While many health systems continue to outsource revenue cycle functions, some have brought services back in-house and are seeing results.
Roseville, Calif.-based Adventist Health said in its most recent financial report that it is continuing to see “positive momentum” after moving revenue cycle operations in-house. The 27-hospital system said insourcing resulted in days in accounts receivable of 56 in 2025 and cash collections of $5.2 billion, reaching 100% of the system’s goal. As of June 30, days in accounts receivable improved to 55.5.
Adventist said insourcing revenue cycle operations has improved transparency and teamwork between finance, managed care and revenue cycle departments.
“An example of this collaboration includes the accelerated identification and escalation of denials, aging and underpayments from managed governmental and commercial payers leading to quicker resolution,” Adventist said in its Aug. 28 financial report. “Based on these and other actions, net patient revenue per CMI adjusted discharge was 3.8% higher than the six months ended June 30, 2025.”
Adventist completed a systemwide Epic rollout on Aug. 30 and anticipates additional revenue-yield opportunities after stabilization.
Billings (Mont.) Clinic is another system that saw benefits from insourcing a revenue cycle function. Felicia Kimble, former director of billing operations at the system, told Becker’s that while she was at Billings, she 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 move the function back in-house.
Ms. Kimble — now director of revenue cycle at Rawlins, Wyo.-based Memorial Hospital of Carbon County — said the initiative resulted in 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.
She added that the initiative also created a strong personal connection between patients and 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.”
Chicago-based CommonSpirit is in the process of transitioning revenue cycle operations in-house as it exits its outsourcing partnership with Conifer Health Solutions. In February, it was announced that Dallas-based Tenet Healthcare would regain full control of Conifer. Under the agreement, CommonSpirit will pay Tenet about $1.9 billion over the next three years.
CommonSpirit CFO Michael Browning said on the system’s May 29 investor call that the decision to exit the Conifer joint venture connects directly to its broader payer strategy.
“We have been clear that we cannot continue to provide high-quality care at reimbursement levels that do not reflect the true cost of care,” he said. “Strengthening payer relationships, improving reimbursement and reducing the cost to collect are all part of building a more sustainable operating level.”
CommonSpirit believes insourcing revenue cycle functions can significantly lower its cost to collect, which is currently about double the industry average. Mr. Browning said bringing that metric closer to the industry benchmark would generate more than $1 billion in annual operational savings.
The system’s contract with Conifer ends on Oct. 30.
