Latest / Becker’s Healthcare Podcast / Sheila Augustine on AI, Denials and the Future of Revenue Cycle

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Sheila Augustine on AI, Denials and the Future of Revenue Cycle · Becker’s Healthcare Podcast

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  - This is Laura Dierdahl with the Becker's Healthcare
• 1:00
  - podcast. I'm thrilled today to be joined by
• 1:02
  - Sheila Augustine, executive director of revenue cycle at
• 1:05
  - Nebraska Medicine. Sheila, it's a pleasure to have
• 1:08
  - you on the podcast today. Yes. Thank you
• 1:10
  - for having me. Absolutely. Now I'm excited for
• 1:12
  - our conversation. I know we're gonna be digging
• 1:14
  - into some of the cool things you're doing
• 1:15
  - at Nebraska Medicine as well as how you're
• 1:17
  - thinking about the future. But before we dive
• 1:19
  - in, can you tell us a little bit
• 1:20
  - more about yourself and your background?
• 1:23
  - Yeah. Happy to.
• 1:24
  - I am currently the executive director of revenue
• 1:27
  - cycle here at Nebraska Medicine.
• 1:30
  - I have been with Nebraska Medicine
• 1:33
  - for twenty one years,
• 1:35
  - maybe six months, not within the revenue cycle,
• 1:38
  - but the rest of it always within rev
• 1:40
  - cycle.
• 1:41
  - I have just really grown up in this
• 1:44
  - space.
• 1:44
  - It's near, dear to my heart.
• 1:47
  - And just to give some context about our
• 1:49
  - health system, we have two hospitals,
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  - 855
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  - beds,
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  - and we have 1,200
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  - physicians, and we are right at about a
• 1:59
  - $3,000,000,000
• 2:00
  - net patient revenue organization.
• 2:03
  - Got it. Well, that's definitely impressive to see
• 2:05
  - everything you've got going on underneath the Nebraska
• 2:08
  - Medicine umbrella and and certainly
• 2:10
  - a lot of innovation too. So let's dig
• 2:12
  - right into it. Could you give us a
• 2:14
  - quick state of the union? What's gone well
• 2:16
  - this year, and what do you focus on
• 2:17
  - for the rest of 2026?
• 2:20
  - Yeah.
• 2:21
  - So what's gone well this year is we
• 2:24
  - have implemented
• 2:26
  - AI
• 2:28
  - in certain use cases.
• 2:30
  - A couple in particular that I'd like to
• 2:33
  - call out that have been
• 2:34
  - super exciting to just see up and going
• 2:37
  - is our missing charge opportunities
• 2:40
  - and mismatched
• 2:42
  - charge opportunities.
• 2:44
  - This has really helped us to find
• 2:47
  - things that, essentially, we didn't even know were
• 2:49
  - missing.
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  - I would also say with one of the
• 2:53
  - other use cases that we are
• 2:55
  - working on and will probably,
• 2:58
  - hopefully,
• 2:59
  - close out at the end end of this
• 3:00
  - year is charge reconciliation
• 3:03
  - and utilizing
• 3:04
  - AI to help us from a charge reconciliation
• 3:07
  - perspective.
• 3:09
  - If many of my colleagues are listening to
• 3:12
  - this podcast,
• 3:13
  - nobody ever wants to do charge reconciliation.
• 3:17
  - Each area is responsible for its own. So
• 3:20
  - looking really for ways where we can automate
• 3:23
  - and just be
• 3:25
  - more proactive
• 3:26
  - than historic world where we've been reactive.
• 3:31
  - So I'd say just a lot of the
• 3:33
  - mix coming together and, you know, again,
• 3:37
  - many projects all happening at one time, but
• 3:40
  - just seeing them to close or to fruition,
• 3:43
  - it's a great opportunity.
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  - Absolutely. I love that. And, you know, I
• 3:48
  - think it's exciting to hear about the different
• 3:50
  - technology and AI that,
• 3:52
  - can support
• 3:53
  - the workflows and processes and and really augment
• 3:57
  - everything that the human workforce is doing, to
• 4:00
  - to superpower in many ways, it sounds like,
• 4:02
  - the revenue cycle. And, you know, from your
• 4:04
  - perspective, as you're leading through this and bringing
• 4:06
  - in new technologies and trying to become more
• 4:09
  - proactive, I know there's a cultural change in
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  - there too. So what does it take for,
• 4:14
  - you as a leader to,
• 4:15
  - work with your teams and and make sure
• 4:17
  - that the adoption is done the right way?
