Kem is an Innovative Healthcare Leader with a passion for practice transformation through best practices, technology & education. She is the founder and president of Medical Revenue Cycle Specialists, a boutique medical revenue cycle consulting firm, which improves workflow and practice revenues for small to mid-size physician practices, allowing them to focus on patient care.

Over her career of over 20 years, Kem has earned a reputation as a transformational healthcare leader. She is currently also serving as the President of the Hyattsville/Prince George’s County Chapter of the American Academy of Professional Coders (AAPC). In this interview, Kem talks to me about overcoming challenges during the COVID pandemic and her experience as an author.

Starting out in Revenue Cycle Management

Kem’s first foray into healthcare emerged from her family background. Both of her grandmothers immigrated to the United States and her maternal grandmother entered the healthcare domain and owned her healthcare business, a call center.

‘Revenue cycle management is a holistic view of the entire process from the initial interaction with the patient through scheduling and the phone call through the key performance indicators and following up on accounts receivables to making sure that the patient’s balances end up at a zero balance.’

One of the aspects that have kept Kem interested in this field is the numerous opportunities to do root cause corrections and identify areas that can be improved within the revenue cycle. For instance, Kem believes in mapping workflows to the revenue cycle and breaks the revenue cycle down into four quadrants. This allows her to identify where the gaps in the revenue cycle exist for root cause corrections.

Kem recalls signing up her first account when she was a practice administrator for a pulmonary and critical care group -Annapolis Asthma Pulmonary And Sleep Specialist, in Maryland. She was working for them as the chief administrative officer. With 10 years of experience and a desire to do more, Kem was approached by an HR manager working with Easterseals, a huge company that became Kem’s first client.

‘I met with the senior leadership at Easterseals and one thing that I do in discovery meetings with any new client is I like to educate.  In most discovery meetings with new clients, I am already thinking of a work plan, so I am envisioning what the work plan is going to be 15 minutes within the conversation.  I came up with the work plan in the meeting, and they brought me on right away.’ 

Current Business Scope at Medical Revenue Cycle Specialists

Presently, the organization works primarily on the ambulatory side, the outpatient side.  They have 20-25 active clients and a team of 8-10 people. One of their major clients was a DC hospital. Working on their ambulatory side, the company helped them evolve from paper records to an electronic health record system which required multi-departmental coordination, training and education, revenue cycle processes, and fee schedules, among others.

The company has also worked with the local county health department, as well as some small practices and big clients. For Kem, the focus is not on the volume of the client their footprint, and their impact on the community.

‘We have worked with a pediatrician in Maryland who has been serving her patients for over 30 years and her patients have graduated to be the parents of her patients.  Making sure that physicians like that are sustainable is very important.’ 

Other clients the company has worked with include medical societies as back office support whenever their members need practice management and revenue cycle support, large malpractice insurance companies to provide their policy holders with risk management and compliance guidance, specifically related to coding, revenue cycle management, and billing and practice management.

Additionally, they also work with Medicaid MCOs to improve HEDIS and EPSDT measures within the practices that participate with them.  Most MCOs are not meeting the necessary criteria to keep their star rating and they get penalized financially. Kem’s team goes into their participating provider’s offices and makes sure that they have the necessary RCM infrastructure, coding infrastructure, and documentation infrastructure. The company has also worked with the military, Walter Reed, in developing coding documentation training for their providers and their leadership.

‘I am really proud of the wide scope of facilities and entities that we have worked with, especially corporate practices. I strongly believe in these clients and we want to help the practices of people who are doing a great job in our communities.’

Being a small business with so many active clients, Kem states that they also have a huge network of people that they can tap into to build up their capacity for certain projects. The company has a project management tool, a CRM database, and scheduled meetings with the team working on certain projects to make sure that everyone is in the loop.

The company has project managers for each client and Kem is involved in every project.  She provides guidance where it is needed, but believes the team is motivated and knowledgeable with most of them having over 20 years of experience individually.

‘We work very closely with our clients to make sure that we set reasonable expectations and we do regular check-ins with our clients.  I am usually on-call 7 days a week and I don’t expect my team to be because I believe that people need to have downtime.’ 

Journey from Co-Authoring a Book to Heading a Certificate Program in RCM

Kem is the co-author of Revenue Cycle Management: Don’t Get Lost In The Financial Maze. One of the things that struck her vividly before writing the book was the realization that revenue cycle management is not a part of a standard bachelor’s degree in healthcare administration at the university level.

Realizing this huge gap in the industry, Kem and her co-author Shawntea Moheiser, approached MGMA with the suggestion of adding this book to the library.  The book breaks down every aspect of the revenue cycle from check in, scheduling, prior authorizations, credentialing, denial prevention, and a lot more.

