P&C Global Practices: AI, Data, & Cognitive Sciences, Corporate Performance
Transforming Revenue Cycle to Sustain Clinical Excellence
Faced with mounting operational and financial pressures, a world-renowned academic physician group affiliated with a top medical center recognized the strategic necessity of overhauling its revenue cycle operations. The organization’s cost to collect was notably high, driven by a decentralized billing model split between individual departments and a central billing office. This fragmentation led to inconsistent processes, billing errors, and duplicate efforts. At the same time, external pressures—most notably rising expenses outpacing revenue growth in academic health systems—put significant strain on margins. For the leadership of this physician group, revenue cycle optimization became a strategic imperative to restore financial health. The physician group realized that by lowering the cost-to-collect and improving revenue capture, they could free up resources to support their clinical mission and remain competitive in a landscape where reimbursements lag rising costs. In short, the group needed to transform its revenue cycle operations to boost efficiency, reduce leakage, and sustain its reputation for excellence.
The organization engaged P&C Global to lead a comprehensive revenue cycle transformation, leveraging the firms proven track record in corporate performance and its deep expertise AI and data science within healthcare. The initiative sought to streamline operations, improve revenue capture, and reduce costs—without compromising the patient experience. What followed was a high-impact, data-driven transformation that turned a fragmented revenue cycle into a model of operational excellence.
Strategic Objectives of the Engagement
The physician group partnered with P&C Global to pursue five core objectives:
- Improve Billing Accuracy and Charge Capture: eliminating errors in coding and billing documentation to ensure claims are correct at first submission, reducing downstream denials
- Strengthen Denial Management: identifying root causes of insurance denials and put in place controls to prevent them, thereby increasing net collection rates
- Increase Net Patient Revenue: capturing all revenue due for services rendered through improved collection processes and payer compliance to lift the organization’s top-line without expanding services
- Reduce Operating Costs: streamlining and automating workflows to lower the cost-to-collect, moving the metric closer to industry best practice for large providers
- Enhance Visibility and Oversight: providing real-time analytics and KPIs for proactive decision making and continuous improvement
These objectives had to be achieved without compromising the patient-centered approach, a core element of the client’s brand promise for delivering a seamless financial experience. The engagement was designed to align with the client’s strategic goals of increasing revenue and reducing costs, while also targeting operational enhancements in process and technology to support sustainable performance.
Complex, Cross-Functional Challenges
In addition to meeting these five key strategic objectives, the client had to adapt to address a range of complex, cross-functional challenges:
- Fragmented governance structures, as well as decentralized core processes and operations, leading to inconsistent workflows, redundant roles, significant variation in performance, and a lack of standardized operational playbooks for documentation and billing procedures
- Delayed billing cycles, labor-intensive processes, and a high risk of manual errors
- Need for transparency and accountability for key metrics such as days in A/R, denial rates, and cash collections across departments
- Maintaining a patient-centered approach while managing change across stakeholder groups like front-line staff, clinicians, and physicians to ensure adoption and trust
The organization’s leadership identified revenue cycle optimization as a critical lever to address these challenges. But transformation required more than cost-cutting—it demanded enterprise-wide redesign, cross-functional alignment, and digital innovation at scale.
Solution: Intelligent Design Meets Financial Rigor
To address this complexity, P&C Global deployed a cross-disciplinary team that embedded deeply with the client’s executives, department chairs, and front-line billing teams. The solution combined strategic redesign, digital enablement, and operational governance.
We began by conducting a data-driven diagnostic, analyzing two years of billing and claims data to benchmark performance against peer institutions and industry standards. This diagnostic confirmed significant variation in workflows across departments and revealed that billing errors and avoidable denials were among the top issues hampering financial performance. Armed with these insights, P&C Global’s Corporate Performance experts led the redesign of core revenue cycle processes, centralizing operations that had previously been managed independently across departments. Standard operating procedures were implemented to ensure every patient encounter followed best practices in documentation and billing. Duplicate roles were consolidated, and a new Central Business Office (CBO) was established to handle high-volume tasks, enabled by specialized staff and technology.
Concurrently, P&C Global’s AI, Data, & Cognitive Sciences team introduced advanced analytics and workflow automation into the client’s billing operations. This included next-generation tools to digitize and automate revenue cycle operations to support the new processes. We implemented an AI-powered billing platform that provided real-time insights into billing operations, flagging anomalies and bottlenecks instantly. Machine-learning algorithms were deployed to predict claim denials before submission by analyzing historical denial patterns to alert staff to high-risk claims such as missing info or coding issues for correction prior to billing. This proactive approach dramatically reduced the volume of denied claims that needed rework. Robotic Process Automation (RPA) was deployed to handle repetitive tasks—eligibility checks, claim status inquiries, and payment posting—allowing staff to focus on higher-value activities. An intelligent claims engine enhanced coding accuracy and compliance by cross-referencing clinical notes with payer rules, further improving first-pass acceptance rates and reducing rework.
