Christy Pehanich

JENA R. EGGERT

CEO & Founder RCR|HUB and JER Marketing

Nurturing in May

Dear RCR|HUB CommUnity,

Welcome to May’s edition of RCM Connections. This month, I had the privilege of interviewing Christy Pehanich from Geisinger.

Christy embodies the spirit of collaboration and camaraderie that defines our RCM CommUnity. Approachable and ever-willing to contribute, she has graciously participated in my provider panels, roundtable discussions, and even after-hours events during the challenges of the COVID era.

What sets individuals like Christy apart is not just their expertise but their unwavering commitment to continuous learning and progress. They

Connections

serve as beacons of inspiration, illuminating our collective journey with their passion and dedication. These meaningful connections and shared insights enrich our experiences and propel us forward.

Here’s to fostering connections, sharing stories, and cultivating a thriving RCM CommUnity where every voice is heard and valued. Together, let’s embrace the opportunities that lie ahead, knowing that it’s the people like Christy who make our journey genuinely extraordinary.

Jena Eggert Editor-in-Chief RCM Connections

TABLE OF CONTENTS

SPOTLIGHT ALL ABOUT GEISINGER

SPOTLIGHT CHRISTY PEHANICH

13.

SPONSORS

17.

RCR|HUB SPONSORSHIP OPPORTUNITIES

A BACK TO BASICS APPROACH TO COMMON HEALTHCARE REVENE CYCLE MANAGEMENT CHALLENGES

ABOUT

On March 31, 2024, Geisinger became the first member of Risant Health, a new nonprofit charitable organization created to expand and accelerate value-based care across the country.

1.2

$10

MILLION BILLION

Geisinger is among the nation’s leading providers of value-based care, serving 1.2 million people in urban and rural communities across Pennsylvania.

Founded in 1915 by philanthropist Abigail Geisinger, the non-profit system generates $10 billion in annual revenues across 134 care sites - including 10 hospital campuses and Geisinger Health Plan, with more than half a million members in commercial and government plans.

$14

EMPLOYEES

The Geisinger College of Health Sciences educates more than 5,000 medical professionals annually and conducts more than 1,400 clinical research studies. Geisinger has 26,000 employees, including 1,600 employed physicians.

Geisinger is among Pennsylvania’s largest employers, with an estimated economic impact of $14 billion on the state’s economy.

AVP ReVenueMAnAgeMent PRofessionAl oPeRAtions

Jena Eggert: Please tell us about your current position, organization, demographics, team, and responsibilities.

Christy Pehanich: My current title is associate vice president of Revenue Cycle Management. I am one of seven direct reports to our Revenue Cycle vice president & Chief Revenue Officer, Bob Dewar. I have been working at Geisinger for 27 years,12 of which have been in my current role. There are approximately 1,100 folks who work in Revenue Cycle, and approximately 20% of those resources report to me.

I began my career in the revenue cycle field in 2005, focusing on professional billing. Prior to this, I spent seven years working for our insurance operation. In 2005, I was one of four leaders selected to bring Geisinger physician billing and AR management in-house and to

establish a dedicated team distinct from the hospital revenue cycle operation.

Today, I continue to oversee physician billing, insurance collections and denial management for the physician side, which accounts for approximately one-third of my current team. As time passed, my role expanded. After establishing stability in our professional operations, I became responsible for our combined self-pay team. Today, this team is responsible for patient services and patient collections for all Geisinger entities and carries the department name Patient Service Call Center.

Our Patient Service Call Center takes all incoming patient calls. Mostly, there is a lot of correlation between the patient statements we’re sending out or billing notifications and calls that come back into the organization. They also do outbound patient collections.

We’ve been afforded a lot of technology that not all healthcare organizations have the privilege of using in terms of bells and whistles, outbound campaigning, and sophisticated voice and technology systems so that we can do our patient collections in-house. And then I have all my other areas, including home infusion pharmacy and ambulatory pharmacy, that I’m responsible for now.

Pharmacy is relatively new to Geisinger’s centralized revenue cycle. Then there’s our substance abuse rehab/addiction treatment center, Geisinger Marworth.

I also oversee their revenue cycle activities, and I cannot forget about Geisinger-EMS, that team bills for ground ambulance transportation.

As you can tell, several areas don’t cleanly fall under the traditional hospital or the clinic. And many of those entities revenue cycle responsibilities report up through my organizational silo structure.

JE: How did you begin your career? Did mentors or family members play a significant role in your journey?

