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Using your EHR to Automate Charges

Courtney Patterson - Friday, December 08, 2017



by Teri Tsutsui


Many organizations know they want to automate charging to whatever extent they can in their electronic health records (EHRs), but may not know which processes to automate. Here, we review a few ways you can configure your EHR so that a clinician’s workflow automatically enters the appropriate charges – all for the right patient at the right time, of course.


Updating EHR build to include automatic charging functionality can take a lot of staff time, which might discourage some organizations from making these updates during optimization or upgrades. So, why bother? Automatic charging can improve accuracy, consistency, and timeliness. The more charges you can automate, the more consistent charge entry will be. Work with your organizations’ certified coders to ensure that you link the correct charges to procedures. Charges that are automatically triggered from the appropriate clinical documentation help minimize delays.


You can configure your EHR to trigger charges based on several actions, including order completion, note completion, and documentation in flowsheets or procedure logs. Following are some more detailed examples of workflow options for charging automation:

  • Medication administration: To charge for the medication patients receive, you can set the EHR to charge when the pharmacy dispenses it, or when the nurse documents administering it.
  • Nursing or therapy flowsheet documentation: You can configure charges to file with the documentation when users enter a certain activity, quantity (of exercises, for example), or time range (such as for oxygen).
  • Order completion (or procedure completion): Providers enter orders electronically, and when they are marked as completed, a charge can automatically file for the order or procedure performed (such as placing an IV).
  • Note completion: Because procedures require documentation, it’s possible to configure the EHR to complete the order and file charges when a provider signs their procedure note. Providers can also document using notes with discrete data, which can enter charges based on the options selected in those discrete data elements.
  • OR documentation completion: Charges for supplies and equipment used during a procedure can file based on documentation completed during the procedure.

These automated charge methods will help boost charging efficiency at healthcare organizations. Sagacious Consultants can provide services to evaluate and implement these workflows and methods. For more examples of charging success projects, read about our work at a major healthcare organization in the northeast or browse our case studies.


Managing Mayhem: A Healthcare Consultant's Frustrations as a Patient

Courtney Patterson - Thursday, November 16, 2017


by George Evans


Over the course of my 30+ years working in healthcare IT, I have participated in hundreds of improvement initiatives as a provider CIO and now as a consultant. I, along with my team, have reduced expenses, streamlined workflows, improved quality metrics, increased cash flow and more—all to take better care of patients in the most cost-effective, high-quality manner possible. Every now and then the tables get turned and I find myself a patient rather than a supplier. At those times, I intensely observe what I’m experiencing with an eye toward making healthcare better.


I recently had an emergency room visit and minor surgery in two separate encounters at the same organization. In both cases I was registered and seen promptly, cared for by pleasant staff, and pleased with the outcome. If I had received a patient satisfaction survey upon discharge I would have given my provider top scores.


But my attitude soon changed. I received my first bill. And another bill. And another. And then three more. The six bills came from five different companies, only one of which was the provider that had performed the services. Every bill contained at least one error or unintelligible description of charges requiring a call to their customer service line. I waited on hold an average of 15 minutes, and several items took more than one call to resolve. 


How can things go so well for most of the encounter and wind up unraveling right at the finish line? Billing and collections ought to be the easiest part of the whole process. As an insider, I understand how scenarios such as the above occur, but that doesn’t make them any more acceptable. To the average person the lack of coordination is baffling.


Several factors can contribute to the dysfunction:


Set and forget outsourcing – Out of sight shouldn’t mean out of mind. Don’t hide behind the vendor. Outsourcing is a great option but you still own the process from the patient’s perspective. All outsourcing vendors should be held accountable through mandated performance metrics and service level agreements. Make sure patients know how to get in contact with you if they have issues.


Perpendicular structure – Most organizations are organized vertically (registration, surgery, imaging, etc.), but patients interact with the organization horizontally. Coordination across functional units is critical to ensure optimal patient outcomes and experience. Governance that includes representation from all areas and cross-functional teams supports an integrated process and timely reaction to any hiccups.


Compartmentalized colleagues – No one owns the entire encounter (although in the patient’s mind the hospital does). In many organizations, anesthesia, emergency room physicians, radiologists and others each bill for their own services. The involvement of multiple, separate parties makes it difficult to provide a patient with an accurate estimate of total charges. A unified bill, whether accomplished by employing all the providers or via a web-based user interface (e.g. patient portal), can make you stand out from the crowd.


In their 2017 Digital Health Technology Vision, Accenture notes that “healthcare enterprises are increasingly integrating their core business functionalities with third parties & their platforms. [Healthcare organizations] have begun to realize that healthcare should be organized around the patient, not the enterprise.”