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  - And then two, you know, you're really getting
• 4:21
  - people to think more proactively as they're looking
• 4:23
  - at their, day to day and and what
• 4:25
  - they're responsible for.
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  - Yeah. Especially
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  - with implementation
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  - of AI,
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  - that scares staff members.
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  - Right? It makes them think that, oh my
• 4:38
  - gosh. My position is gonna be replaced.
• 4:41
  - If you word it into the fact that
• 4:43
  - it's really complementing
• 4:45
  - your work, it's allowing you also to maybe
• 4:48
  - look at things that you couldn't get to
• 4:51
  - because you were doing these manual processes.
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  - I think when you allow your staff members
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  - to be
• 4:58
  - the superuser
• 5:00
  - or SME,
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  - as part of these use cases in bringing
• 5:04
  - on AI,
• 5:05
  - they get to see it and they get
• 5:08
  - to, like,
• 5:09
  - feel the thrill of utilizing it. And so
• 5:12
  - one of our areas
• 5:14
  - was writing appeals or help having AI help
• 5:18
  - write appeals.
• 5:19
  - We had two super users that focused in
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  - and were doing it.
• 5:23
  - They are the champions. They get to go
• 5:25
  - back and talk to their team and share,
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  - here's the great thing. So I think it's
• 5:30
  - really talking about
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  - what it's doing for you now
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  - and then what it's gonna do for us
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  - later. What you know, will it bring in
• 5:39
  - additional money? How how do we look at
• 5:41
  - this long term versus just
• 5:43
  - now trying to be that proactive?
• 5:46
  - So having them engaged in some of those
• 5:49
  - things and
• 5:50
  - really running with certain projects
• 5:53
  - as well,
• 5:54
  - that keeps them motivated and, essentially,
• 5:57
  - they are the end users.
• 5:59
  - You want their you want their feedback because
• 6:03
  - the feedback that they give
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  - will be the best for the team.
• 6:08
  - That's amazing to hear. You know, such a
• 6:10
  - a great, words of wisdom as you're thinking
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  - about technology and trying to change that,
• 6:16
  - initial reaction of being scary or nervous about
• 6:19
  - what all the impacts could be and understand,
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  - you know, how you can actually incorporate the
• 6:24
  - technology and and really make things work for
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  - better. So when you're looking ahead, what are
• 6:30
  - some of the headwinds that you're keeping an
• 6:31
  - eye on and preparing for?
• 6:34
  - You know, some of the biggest things that
• 6:37
  - we always have to keep our eye on,
• 6:39
  - the easy one is denials. Right? So every
• 6:42
  - payer the payers are
• 6:44
  - scrutinizing
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  - claims more than they ever have.
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  - You have to essentially
• 6:51
  - start digging into these payer policies and really
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  - trying to combat the denials.
• 6:57
  - That one's an easy one. Denials is always
• 6:59
  - something that people are keeping their eye on.
• 7:03
  - The Medicaid the changes to Medicaid that most
• 7:06
  - states will incur on 01/01/2027.
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  - Nebraska
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  - actually was the first state that actually implemented
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  - the changes for Medicaid
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  - this year in 2026.
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  - So we are trying to keep an eye
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  - on
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  - the people that are losing Medicaid as part
• 7:25
  - of this and get them reenrolled or help
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  - to get them on other
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  - governmental programs if you can. I think that
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  - that's going
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  - to continue to be a focus this year
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  - as well as how it's going to look
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  - next year.
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  - And I do anticipate,
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  - you know, places reaching out to us since
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  - we did have this already
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  - happen to us.
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  - I would just say and, again, like, staffing,
• 7:52
  - you know, it's ebbs and flows. Right? People
• 7:54
  - don't stay
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  - at places as long as they once used
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  - to, and so you tend to lose expertise.
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  - And then,
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  - you know, things sit while you're waiting to
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  - refill yet another position. So I think there
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  - are so many things
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  - that we have to keep our eye on
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  - as part of all of those pieces.
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  - That makes a lot of sense. And I
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  - I think I'm curious from, you know, your
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  - perspective of Nebraska being early adopter of some
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  - of these Medicaid changes and things that go
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  - along there. Is there any additional advice you'd
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  - give to revenue cycle leaders and hospital health
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  - system leaders in general,
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  - about what you've seen or or how things
• 8:33
  - are changing and shifting as they're preparing for
• 8:35
  - January 1?
