San Antonio-based University Health is taking a proactive, hands-on approach to revenue cycle management that’s helping the health system achieve significant results.
By embedding its managed care contracting team directly into daily revenue cycle operations and launching a structured contract implementation process, University Health has strengthened its ability to push back against aggressive payer tactics — including rising denial rates, delayed payments and prior authorization hurdles.
In a recent episode of the “Becker’s CFO and Revenue Cycle Podcast,” Kevin Barron, deputy vice president for payer relations at University Health, shared how the health system’s contract performance audit function and a newly launched program are helping recover millions in high-dollar claims, improve contract rollouts, close knowledge gaps and streamline payer collaboration.
Mr. Barron offered a detailed look at the system’s strategies to ensure contracts are not only negotiated effectively but also fully implemented and understood across revenue cycle teams — a shift that’s enabling University Health to act faster, hold payers accountable and better protect its financial performance in today’s challenging reimbursement environment.
Editor’s note: This is an excerpt from an episode of the Becker’s CFO and Revenue Cycle Podcast (click here to listen to the full episode). Responses are lightly edited for length and clarity.
Interested in featuring a CFO or revenue cycle leader from your health system on the podcast? Contact Alan Condon at acondon@beckershealthcare.com.
Question: Health systems are pushing back against increasingly aggressive tactics from commercial payers. There’s no silver bullet for these challenges, but are there one or two specific strategies University Health is using to fight denials and protect financial performance?
Kevin Barron: On the operational side, we’ve built a contract performance audit function within our managed care team. We have three positions dedicated to this: a senior manager who oversees the function and two contract auditors. Essentially, they review trends and payment issues, identify them, determine the scope and depth of the problems, and get those issues to the payers to work toward a resolution. A lot of health systems typically handle this in the business office, but we’ve shifted some of that responsibility to our team to help lighten the load for the business office, which already has a lot on its plate. On our side, it’s been pretty successful.
One specific program we’ve developed involves pulling all high-dollar claims at a certain point — when they hit one of our Epic work queues. Our team reviews those claims. Last fiscal year, when we ran the report, we were able to assist in collecting an additional $12 million on high-dollar claims. For every claim we were able to support, we were collecting about another $150,000 per claim.
We focus on high-dollar accounts and watch for when they hit a certain age in our [accounts receivable] — the point where it’s typically harder to collect. Even then, we go after them aggressively, working directly with the payers to explain what’s going on with the claim, making sure they have the records they need and handling all those steps from our side. Of course, these activities also happen in the business office, but adding this layer from our team has been really helpful.
Being directly embedded in the revenue cycle makes a big difference. I meet every Friday morning with our business office team, reimbursement team, revenue integrity team, and our [chief revenue officer] for AR meetings. Having contracting in those AR meetings isn’t always the norm, but it’s been a big advantage. It gives me a chance to hear the pain points in real time and follow up immediately with the payers to address issues or at least get things moving.
One of the most recent initiatives we’ve launched is building a contract implementation process, which we hired a dedicated manager to lead. Every time you complete a contract, it can feel like it takes forever — and now, more than ever, it’s incredibly challenging. Historically, once a contract was finalized, we’d just move on — send a copy to legal, the business office, and whoever else needed it, and then jump into the next negotiation. We haven’t worked that way in a long time, but now we’re really focusing on improving this process.
We’re calling it our PAC (payer access and contracting) program, which is essentially about making sure we have the right education for revenue cycle teams, identifying knowledge gaps, fixing access issues with payer portals, and getting the payers to provide on-site or virtual (Teams, WebEx, etc.) in-services for our revenue cycle staff and leadership.
We’ve only done a couple so far because it’s still pretty new, but I’m excited about what this program can bring. The person managing this initiative is also going to handle our joint operating committee meetings with payers to ensure we’re following up on outstanding issues. What’s great is that the person we hired for this is a recent undergrad who started as an intern with us and helped build this from the ground up. She’s incredibly enthusiastic about the work, and I’m really excited about the potential of this project. I think it’s going to help us accomplish things we haven’t been able to do in the past by making sure that the contracts get rolled out appropriately.