Equally important was the governance and change management structure underpinning these innovations. P&C Global helped the client establish a Revenue Cycle Transformation Office, chaired by the CFO and Chief Physician Executive, to drive this initiative. A cross-functional governance committee met bi-weekly to review progress, resolve escalations, and ensure accountability for results. The client’s leaders also invested in transparent communication. P&C Global stood up user-friendly performance dashboards that gave stakeholders visibility into key metrics like days in A/R, denial rates, and cash collections across departments.
This transparency-built trust and urgency for change. Comprehensive training and change management were rolled out to engage front-line staff and clinicians in the new ways of working. Physicians, in particular, were involved in designing workflow changes (such as clinic checkout procedures to capture charges promptly), which helped secure their buy-in. By combining process redesign, advanced technology, and disciplined change management, P&C Global delivered a solution that transformed a once-fragmented, labor-intensive revenue cycle into a streamlined, data-informed operation.
Throughout the initiative, P&C Global served as the end-to-end transformation partner, aligning executive vision with operational execution and enabling sustainable improvement through technology and culture.
Outcomes: Operational, Financial, and Patient-Centered Gains
The engagement delivered substantial, measurable performance gains across key financial and operational areas.
Financial and Operational Impact
- $17M in Annual Operating Cost Savings: reflect reduced labor and overhead expenses in the billing departments, representing more than 15% reduction in revenue cycle operating costs that can be reinvested into patient care.
- $15.6M Increase in Yearly Net Patient Revenue (without any increase in patient volume or fees): by preventing leaks in the revenue capture process including fewer missed charges and denials.
- 20% Reduction in Days in Accounts Receivable: accelerating cash collections. Real-time tracking and worklist prioritization allowed staff to accelerate the reimbursement cycle, improving cash flow.
- Improved Billing Accuracy and Denial Rates: with fewer coding errors or missing information on initial claims, driving claim denial rates to its lowest on record
- Higher Staff Productivity: with mundane tasks automated and workflows simplified the team can effectively handle a larger volume of claims per full-time employee than before, and staff can devote more time to complex problem-solving rather than clerical work.
Reinvestment in Clinical Programs: The dual impact of higher revenue and lower costs has improved the group’s operating margin significantly. Leadership has consciously reinvested the realized savings into mission-driven programs – for example, hiring additional nurse navigators in Oncology and funding novel research. The $17M in cost reduction effectively became an engine to enhance patient care offerings and strategic growth initiatives, illustrating a sustainable cycle of improvement.
Clinical and Patient Experience Enhancements
- Streamlined billing experience, with consolidated billing statements and upfront cost transparency tools for patients for more convenient payment options, enhancing satisfaction and trust.
- Improved physician and clinician satisfaction, as friction from billing issues was removed from care delivery
- Reinvestment in clinical programs, including new hires in Oncology and expanded research funding
These outcomes reflect more than financial success—they signify cultural transformation, operational maturity, and a renewed focus on the patient as both recipient of care and stakeholder in the financial journey.
Industry Recognition and Strategic Positioning
The organization’s results have earned national recognition. It was honored with a healthcare industry award for revenue cycle excellence, reflecting its new status as a national leader in healthcare financial management. Notably, the group met all key criteria for the HFMA “MAP Award for High Performance,” which recognizes providers that hit industry-standard benchmarks, implement patient-centered billing best practices, and achieve outstanding patient satisfaction. Achieving this honor has placed the client among a select group of top-performing institutions in revenue cycle – a remarkable turnaround from its prior challenges.
Beyond industry awards, the improvements have been felt and acknowledged within the organization and by those it serves. Physicians and clinical leaders have praised the changes for making billing “nearly invisible” to their day-to-day work, allowing them to focus more on patient care. Front-line staff have reported higher morale due to less tedious rework and clearer processes. One department head noted that denial fights and billing complaints, once a frequent topic in meetings, have dwindled to near zero. The improved transparency and efficiency have built trust between the central revenue office and the clinical departments, aligning everyone around shared performance goals.
Most notably, patients have noticed a difference. Billing statements are more timely and easier to understand, and out-of-pocket cost estimates are provided up front, reducing surprises. The clinic’s patient satisfaction surveys now routinely mention the smooth billing experience. As one executive observed, “While our tradition of clinical excellence dates back decades, our approach to revenue cycle could not be more contemporary. Our entire team is dedicated to making the financial experience a seamless one for our patients.”
This sentiment captures the cultural shift that accompanied the technical changes – a recognition that financial interactions are a core part of the patient experience. The CFO likewise commented that the revenue cycle transformation has strengthened the organization’s overall financial sustainability, enabling it to invest in growth and innovation.
The engagement’s outcomes have also been featured in industry forums and case studies. The physician group’s story has been shared as a model for how AI and performance improvement can dramatically reduce the cost of care administration. Healthcare leaders from other institutions have visited to learn from its approach. In summary, P&C Global’s partnership with this world-renowned academic physician group not only achieved its strategic goals but also earned the client accolades as a forward-thinking leader in healthcare management. The project demonstrates a blueprint for transforming revenue cycle operations in a way that delivers enduring financial benefits and enhances the mission of patient care – truly a sustainable, transformative success that will resonate for years to come.
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