Many healthcare organizations prioritize initiatives such as expense reduction, regulatory compliance, operations improvement and quality. While these are all worthy pursuits, you can never lose sight of who you’re there for: the patient. Take the time to look at the entire care process from their perspective.




About the Author

As the son of a physician, George Evans has been in and around healthcare his entire life. He has over 30 years of experience in healthcare IT, over 20 of them as a Chief Information Officer. He’s now a Senior Manager with Sagacious Consultants, part of Accenture.


A Consultant’s Journey: From EHR to Blockchain in Healthcare

Courtney Patterson - Thursday, November 09, 2017

by: Noah Lincoff



When Sagacious Consultants became part of Accenture, employees gained numerous perks – one of the greatest of these was the immense career advancement opportunities available in a large and well-positioned firm. As a 425,000-employee company, Accenture has a presence in nearly every industry in the world. And for a company of this size and reach, what is truly remarkable is its open nature towards employees and encouragement to move into fields of interest.


For me personally, these opportunities have manifested in a few different ways. For the past three years, I’ve worked with Sagacious Consultants’ Hospital Billing team on implementation, augmentation, and maintenance. This year I branched out into exciting new areas; I have been able to take on a leadership role within our North America Health & Public Service blockchain team, work with Accenture Ventures in varied tasks and external partnerships, plan innovation conferences and events, and work with Accenture Europe on a client project in Copenhagen (and potentially emerging healthcare tech within Europe, such as blockchain).


To successfully network my way into these new areas, I found that I needed to be proactive, persistent, patient, and willing to take on whatever tasks would help establish my presence within a group. When I got involved with blockchain, for example, I made connections with the team by reaching out to a couple Managing Directors, who I had seen quoted in a Business Insider article. Once they learned of my EMR background, they put me in touch with the head of the blockchain in healthcare team. From there, I was invited to their weekly go-to-market meeting, where I signed up for any and everything that needed to be done and to have one-on-one introductions with whomever would meet with me. Gradually, I started to take on tasks of higher and higher responsibility, which has led to many great experiences and to me taking on ongoing leadership roles in an area that highly interests me.


My involvement with Accenture Europe began through their work with a client in Denmark. They needed an Epic Hospital Billing resource in Copenhagen. While working in an HB analyst role wasn’t necessarily my goal for my next role, I could not pass up a phenomenal opportunity to gain international healthcare experience, as well as to network with Accenture Europe.


From here in Copenhagen, I have been employing a similar networking technique to get involved with our presence in European blockchain in healthcare. There is a keen interest in blockchain in healthcare in Europe, which I discovered from a blockchain conference in Nashville I attended a couple months ago, as well as from discussions with a few of our managing directors in Europe. My aim is to help build our presence and business in Europe much in the same way I have done in the US, while building my network within the firm.


My career is still evolving at Sagacious Consultants, and new opportunities continue to present themselves through Accenture. I’m excited to see where the path will lead.


Curious where Sagacious Consultants can take your career? Contact careers@sagaciousconsultants.com.


Using the Pod Model to Improve EHR Reporting

Courtney Patterson - Tuesday, October 17, 2017

By Anthony Marzorati, Business Delivery Manager and Scrum Master


With over 25 Epic go-lives under my belt, I have seen many clients struggle with ticket management during post live stabilization and optimization. One effective way to alleviate these issues is with Agile methodologies, specifically using a Pod model that can expedite and simplify your ticket management process.


A Quick Response to Reporting Backlogs


Here’s a typical example of where I see the struggle: The Director of Accounting asks for a report on remark codes by payor. She wants to see how many denials are occurring by payor and which payor has the most occurrences in a given timeframe. I put the director in contact with an at-the-elbow claims analyst who shows her a few reports she can review.The director has additional questions about the data and requests a new report.


Typically, this goes into a report request backlog until it is triaged, prioritized, and assigned to a report developer. The developer then tries to get in contact with the requester once they begin working on the request. A lot of time can pass while the requester and report writer wait on one another to work through the iterations of development. Eventually, maybe months later, a report will be published that meets the specifications outlined by the requester, and since it may not be optimized for enterprise use, that report may only be used by that particular director. Sound familiar? In this instance, the Pod model could help increase utilization and efficiently tackle issue backlogs.


Applying the Agile Pod model to EHR Reporting Teams


Agile Management is a set of guiding principles to efficiently and iteratively design, build, and deploy solutions. Originally used in software development, the Agile method has also been used successfully in other business areas, such as ongoing ticket management. The flexibility of the Agile method means that months spent designing, building and testing can be compressed into shorter sprints while also optimizing deliverable quality. The Pod model builds on the Agile methodology, creating an integrated team who can leverage their complementary skills and work to complete delivery in a specific business area. These Pods are designed to focus on clearly prioritized ‘use cases’ within a given area, bringing together all invested parties.