CP: I’m the eldest of three children. Being the oldest, I’ve always felt a sense of responsibility, like a caretaker. That’s probably why I was drawn to healthcare. I always thought I’d be a nurse, but nursing was very competitive when I looked at career opportunities in the early ‘90s. So, I became interested in healthcare management. I guess it was a combination of being in the right place at the right time and meeting the right people who helped me advance in my career. I’ve had the privilege of working with some incredible mentors at Geisinger. Most of my experience has been in Revenue Cycle, except for the seven years I spent working at Geisinger Health Plan. That’s where I learned a lot about reimbursement, billing and provider networks.

In terms of personal experiences, there have been some key leaders who really helped me grow throughout my career. Susan Friel is one of those people. Susan was my boss at Geisinger Health Plan when I worked in provider network

management. She pushed me to learn dreaded pivot tables and how to work with advanced data. I always thought I was good with Excel, but pivot tables were a game-changer when it came to Microsoft Access and big data.

Susan is one of those people who could see skills that would be useful no matter what job I had. She taught me the importance of working with data, even big data, and how to synthesize it into clear information. She emphasized the importance of tailoring presentations to the audience, whether they needed high-level information or more detail. Susan taught me how to leverage data analysis and presentations to persuade people and make change. Data can be a powerful tool to get your point across. If you had data to support your request, Susan would definitely be someone who would help you build a strong case. Early in my career, she helped lay the groundwork for this.

From a revenue cycle perspective, I must mention Barbara Tapscott. She’s very well-known in revenue cycle circles. It was an honor to work under someone like Barbara, who is a natural teacher. She would always be willing to roll up her sleeves and show you how she tackled challenges — that’s not something you find with every vice president. She instilled accountability but led by example. She was a great person to have in your corner as a teacher and a boss.

JE: Thank you. I agree that Barbara Tapscott is a rockstar! I’m fortunate to consider her a friend as well. Shifting

gears, are you and your teams remote?

CP: We’re mostly remote 100% of the time, with a few exceptions. We have a practice consultant division, and their role is to be a liaison with our clinical service line leaders. They do physician education, so they have a bit of a hybrid role. They’re out in the field interacting with their customers, whether that’s in physician offices or hospitals. But they can also do a lot of the preparatory work and analytics from home. So, some positions are hybrid, but outside of Patient Access, the rest of us are at home. For Patient Access, we still have on-site registrars at all our hospitals and emergency room departments, as well as Patient Access personnel who check patients in and out of our physician locations. Those personnel are on site. But anything that’s not patient-facing or physician-facing is remote.

JE: In our digital age, what excites you? What do you observe? What are you anticipating?

CP: AI is definitely here to stay, and there’s a lot of potential in terms of what it can do to bring cost savings and streamline operations. We’ve begun experimenting with more sophisticated claim statusing. Typically, we categorize our inventory into claims that have been denied and require additional work and those awaiting a payer response but where the deadline to pay hasn’t passed yet. These claims are essentially stuck in limbo, waiting for staff to review them. Then there’s a large backlog of accounts receivable where the deadline to receive

a remittance from the payer has expired. We call these cases “no activity” or “no response” inventory. To address this, with the help of Geisinger’s Steele Institute for Health Innovation, we’ve started working on our no-response queues to check the status of each claim with the payer. This includes whether the claim is on file and, if so, whether it’s tagged paid or denied. If it’s been paid, we record the payment date and defer reviewing it by staff until after that date.

If it’s been denied, the claim statusing bot determines the reason for denial and checks if there’s anything we can do to expedite the process, such as requesting additional medical records. The bot can also identify claims that are not yet on file with the payer and automatically rebill them without human intervention.

For claims that are on file but not yet denied or paid, the bot prioritizes how we reach out to the payer based on the

expected value of the claim and other factors. So, using a bot in the claim space is something we’ve just begun experimenting with this year. We’re constantly looking for areas in the revenue cycle workflow where we can reduce manual tasks and improve efficiency. For instance, in real-time eligibility, we can now query payers for eligibility and automatically post all the relevant policy and benefit information, including expected out-of-pocket costs, directly into the patient accounting system.

We’re seeing a lot of movement with Medicaid and Medicare patients switching between plans. Real-time eligibility systems keep us updated on which plan a patient is enrolled in on a particular date of service. For example, if a patient switches from traditional Medicare to a Geisinger Managed Medicare Plan, the system can automatically confirm their eligibility with Geisinger Health Plan and update

Kelly Samuel, Heather Stanisci (both from Annuity Health), Melissa Kern, Christy Pehanich, and John Gadomski.

our records. So, our focus areas for AI have been eligibility, cash posting and claims. We’re always asking our staff for input on where they spend a lot of time on repetitive tasks that could be automated. This way, we can work together to identify opportunities to streamline workflows and improve efficiency.

JE: What is your approach to hiring and team building as an AVP?