The focus of the book is not to just give a foundational overview of revenue cycle management but also why certain areas of the revenue cycle are important and how they overlap with other areas of the revenue cycle.

The strategy was to identify the key concepts, explain why they overlap in each area, and give solutions on how to best optimize those key performance indicators. Kem states that a lot of people at the executive and entry level purchased the book and gained great value.

The book also serves as the content base for the RCM certificate which break down and does knowledge checks for each area of the revenue cycle to make sure that whoever is going to either be managing the revenue cycle, who is going to be inside the revenue cycle, who is about to enter the revenue cycle understand all of the key components that are necessary to have a successful revenue cycle. This is not just about AR but includes compliance, customer service, intake and measuring and evaluating oneself.

The target audience for the RCM certificate program includes practice administrators, office managers, billers, and coders. Talking about billers, Kem states that billers are submitting claims and working claims edits while making sure that they work any denials and non-payments and do payment posting. However, they don’t get exposed to value-based reimbursement and MIPS measures.

If the practice is not heeding MIPS measures, there is going to be a penalty that will be imposed by the biller. The certificate program aims at making sure that everyone who is a part of the revenue cycle is exposed to the necessary elements of the revenue cycle that are going to overlap with their daily operations.

Another educative aspect Kem is involved in is the Fun Fact Friday on LinkedIn. She credits her interns at Johns Hopkins University who work with Kem weekly for these. Looking at the extensive content created by Kem for her book and certification as well as their library of 60-plus programs related to revenue cycle management, the idea was to share some of it every week.

‘I think it is important that we all stay up to date on the trends in the healthcare and every single week I take time out of my schedule to find an area that I want to share a piece of information with my colleagues. It has been really helpful to me because it also allows me to do a deeper dive into that particular subject.’

In addition to Fun Fact Friday, Kem also hosts a podcast with her co-author, on revenue cycle management.

Standout Moments as a Business Leader in the Domain of RCM

Being a mentor is a standout moment for Kem who has a passion for not keeping the information that she learns to herself but sharing it with others. She is also a volunteer with different medical organization boards.

Completing her book is a huge professional and personal goal and a highlight of her career.  Kem also talks about the roll-out of the RCM certificate program with her co-author Shawntea as a prominent highlight.

Talking about her company’s achievements Kem says that they have developed resources for their clients which serve as templates and checklists. These allow clients to evaluate themselves and in turn allow the company to evaluate the clients. The company has developed practice assessment templates, revenue cycle assessment templates, coding audit templates, and staffing ratio templates.

‘I think one of the areas that we have done a really good job and achieved some great success is the development of resources that are available to our clients to help them improve their workflows.’ 

Other achievements for Kem include repeat customers due to doing a good job as well as her work with a local health department in Maryland, Prince George’s County Health Department, where they managed a team of programmers to develop software for the county. Their expertise in coding, revenue cycle management, and practice operations were leveraged in the development of those programs to assist with care coordination and diabetes prevention.

Overcoming Challenges Over the Years

COVID was a huge challenge. Being able to be flexible and shift their business approach was quite challenging. Kem claims that they had a significant number of providers who reached out to them for support in implementing Telehealth services and making sure that they have the appropriate staff.

However, along with being a challenge, Kem also believes it has been an opportunity to revisit how business operations and how revenue cycles are managed in the virtual environment. Coming up with a matrix that allows leaders to identify the success and areas of improvement within their revenue cycle, working with virtual work first, has been one of the challenges.

Another challenge in the healthcare sector is being able to educate their physician business owners on the importance of the various aspects within the revenue cycle. This is a priority area of focus where it is important to be diligent and make sure that the company is speaking in the physician’s language.

Business Plans for the Future

Strategically, there are ways that Kim would like her company to assist their client base in the future.  They have done a lot of support services in the Telehealth space.  They partnered with Maryland Healthcare Commission through another partner, Zen Networks, to provide billing and coding training to physicians in the state of Maryland, based on a grant that pays for those services.

The plan for growing the business is to keep doing what the company is doing – making sure that the systems in place continue to meet the needs of the clients. Additionally, Kem’s focus to grow the business is to understand the forecasted trends in healthcare, so that the company is agile enough to adapt to those trends and to provide value to the clients before they even need it. Also, she believes there is great value in building relationships with other partners.

‘We want to make sure that we are ahead of the game.  We don’t claim to have all of the expertise in-house, so we want to make sure that we are partnering with the right strategic relationships.’

