, she described it as an “augmented staff model” — an extension of the business office itself, with daily huddles and ongoing collaboration.
“That dynamic is inherently different because you’re seen in a collaborative partnership versus just a handoff,” she said.
“I think we’re really stepping away from one denial, next denial, next denial to big group projects,” Ms. Williams said.
