Colleen Hall – Managing Principal
of the Healthcare Services Group,
Colleen is a business leader in revenue cycle management and is recognized for her specialty knowledge in major outpatient revenue-producing hospital departments. She is the managing principal of the healthcare services group at Crowe LLP, a public accounting, consulting and technology firm in the U.S. with offices around the world, where she oversees the delivery of the firm’s full range of services to the healthcare industry and leads the revenue cycle team, making her an expert in the field.
In this interview with me, Colleen talks about her experience spending over a decade with the company and the changes she has witnessed over the years.
An Early Start in Healthcare
Colleen had always been interested in the business end of healthcare. The ability to help organizations manage the administrative side of their business so that they can in turn care for patients was a major attraction point.
Her first job was as a Medicare specialist for a durable medical equipment provider. During her tenure there, she learned about various aspects such as billing claims, processing claims, and work denials, among others.
Her next opportunity was managing a physician practice which further broadened her experience in the field. Colleen gained exposure in all aspects of revenue cycle from scheduling patients to making sure the appropriate payment was received.
She then moved to consulting where she specialized in the middle of the revenue cycle related to charge capture. She began consulting at Ernst and Young and is now at Crowe LLP, where she currently leads the healthcare services group, which includes the entire revenue cycle team.
‘It feels good that we are able to make a difference in how care is provided to the patients by ensuring that our clients are maximizing their processes and that they are able to get paid effectively for all the work that they are providing.’
Current Business Scope at Crowe
Colleen has grown at Crowe with over 11 years of experience at the company. Presently, her clients consist mainly of hospitals along with some physician practices as well. Crowe has well over 600 individual clients in their healthcare vertical. Of these, each client could be responsible for multiple hospitals, so the firm is providing services to over 1200 individual hospitals and practices.
The healthcare vertical has over 600 employees with Colleen leading a team of 75 individuals in revenue cycle. The consulting services include educating clients to improve their current processes. Unlike an outsourcing organization, the experts at Crowe go in and train the client’s teams on how to do things most effectively and appropriately.
‘We offer consulting services using the client’s existing technologies, implement some of our own technologies and ensure their revenue cycle processes are optimal from start to finish.’
The Crowe team also helps validate the performance of an outsourced vendor relationship that the client may have. Since Crowe has access to valuable information and data, they can validate the KPIs that the outsourced vendor is either looking to achieve or that they are being monitored against. Using that information, Crowe can provide clients with a service level agreement validation to ensure that they are paying the outsourced vendor appropriately.
A lot of the work requires traveling to client locations, where the Crowe team can physically observe the client processes and educate in-person on how to do things more efficiently. However, even prior to the pandemic, Crowe implemented a flexible work location policy so they were able to make the transition to full-time remote work as smooth as possible for their people, clients and the firm.
COVID-19 Impact on Business
For a team that was used to traveling extensively to support their clients, the sudden onslaught of the pandemic presented a challenge. The focus shifted from meeting face-to-face with clients to finding a way to be effective without in-person meetings. Colleen credits flexibility, on both the client’s and Crowe’s end, for overcoming the challenges comfortably.
‘It was a time of us coming together collectively and collaboratively with our clients to say we’re both in the same boat together here, now let’s just figure out what is going to be the best way forward to make this happen.’
Colleen remembers that some of the products that they had underway at that point in time were delayed, but the team came together to figure out other ways of working with the clients to minimize the effects of any delays.
Standout Moments as a Business Leader in the RCM Domain
Over the course of 16 years, Colleen has had several standout moments that bring her pride. One of them includes the collective revenue that the team she oversees has been able to identify and provide for clients over the years. She believes it amounts to almost a billion dollars of additional revenue that they have been able to appropriately direct back to their clients.
‘Thinking about the impact that additional money has been able to make for our clients and then ultimately trickle down to their missions and visions, it is pretty amazing to know that we had a hand in all of that.’
On a personal note, the journey from specializing in the middle of the revenue cycle to being able to now lead a group that does everything related to revenue cycle has been amazing. When Colleen and her team work with clients in the revenue cycle domain, they don’t just take over the department. Instead, it is a complete knowledge transfer and learning experience for the clients which allows them to sustainably improve their operations and their revenues. This approach not only works well but creates better value in the industry as a whole.