Talking about marketing activities for her company, Kem states that they do not have an active marketing strategy. They have a website and marketing collateral, and have attended conferences and had booths in the past. These are the forms of marketing that they are involved in but the rest of their clients come from referrals.  They come from people who have worked with the company in the past, people who have attended the programs and found that the information shared was very useful.

‘I would not say that we have a real marketing strategy.  I think as long as you produce a good product, and you add value to the people who you work with, marketing isn’t as much of a necessity if you can show results.’

Top Philosophies and Core Values in Business

The first thing is to make sure as a leader in RCM is that the team has all the resources that they need and to avoid silos. A big challenge in revenue cycle management is silos workflows and is an area that should be prioritized during a public health emergency.

There is already the challenge of an office staff and back office billing staff communicating with each other while they are in the same office. Now, owing to remote working, some of the billing staff is working from home while the front office staff is still in the office. As a leader, it is crucial to ensure that communication flow is clear and constant.

Another area of focus for Kem is patient accounts.  This is a very important part of the revenue cycle.  Patient statements should not be submitted or sent out unless they have a clean bill.  This ensures that there are not any credit balances which tend to build up over time if they are not addressed.

‘Our patients are also customers and they have choices, they do not have to select our providers.  One of my philosophies is to make sure if patient AR is clean then that is a trickle up effect the insurance AR and to patient satisfaction.’

Advice for Newcomers Starting a Career in RCM

The first piece of advice by Kem is to network. And then it is valuable to join medical associations.

Building your network, having your LinkedIn profile, having a Twitter, staying connected, going to conferences and not just sitting in the office is important. These days with social distancing still in effect, networking can be done remotely or virtually.

Kem credits networking as a prime reason for her job as a COO of a large anesthesia practice.

Key Benefits of Medical Revenue Cycle Specialists Services

The key benefit would be structure.  Some of the organizations that the company works with may have been lacking revenue cycle structure and that may have resulted in inefficiencies or the capability to foster denials.

Another benefit is that by being involved in healthcare from a national level, the company can bring back trends to the local partners and local clients who don’t have to attend all of the meetings and webinars as they can rely on Kem and her team for that guidance.

Additionally, Medical Revenue Cycle Specialists have a large network and access to vendors that clients may not have access to. The company has numerous strategic partners in the electronic health record space as well as coding and even payroll management. When their clients are looking for a vendor they can receive trusted referrals directly from the company.

A key differentiator of this company as compared to several of their peers is that they not only from the medical side but also with the insurance side. Kem believes this helps in understanding the different perspectives on either side.

The company has team members who have worked with some of the large payers which give clients valuable insights into their operations and their decision making.

‘I don’t want to be the smartest person in the room.  I want to make sure that I surround myself with really smart individuals that I can learn from and who can learn for me as well, and at the end of the day we all teach and guide our clients.’

Vision for Future of the Industry

Kem believes the RCM management needs to adapt to virtual care. Additionally, she feels the future will bring the need to map technology to revenue cycle management processes. The industry is at a point in the lifecycle of RCM where complete reliance on manual processes is no longer feasible.

It is important to give the patients touchless payment options.  Also, the workforce needs to have access to ERAs instead of EOBs.  Companies need to ensure they have the analytics within their practice management software to run meaningful reports and predict trends in reimbursement that are coming down the road.

There is also a growing need to stay on top of the public health emergency declarations and when that expires and how that is going to impact coding and reimbursement and patient care.

For organizations looking to stay successful in this domain, Kem advises making it a priority to understand how the federal government is going to address Telehealth services and prioritizing mapping technology to the revenue cycle.

To remain sustainable, the revenue cycle leaders are going to rely on technology. Additionally, leaders need to expose their workforce to areas of the revenue cycle that they might not typically be exposed to.

‘I think the more our workforce understands the how and the why, the more successful that they will be in their jobs. It is important that they are able to see how they impact the overall revenue cycle, and the documentation.  I recommend educating people on areas within the revenue cycle that they may not have to be responsible for on a daily basis but that is impacting their ability to help the company be successful.’

Leadership Lessons Learned Over the Years

‘Don’t expect everyone to think like you, don’t expect everyone to approach a problem the same way that you do, encourage creativity, and encourage people to think differently than you.’ 

Over the years, Kem believes she has learned to embrace diversity, embrace the differences that everyone has. She has a mix of baby boomers, millennials, and Gen X’s in her organization and they all learn something from each other.

‘One of the most important leadership skills that I have learned is to foster creativity within your team, expect people to bring their ideas to the table, and have diversity.’

Follow Kem Tolliver On: LinkedIn