CP: I very much believe it is important to hire people who are smarter than you, people who have skills that complement your own or make up for your own deficiencies.

I always try to hire people who are bright and have the capacity to learn. You don’t have to know everything right off the bat, but having the right attitude and the right motivation is key. You know those are the people you can trust to do their job to the best of their ability and seek counsel or advice if they hit barriers. I kind of pride myself on not being a micromanager. By not micromanaging and making the team accountable, you are giving them ownership!

Although I like to know what’s going on, I don’t necessarily ever dictate how somebody would get from point A to point B. One of the best things about RevCycle is the fact that there are key performance indicators. There is so much data; everything you do is measured and reported in some way, shape, or form. So, the competitive piece of me likes it when staff does well, and it’s shown in our AR days and denial rates. It’s not just that you’re telling the story of how hard your team works; the numbers show how efficiently your team works and how dedicated they are.

But you also have this set of numbers that you could hold up and say, “Look what my team’s been able to accomplish.” We’ve been able to bring denials down by three points, which is something that my PB team prided themselves on. After installing Epic initially, our denial rates increased. However, we were able to quickly bring them back to their previous levels by implementing the techniques we’ve learned over time and leveraging the system’s capabilities to streamline operations.

At the end of the day, we’re all a team, and we’re all here to help and support one another. But trusting people to do the right thing is half the battle. You really need to hire the right people, give them the tools that they need to succeed, and then trust that there’s more than one way to get the job done. You have to let people navigate their own path. You’re there to guide them along the way, but not to dictate how things get done.

JE: What aspects of our RCM Community do you find most

Shelia Hojnacki, Melissa Kern, Christy Pehanich and Barbara Tapscott.

valuable? What advice can you share?

CP: HFMA stands out as the primary network I’ve tapped into. Early on, Barbara mentioned how the healthcare revenue cycle world is surprisingly small, and it didn’t fully register then. But over time, encountering the same names, faces, and respected leaders in the industry has really driven that home. HFMA has truly been an exceptional networking platform for me. Of course, there are other reliable sources like the American Hospital Association, CMS, and Becker’s that I also turn to for information.

What’s remarkable about revenue cycle is the culture of sharing. People willingly disclose their successes and failures, offering insights to prevent others from repeating their missteps or moving too hastily. It fosters a deeply collaborative environment. Despite the competitive nature of health systems, especially regionally, the revenue cycle leadership community is remarkably open. With regulations evolving rapidly and AI gaining traction, there’s a wealth of stories about what works and what doesn’t in different organizations. This collective sharing of experiences, both positive and negative, is invaluable.

As for advice, why healthcare revenue cycle? I think there’s this perpetual need to be a lifelong learner. Things never stay the same. Revenue cycle regulations, payer rules, and market dynamics are in a constant state of flux. So, what organizations really need are individuals who not only understand the intricacies of revenue cycle operations but also possess leadership and change management skills.

Being nimble and adaptable is key. It’s like being the engine that keeps everything running smoothly behind the scenes. This work directly impacts an organization’s ability to recruit top talent and stay equipped with the latest resources. And the best part? You get to witness the results of your efforts every single month. It’s exhilarating! Revenue cycle management is a field filled with opportunities for those who remain engaged. With healthcare being an evergreen industry, there’s always going to be a demand. That’s why I want to see more early careerists getting involved, and organizations like HFMA are doing great work in that area.

JE: Lastly, I wanted to ask you about Risant Health. Can you provide some information about it for our readers?

CP: Geisinger recently joined Risant Health as the first member. We’re doing this to accelerate our mission of making better health easier for the communities we serve. Being part of Risant Health allows us to access the tools, expertise, and capital to accelerate our charitable mission and strategy and expand our impact to other communities across Pennsylvania and beyond.

Brian Babilon, Christy Pehanich, Tiffany Jones and Lori Masters.

Garland F. Goins Jr., is the Vice President of Revenue Cycle Management for Alo / Avance Care in Durham, NC. In this role, Garland is responsible for organizational charge compliance, revenue preservation and enhancement, and value-based care integrity. Garland has held progressive leadership roles in the revenue cycle for Comprehensive Primary Care and Academic Medical Centers for over 18 years and is an active local and national member of HFMA’s Physician Practice Executive Council, AAPC, NAHRI’s Leadership Council and AHIMA.

Healthcare revenue cycle management plays a vital role in the compliant financial health of healthcare organizations, extensively involved in patient satisfaction, coding/charge capture, managing claims, processing payments, and revenue generation. Despite technology and solution modernization, revenue cycle management still faces countless challenges that impact clinical and operational efficiencies, overall financial performance, and ultimately organizational success and sustainability. This article is designed to explore some of the common pain points and challenges facing healthcare organizations through streamlining the basics in revenue cycle processes.