For Colleen, another proud accomplishment of hers is the value that they bring their clients as well as the growth they’ve seen in the revenue cycle team over the past 11 years.
‘We now have hundreds of clients that we have delivered revenue cycle services for and I can confidently say that of all of those clients would likely tell you that they had their expectations exceeded by the work that we had performed.’
Overcoming Challenges During the Expansion of the RCM Vertical
Colleen states that with the job market so strong and competitive, they are focusing on recruiting and maintaining top talent. The focus is also on expanding and continuing to grow by taking a product-led approach.
Over the years when the team at Crowe has considered adding onto or building a new technology, they have held back as a lot of those types of technologies or products were already in the market and would not be a different offering.
For Colleen, the focus is on looking at where the gaps are in the different types of products that their clients are asking for and then determining whether the decision is to buy or make the product. Going forward, Colleen and her team want to have products that they can lead with to ensure they’re in line with the client’s expectations. For their continued growth, the aim is also to build products that can help support the services that they are providing.
‘We have a really good product called performance integrity that is in development right now and is going to help with revenue cycle performance in a broader manner.’
Business Plans for the Future
With the upcoming performance integrity solution hopefully ready to be deployed by the end of the calendar year, Colleen expects it to open some significant doors and provide insights to their clients regarding areas of opportunity that they don’t need outside help to fix.
Looking at the growth and the way that things are changing, this product is going to help Crowe set the path for something that no one in the industry has seen before. Another focus is the ability to continuously adapt to the environment. The way the company processes revenue cycle work today is quite different than 10 years ago.
Getting ahead of any expected changes regarding revenue cycle and meeting client demands have helped the company adapt and prepare for the future. Whether it is the new pricing transparency or the No Surprises Act, there are various regulations that clients need help with, and Crowe is in a position to assist them.
‘It is about being as knowledgeable as we can be when we are talking about decisions made by the government and always being a couple of steps ahead.’
Top Philosophies and Core Values in Business
Colleen believes that from a revenue cycle perspective, it is important to understand that every single provider out there is different. As consultants, it is important to view each project as a new one. It cannot be looked at as a standard cookie-cutter system where people go in and put the same process in place repeatedly.
While there may be similarities, consultants need to be open to knowing that there is going to be a specific way that a process needs to be optimized for every individual client.
‘Not being set in our ways, being flexible and open in the way we deliver the work, ensuring that we are going in with a new set of eyes every single time and doing what’s best for the client is important.’
A lot of organizations go in with tunnel vision and repeat a standardized process. This does not allow for full adoption or the sustainability of improvements. At Crowe, each client is an individual and the focus is on what works best for them. Another business philosophy is to never make promises or commitments that cannot be achieved.
‘Being honest and open with clients is critical and it allows them to trust us and know that we are there to be a true partner. We are not there to just get more fees out of the work that we provide. It is about long-term relationships.’
Advice for Newcomers Starting a Career in RCM
Revenue cycle is incredibly complicated and someone looking to start a career in this field should understand the entire revenue cycle process before they look to specialize in any particular area.
Each step in revenue cycle builds on the next so if someone does not understand how they got to a particular point in the revenue cycle and where a breakdown is occurring, then they are not going to have a full understanding of the overall process and the reason for its implementation.
For someone starting out in revenue cycle, it is helpful to imagine and walk through what a patient experiences from start to finish. If it is a medical necessity denial that they are trying to deal with, they should understand that it may be because that patient status potentially was not correct when that patient was admitted to the hospital or they didn’t get prior authorization before having that procedure performed.
‘They are all interlocked together so it is important to have a broader understanding of revenue cycle before you try to dive in because you’re going to need to know the “why” behind it.’
Best Practices Implemented in the Field of RCM
There have been many best practices implemented at Crowe, and the team decides which are applied based on each particular client situation.