• 8:37
  - Yeah. I mean, I would say looking at
• 8:40
  - your workflows,
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  - do you have
• 8:43
  - the capability
• 8:45
  - to identify patients who
• 8:48
  - may have once had Medicaid,
• 8:50
  - who are maybe going to lose it
• 8:52
  - because
• 8:54
  - maybe they don't we have them as unemployed
• 8:56
  - in our system
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  - or we're on Epic as our electronic health
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  - record.
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  - Can you do
• 9:03
  - essentially some campaigning, right, and reaching out to
• 9:06
  - patients proactively?
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  - I think we've
• 9:09
  - always been worried about the patients while they're
• 9:12
  - here or after they leave.
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  - How can we identify the patients who are
• 9:17
  - coming? And so we can start the work
• 9:19
  - on it now.
• 9:21
  - So you might have to relook at your
• 9:23
  - workflow
• 9:24
  - and change it to be
• 9:26
  - more in line and call out these certain
• 9:29
  - requirements
• 9:31
  - to get to these patients.
• 9:33
  - And, you know, there could be depending on
• 9:35
  - the size of the facility.
• 9:37
  - You know? Is is that an opportunity maybe
• 9:39
  - to outsource,
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  - or do you need more staffing to make
• 9:43
  - sure that
• 9:44
  - you can meet those requirements
• 9:46
  - and help patients fill out that application?
• 9:50
  - That makes a lot of sense, and it's
• 9:52
  - really helpful to understand. Thank you for digging
• 9:54
  - a bit deeper there. Now
• 9:56
  - I I can imagine there's a lot of
• 9:57
  - excitement and and ability to grow as well
• 9:59
  - as you're looking ahead. So what are some
• 10:01
  - of those best opportunities for growth in the
• 10:03
  - next two to three years or so?
• 10:05
  - You know, best opportunity to grow in the
• 10:08
  - next two to three years,
• 10:10
  - one, I would say
• 10:13
  - secession planning.
• 10:15
  - That's such a great opportunity for any organization,
• 10:19
  - and revenue cycle is no different within the
• 10:21
  - healthcare arena.
• 10:23
  - Making sure that you have identified leaders who
• 10:26
  - can take that next step and, you know,
• 10:29
  - give them it all it ties back to
• 10:32
  - some of the projects that we worked on.
• 10:33
  - Give somebody that's a high performer
• 10:36
  - possibly a project that they can do, and
• 10:39
  - you get to see it them bring that
• 10:42
  - to light. And
• 10:43
  - will they have an opportunity to grow and
• 10:45
  - be successful maybe in a leadership role?
• 10:48
  - I would say
• 10:50
  - we're just dabbling into the whole AI.
• 10:54
  - I think there's still more room
• 10:56
  - to utilize AI within the revenue cycle.
• 11:00
  - I'm excited to see
• 11:02
  - there's many
• 11:04
  - business partners out in the industry today that
• 11:07
  - can help support your revenue cycle.
• 11:10
  - I'm very interested
• 11:11
  - to see the ones that continue to pop
• 11:14
  - up,
• 11:15
  - the niche provider or vendors that's,
• 11:19
  - you know, maybe honing in on a
• 11:21
  - issue that you didn't really realize was an
• 11:23
  - issue because we're so focused
• 11:26
  - on AR days and denials. So I think
• 11:28
  - that there's just some really great opportunity
• 11:31
  - to see other places grow that you can
• 11:34
  - complement within your health system.
• 11:37
  - I love it. I I think that makes
• 11:39
  - so much sense. And, you know, it's can
• 11:42
  - be, such a an important aspect of looking
• 11:45
  - at things globe globally, thinking about it strategically,
• 11:47
  - and having,
• 11:49
  - that leadership,
• 11:50
  - you know, in the right spot so you
• 11:52
  - can,
• 11:53
  - continue to elevate in a broader way. And,
• 11:55
  - you know, to that point, when you think
• 11:56
  - about leaders,
• 11:58
  - how do you, you know, find the right
• 12:00
  - people to bring in this next,
• 12:02
  - iteration, the next era of health care and
• 12:04
  - health care revenue cycle, especially given all the
• 12:07
  - challenges today. What do you look for in
• 12:09
  - leaders and what qualities,
• 12:10
  - really make the the people who are gonna
• 12:12
  - be most successful in the future?
• 12:14
  - Yeah. That's a big question.
• 12:17
  - You know,
• 12:18
  - when I look for leaders, I
• 12:21
  - look to somebody.