I.Complex Payer Contracts and Reimbursement Models:

Navigating complex payer contracts, varying reimbursement models, and evolving regulatory requirements remain prominent challenges for healthcare organizations in managing revenue cycle processes.

II.

NAVIGATING A Back-to-Basics Common Healthcare Cycle Management

by: Garland F. Goins Vice President, Revenue Cycle

shifted a significant burden onto patients to cover their healthcare expenses prior to the payer covering any of those expenses.

Can we discuss what your plan means: Proactively and candidly discuss with your patients what their plan types truly cover. Create the expectation of support through their healthcare experience, understanding collecting of payments, estimating costs accurately, offering financing options (i.e. payment plans), and addressing any financial concerns are essential to maintaining mutual trust and optimizing revenue cycle collections.

III.

Can we have a data-driven conversation: Ask your payers if you’re getting the best possible rates for the quality of care you’re providing. Ensuring mutual compliance within contracting terms, adapting to value-based payment models, and highlighting documentation standards of care can aid in cultivating a genuine payer relationship, with continuous monitoring,

Billing and Coding Errors:

One of the most prevalent challenges in revenue cycle management is the recurrence of billing and coding errors. Incomplete documentation, misinterpretations, and inaccurate diagnosis sequencing and charge capture can lead to claim denials, delayed

NAVIGATING COMPLEXITIES:

Approach to Healthcare Revenue Management Challenges

Goins, jr

management strategy leveraging analytics for trend timely trend analysis can reduce avoidable denial rates and maximize revenue capture. Do not forget to share findings through your enhanced communications with payers to ensure all efforts of denials prevention are transparent and maximized.

V.

Compliance and Data Security:

Protecting patient health information, ensuring data security, and maintaining compliance with evolving regulations are paramount to the revenue cycle, IT, and the patient-organization relationship.

structured training program for all functional roles, coupled with quality assurance processes with identifiable career pathways, and leveraging EMR/system edits to mitigate errors and prevent coding/billing errors will lead to a highly resilient and performing revenue cycle.

IV.

Claim Rejections and Denials:

Claims rejections and denials are considerable pain points that not only impact revenue cycle efficiency but also the patient’s experience.

Can we leverage analytical trends to proactively remedy: Encourage and implement a continuous process improvement mind-set to identify and address the root causes of denials. From demographic mismatches, missing or errant information, eligibility and coverage issues, to visit and scheduling types, and coding errors; having a denials

Can our training include practical application of mitigating non-compliance: Additional investment in robust cybersecurity measures, computer training with Phishing exercises, and risk management practices with communications on how to safeguard data integrity can mitigate potential breaches that erode patient trust and negatively impact organization revenue and branding.

Designing, employing, and maintaining a high-performing revenue cycle management team to combat these common healthcare challenges takes deliberate and focused leadership to ensure financial sustainability, an engaged culture, and returning satisfied patient. Through recognizing and addressing these challenges such as payer complexities, patient financial obiligation, billing and coding errors, claim denials, and compliance issues, organizations can streamline processes, optimize coding and revenue capture, increase patient engagement, and improve the overall financial performance of the operations. Significant investment in unified strategies, technology adoption, staff training, and continuous improvement efforts remain key to effectively navigating the complexities of revenue cycle management.

Why SparkChange?

Our process is different. We’re data-driven. We don’t offer any solutions without first looking at the data in your system. To do that we start with a complimentary system-level analysis of your revenue cycle. Not only is it free, we deliver the results in two weeks with no burden to your team or your IT resources.

Process

System-Level Analysis

We extract build requirements from historical data, model billing activity, and validate data across unlimited scenarios.

Data-Driven

Your data guides all our recommendations, making our approach precise.

Non-Intrusive

Results are gathered without disruption and with no effort from your team and IT.

Two Weeks

In 2 weeks, we uncover core challenges and present our recommendations to your team.

The Insights

Disruptions

AR Overview

Top Balances

Bill Suppression

Edit Failures

Claims in Flight

Denials

Small Balances

Self-Pay

Variances

Revenue Integrity

The Most Precise Clinical DRG Revenue Integrity Solution

Accuity’s

Add Additional RCM Categories

Category Leaderboard Sponsorship

Hang Your Company Logo on a Billboard

Newsletter Ad Space

Innovation Hub Sponsor

Provider / Business Partner Editorial Sponsorship

OPPORTUNITIES FOR BUSINESS PARTNERS OPPORTUNITIES FOR PROVIDERS

Comprehensive Resources

Streamlined Information

Networking Opportunities

Training and Education

Benchmarking Data

Technology Insights

.

Comprehensive Calendar of Events