Colleen looks at any best practice from three lenses. The first one is to ensure that clients are optimizing their technologies. This does not necessarily mean adding a new technology from a third-party vendor, but rather that the functionalities of the available technologies are all established appropriately.
For instance, in electronic medical records, there is a lot of functionality that many clients aren’t using appropriately, or they don’t realize it is there. For Colleen, as a best practice, ensuring that all those elements are optimized is the number one rule.
Secondly, a lot of clients want to automate various services in revenue cycle, but another best practice is to not simply jump to automation. It is important to first ensure that all of the processes related to that automation are working optimally because if not, bad processes will be automated which will then create a bigger problem.
The third best practice for revenue cycle is to not operate in a vacuum. Crowe has done a great job of bridging the gap between the revenue cycle team as a provider and the clinical team. Actions taken at the point of care with the patient have a significant impact on how the revenue cycle will effectively work. Many times, the teams do not communicate with each other, so it is important to maintain connectivity and ensure knowledge transfer, which ultimately allows for timely payment and improved patient care.
Key Benefits of Crowe’s RCM Solutions
A key differentiator that Crowe has related to revenue cycle is the significant amount of data that the company has access to. A technology solution known as Crowe Revenue Cycle Analytics (Crowe RCA) captures every patient transaction for purposes of automating hindsight, accounts receivable valuation and net revenue analyses. Currently, it is used by over 1,200 hospitals throughout the country and Crowe receives that transactional data every day.
This allows the company to take all that information and compile it into real-time data to provide valid and accurate key performance indicators from the revenue cycle performance perspective.
The team can analyze that data by the type and size of hospitals so when they assess a client that has a revenue cycle need, they first compare their performance in a variety of different metrics and KPIs against similar organizations.
This helps instantly identify areas of opportunity in the revenue cycle. The team can swiftly implement change – much more quickly than competitors – because all the data is already available.
Another benefit the company offers is connectivity with the clinical teams. Often there is a line between the clinical staff and the revenue cycle staff from the deployment perspective, but Crowe blends those lines to ensure everyone is on the same page and the outcomes are indicative of it.
Finally, Crowe has a robust middle revenue cycle group and a lot of the other vendors out there don’t have the team, the talent or the abilities to find opportunity in the middle of the revenue cycle, which is where all the money lies right now. This gives Crowe an edge over competitors.
Vision for Future of the Industry
A lot of revenue cycle management is dependent on the regulatory bodies and how they can affect the different steps of the revenue cycle.
Colleen believes that we will continue to see a shift in the way the providers are paid, especially with the Medicare expansion and an increase in conversations about value-based care and pay-for-performance.
Regarding adoption, it is hard to predict as talks about value-based care began 10 years ago and there has not been any significant progress.
‘From my perspective, I would love to see there be less of an opposition between the payers and the providers because right now they are on complete opposite ends of the spectrum and are fighting against each other.’
Even innovative health plans that are part of a larger provider are said to be difficult to deal with. If there was a way for the payers and the providers to start to work together instead of against each other, the process would be more streamlined and help ease the burden that the revenue cycles are under.
For organizations looking to stay successful in this field, Colleen believes it is important to have a broader understanding of each step within the revenue cycle and to be flexible.
‘Each day is different so, for example, you are not going to know if you have to focus on a specific denial or if there is going to be something that breaks and changes the way that the charges are being deployed. To be successful in the field, you must be flexible and have a broad understanding of the revenue cycle in order to address the fires of the day.’
Having a full understanding will help individuals be successful because they have to go where they are going to provide the most value, which can be different from day-to-day.
Leadership Lessons Learned Over the Years
‘As an individual, you are more capable of doing things than you think you are. You are your own worst enemy whenever it comes to confidence and being able to appropriately deliver work or tackle some sort of challenge.’
Colleen advises that when one is doubting oneself, it is important just to take a deep breath and know that they can figure out whatever challenge is ahead. It may not be easy, but people are capable of much more than they believe.
‘It is the people who raise their hand and show me that they are ready to take initiative and prove themselves that stand out in this industry. If you feel like you are ready, don’t be afraid to take on a new challenge and be vocal about what you are looking to achieve.’