• 12:23
  - They don't have to know everything,
• 12:26
  - but they have to be able to, like,
• 12:28
  - guide people. People want to work for them.
• 12:31
  - And so they have to have, you know,
• 12:34
  - we'll say a
• 12:35
  - positive outlook.
• 12:36
  - Be open to change.
• 12:38
  - Because like we've talked about, health care is
• 12:41
  - forever changing. So if you're very set in
• 12:44
  - your ways and this didn't work twenty years
• 12:46
  - ago,
• 12:48
  - that's you're probably not in the right role.
• 12:51
  - You want to look for somebody who's thinking
• 12:53
  - strategically,
• 12:54
  - who's done one of those projects for you
• 12:57
  - and you saw
• 12:58
  - what it brought to light
• 13:00
  - and giving those people an opportunity.
• 13:03
  - You want somebody
• 13:05
  - to
• 13:06
  - be here, do a great job, have results,
• 13:10
  - and be focused on building team morale.
• 13:13
  - And that can be a hard thing, especially
• 13:15
  - in
• 13:16
  - the times that we live right now from
• 13:19
  - a remote perspective.
• 13:21
  - You know, how do you continue to keep
• 13:23
  - your team motivated
• 13:24
  - and engaged as well? And so you're looking
• 13:27
  - for lots of different aspects. And, I mean,
• 13:29
  - if you're looking across the revenue cycle,
• 13:32
  - a coding leader, somebody who's doing coding,
• 13:36
  - might be different
• 13:38
  - in some aspects than somebody that's over denials.
• 13:42
  - Right?
• 13:43
  - And so
• 13:45
  - complementing
• 13:46
  - that the role specifically
• 13:48
  - on what would be the right leader for
• 13:51
  - each role. But in general, those are the
• 13:53
  - things that, ideally, I'm looking for, and I
• 13:56
  - and I want somebody to look for in
• 13:58
  - me as well.
• 14:00
  - I love it. That that's great to hear.
• 14:01
  - And and, you know, it's so important to
• 14:03
  - have that type of energy, passion, and motivation
• 14:06
  - with the team to keep them engaged and
• 14:07
  - to figure out the ways that are gonna
• 14:09
  - be most,
• 14:10
  - beneficial
• 14:11
  - for the future of health care. Now, who
• 14:14
  - is a leader that you admire really from
• 14:16
  - any industry and why?
• 14:18
  - Yeah. That that's a great question. I was
• 14:21
  - I really thought through this one.
• 14:24
  - So most recently in the last
• 14:26
  - year, I would say, I actually started working
• 14:30
  - with our VP of finance. His name is
• 14:33
  - Bryce Brackle.
• 14:35
  - So he is in healthcare,
• 14:37
  - but he actually came to healthcare
• 14:40
  - from
• 14:41
  - not healthcare,
• 14:43
  - so revenue cycle is something new to him.
• 14:46
  - And I think that the reason I admire
• 14:48
  - him the most is
• 14:50
  - he really allows you to kinda think through
• 14:53
  - your thoughts out loud, he provides feedback
• 14:56
  - to you, but he also recognizes
• 15:00
  - he is not the go to person for
• 15:03
  - revenue cycle. He's looking to me for answers,
• 15:07
  - and I think
• 15:09
  - it's just gave it gave me a different
• 15:11
  - mindset to start thinking of and start thinking
• 15:14
  - more strategic
• 15:16
  - and realizing that while healthcare is healthcare,
• 15:21
  - it's a business as well. And so how
• 15:23
  - do I think differently?
• 15:26
  - And I've worked for the same leader for
• 15:28
  - many, many years, and just having him as,
• 15:30
  - like, a mentor
• 15:32
  - has really helped to shape me differently.
• 15:36
  - Oh, that's amazing. And, you know, it's certainly
• 15:38
  - to have a leader like that and a
• 15:40
  - mentor like that,
• 15:41
  - to help grow your career and think about
• 15:43
  - things in a new way is spectacular. So
• 15:46
  - I appreciate that elevation there, and,
• 15:49
  - excited to see you as well. I know
• 15:51
  - you'll be, speaking at our health IT RCM
• 15:54
  - conference coming up in a few weeks, actually.
• 15:56
  - And so, I'll be excited to dig into
• 15:58
  - some of these themes a bit deeper and,
• 16:00
  - see you in person.
• 16:02
  - Yeah. I look forward to it as well.
• 16:04
  - Exciting.