Stroudwater Revenue Cycle Bootcamp

Our billing specialists are organized by payer, allowing them to develop deep expertise in their respective areas. Each specialist subscribes to their payer’s newsletters to stay informed about updates and changes. Additionally, our team leads, Supervisor, and Director of Patient Accounts—along with the Prior Authorization Team—collaborate to share key insights and ensure the entire team stays up to date. This collective approach enhances our ability to navigate payer policies efficiently and provide the best possible service. 

Our billing specialists are supported by a structured leadership team, including two team leads, one Supervisor, and one Director. Training for billing specialists is conducted by our Supervisor and team leads to ensure consistency and expertise. Additionally, billing specialists meet weekly with leadership to review denials and identify payer-specific trends. For new coders, who are required to be certified, training is led by our Coding Lead to maintain high standards of accuracy and compliance.

Billers are first assigned by insurance type and then further divided by alphabetical split. Since each insurance type has multiple billers, the alpha split helps distribute the workload efficiently.

This would depend on the specifics of your union contract. Stroudwater can work with you to review the contract and develop a compliant incentive model.

Our Coding team handles all aspects of coding, including CPT, modifiers, and ICD-10. They thoroughly review all provider documentation to ensure accuracy and compliance.

Yes, we have a report in EPIC that identifies providers who have bypassed the ABN option. We’ve also met with nurses in departments with a high volume of ABN services, such as Podiatry, to improve understanding of the process.

My Prior Authorization team consists of three RNs and one Certified Coder. They handle all prior authorizations and medical necessity reviews.

Our Revenue Cycle team consists of 97 employees across multiple departments:

• Patient Accounts: 1 Director, 1 Supervisor, and 2 Team Leads.
• Health Information Management (HIM): 1 Coding Lead and 1 Medical Records Coordinator.
• Registration/Admitting: 1 Director and 2 Coordinators (one for the hospital side and one for the clinic side).
• Scheduling: 1 Director, 1 Supervisor, and 2 Team Leads.

This structure ensures effective oversight and support across all areas of the Revenue Cycle.

There are multiple vendors that provide this service. While Stroudwater does not partner with any specific vendor, we can work with you and your team to identify the best option for your facility.

We do not have a CDI team at this time. However, all of our coders are certified and required to review all provider documentation. Additionally, we have a Certified Coding Auditor who conducts monthly and quarterly audits to ensure accuracy and compliance.

Claim scrubbing is performed on the front end to ensure accuracy before submission. Even after four years on EPIC, we continuously refine our scrubber edits to improve efficiency and compliance. Regarding our CDM, we conducted a comprehensive review five years ago to ensure accuracy. Since then, I have worked with each department annually to review and make necessary updates. However, we do not implement automatic across-the-board increases each year; adjustments are made based on specific needs and changes.

No, we did not. While we provided some overtime, our team was able to effectively manage the workload and stay on top of it.

We have a dedicated team member responsible for payer enrollment.

If a test is classified as STAT but is not emergent, we require the patient to sign an Advance Beneficiary Notice (ABN) for Medicare or an Advance Patient Notice (APN) for non-Medicare patients.

The Advanced Patient Notification (APN) form was created for our non-Medicare patients, except for those with Medicare Advantage plans, as it cannot be used for them. It closely mirrors the Advance Beneficiary Notice (ABN) form, with slight wording adjustments to align with non-Medicare requirements.

We’ve only encountered this issue with Medicare Advantage plans. So far, we haven’t had any issues with commercial payers.

Stroudwater is happy to work with you and your team on the requirements of the No Surprises Act. This includes policy education, developing internal processes, and creating staff training documentation. You can also explore this case study for more insights: Implementing a Plan to Comply with the No Surprises Act 

For self-pay or out-of-network patients with a scheduled visit (at least three days in advance), a Good Faith Estimate (GFE) is required. However, if the patient seeks care in the ED, Urgent Care, or a Walk-In clinic, a GFE is not required, as these visits are not considered scheduled.

Reimbursement for DSNAP plans varies by state. Stroudwater can work with you to review your state’s specific requirements and determine the best approach.

This continues to be a challenge for us. When we receive one of these, we notify the providers in an effort to prevent future occurrences. Additionally, as part of our ongoing efforts, we launched a ‘Lab Denial Investigation’ team on March 1 to address this issue.

We offer a 15% discount to all self-pay patients. For those applying for financial assistance, the discount is based on their household income and poverty level, considering the number of people in the home. Applicants must provide supporting documentation, including bank statements, pay stubs, tax forms, and any other income verification for all adults in the household.

All bonuses are approved by our Board of Trustees.

We help the community understand that most health plans now include higher deductibles and co-insurance amounts. By communicating co-pay expectations before the date of service, the hospital eliminates uncertainty, allowing patients to focus on their care. Additionally, most patients expect to have some financial responsibility, and providing this information upfront helps them plan accordingly.

We do not have a policy for this. Since we do not turn away patients for non-payment, we collect what we can.

Charity care policies are typically based on a multiple of the Federal Poverty Guidelines and available local resources.

Stroudwater has helped multiple clients develop training modules for front-end staff, including recorded webinars and presentation decks to ensure consistent training across teams. We’d be happy to work with you on this.

Best practice is to use a centralized department to verify insurance for all services provided during a visit. If a centralized approach isn’t available, standardized registration and verification processes should be implemented across all registration areas.

We access EPIC through a partnership with UnityPoint Health in Des Moines. EPIC offers a Community Connect program specifically designed for smaller facilities like ours, allowing us to leverage their system while maintaining operational efficiency.

We work with a third-party provider that exclusively serves Iowa and Wisconsin. Are you located in either of these states? If not, I recommend reaching out to EPIC corporate in Verona, WI, to inquire about a Community Connect Hospital program available in your state.