The roles within the Pod aim to provide a clear line of communication between the business and technical resources. Inside the Pod, a Scrum Master facilitates the model and manages the process of exchanging information. Business analysts, data visualizers, business domain experts, developers, and database administrators also play an important role within the Pod. These users contribute their expertise to facilitate discovery and support a flexible development process. This ensures that solutions provide the greatest value to end users.


The Agile Pod utilizes Sprints to provide flexible and efficient delivery by combining Agile methodologies such as “Scrum” with the Pod model. The Scrum Master leads the review of use cases in the backlog, leveraging Pod input to create a Sprint priority. The Pod works closely to develop, test, and optimize the solution to be deployed at Sprint completion.


Applying the Pod model to our example above, the Director’s request would be quickly addressed and prioritized in a triage meeting. The correct billing representative would coordinate with the Claims report developer to verify that a report doesn’t already exist in the current enterprise warehouse. If a new solution is needed, the Pod members would work in concert to develop, test, and optimize the solution. This would not only ensure delivery in a timely manner to the director, but also account for enterprise usability.


Keys to Success with the Agile Pod


In order to implement a successful Agile Pod, you must ensure that your teams and approach are clearly defined. It is also essential that stakeholders from all impacted parties are included early and often. Clear communication pathways within the Pod, particularly between the business and development stakeholders, need to be defined. Leveraging the Scrum Master to reinforce the approach and facilitate communication throughout the process is key to success within the Agile Pod framework.


Sagacious Consultants has experience tailoring this model to an organization’s specific needs, with prior successes that include leveraging the Agile methodology for efficient workflow and EHR build validation sessions with increased stakeholder engagement, and using the Agile Pod to conquer post-live ticket backlogs efficiently. Contact us for more information.

Don't Get Carried Away with EHR Customization

Courtney Patterson - Friday, October 06, 2017


by: Michael Perretta



Simplicity is valuable in today’s healthcare information ecosystem, where complexity is inescapable. In a philosophical sense, EHR systems attempt to distill order from the relative chaos of paper documentation.


In pursuit of efficiency, organizations often attempt to customize EHRs to reflect their special business requirements, unique quirks, and niche workflows. While configurability is an attractive bet, there are several disadvantages to going overboard with customization.


Support: Customization creates technical overhead and increases costs. It requires additional staff time to develop custom workflows, build, and training materials. Because institutional memory suffers with turnover, unique workflows can present special challenges – when employees leave, they take knowledge of custom functionality with them. Onboarding new employees takes time and disrupts project momentum.


Regression: Introducing functionality B sometimes has the unfortunate side effect of “breaking” functionality A. For example, Charge Router, Cost Center Assignment, and Expected Reimbursement Contracts are particular areas of concern from a Hospital Billing perspective. Unexpected consequences arise when analysts weave new layers of Charge Router tasks and actions. Standardizing workflows, therefore, helps minimize long-term errors.


Go-live: Although Epic implementations are highly structured, customization can prolong testing, go-live, and issue resolution. For example, specialized interface workflows create situations where errors signal issues that are both less obvious and more convoluted. Despite sufficient IT budgets, customization may hinder focus and work output, prolong implementation time, and derail overall project success.


While organizations continue to pursue advancements in healthcare technology, operational leaders must evaluate potential trade-offs between altering existing workflows and increasing levels of system customization.


National Health IT Week 2017 – Demonstrating the Value of Health IT

Courtney Patterson - Monday, October 02, 2017



Sagacious Consultants is pleased to join organizations across the country in celebrating National Health IT Week. We see the impact healthcare IT makes each day at the clients we serve. This year we have gathered a few of our employees to tell their stories on how health information technology has impacted their lives in personal and professional ways.


“I have cystic fibrosis (CF), which is a genetic, chronic disease that primarily affects the respiratory system. I see my care team numerous times throughout the year and am in communication with my CF Nurse Coordinator almost weekly. I have found MyChart, as well as the ability to communicate with my nurse via email, to be extremely helpful in managing my health. MyChart provides me with a comprehensive view of my medical record, including test results, current health issues, current medications, and more. I can look back at my test results history to view trends that may be developing, for instance, if my lung function is declining.


Having instant access to my healthcare records is invaluable when self-managing a chronic illness. It gives me the ability to monitor my own health without having to rely 100% on my care team to monitor and manage the progression of my CF. This tool gives me peace of mind knowing that if my nurse misses something, it won’t go untreated since she has backup – me!”


-Morgan Barrett, Recruiter



“I knew I wanted to make a difference in healthcare, but medical school wasn't my route. I've been able to find my niche in health IT, where I make a positive impact on patients' lives through the laboratory software I help to implement. I know that improvements I help bring to organizations in their laboratory software lead to more accurate testing outcomes and better care delivery - even if I’m not meeting a patient face to face.” 


- Chelsea Sallstrom, Managing Consultant


“We often talk about continuity of care as being a long-term relationship between the physician and the patient, the nature of which improves health outcomes thanks to a shared history. As someone who has moved every couple of years since age 4, continuity of care means that every new PCP has access to the sum of all knowledge from his or her predecessors. With the ubiquity of EMRs and inter-practice communication, I find myself worrying a lot less when it comes to whether a new medication will exacerbate a condition an internist noted years ago.” 


- Stephen Gac, Senior Consultant



“I didn’t always believe I would be in healthcare, but the big reason I decided to stay when other options were available is my mom. She was struggling with her health, and her doctors were not able to effectively coordinate her care outside of an acute setting. This made it a challenge for her to return to her normal standards of living. It would not have been so difficult if the proper tools had been used to make communication and coordination of services more effective. This helped me realize what a great opportunity we have with technology to better address patient needs.”


-Andrew Hecker, Associate Director - Strategic Services



“Although I have been in the healthcare industry for a decade, I didn’t see how care was coordinated until my father got diagnosed with cancer last year. My father saw countless specialists and had endless appointments. Thanks to the EHR, transitioning from doctor to doctor was relatively seamless.  Seeing firsthand with my dad how technology impacts healthcare has only increased my excitement for the future of health IT.”


- Adrian Calderon, Associate Manager of Business Development



“Growing up with a physician father and nurse mother, and working as a former EMT and Respiratory Therapist, I have been exposed to care delivery from a lot of angles, including as a consumer. Working now with Sagacious Consultants, I see ways every day that I can make the experience better for individual patients, and for the industry as a whole. That sense of being able to make a difference drives my passion for the work that I do - from streamlining registration and billing to improving care through expanded data integration and analytics.”


- George Evans, Principal Consultant



“I have been working in IT for over 20 years, with the last two spent in healthcare IT. I can easily say that the last two years have been the most fulfilling and eye-opening. Now when I go to my PCP or urgent care, I can see how technology improves the service I receive while I’m there and after I leave. From shorter waits to having access to my records literally at my fingertips, it’s incredible! And, the future of healthcare with added technology and greater interoperability will be even better!”


-Phil Pauls, Senior IT Analyst




​ A Diversity of Experience Enhances EHR Consulting

Courtney Patterson - Thursday, September 21, 2017


by: Chris Ning


One of the ways consultants can drive additional value for clients – beyond what is normally expected – is by drawing on our unique educational and professional backgrounds to resolve issues. Sagacious Consultants routinely blend our technical and operational expertise; I’d like to share an example where I recently did so. Leading daily General Ledger reconciliation at a recent client was a non-traditional way I blended my technical knowledge of the EHR system with my accounting background.


I started by designing, building, and testing the client’s GL based on their unique requirements. Having a background in accounting allowed me to understand exactly how Treasury wanted to set up their GL and how they wanted to route different types of transactions to different ledger accounts. The reconciliation process involved daily balancing of every transaction in the EHR to the appropriate account in their external general ledger system. Any delays in identifying and fixing troublesome transactions would result in delays to the next day’s load, which could create a significant backlog and negatively impact month-end and year-end balancing.


My accounting training allowed me to quickly identify out-of-balance GL accounts, and my technical knowledge helped me identify which transactions were causing the imbalance. It also helped me identify and remedy issues caused by both build issues and end user errors and prevent them from occurring again.


The main lesson I learned from integrating my accounting background with my Epic build knowledge was that there are many ways we can employ what we’ve learned outside of working with EHR to provide substantial value to our clients. For example, it’s easy to imagine how training in languages, graphic design, and other fields could add value to a consulting engagement. A Spanish speaker could help create patient communications in that language, or a consultant with graphic design skills could help modernize the design of patient statements. The key is for consultants to be proactive in looking for ways to incorporate what we already know with our technical knowledge.

Tips and Tools to Monitor Charge Correction at Go-Live

Courtney Patterson - Tuesday, August 15, 2017

by: Brandon Reese



Sometimes, in the rush to go-live, clinical users and department managers overlook the importance of charge correction. They may overlook proper charge correction workflow documentation, training on these workflows, and monitoring for dropped charges. Go-live does get hectic, but it is important that managers and end users alike know your organization’s processes for this high-impact workflow. Maintaining early charge correction ownership at go-live can help prevent problems, mitigate issues quickly as they arise, and drive frequent workflow review to ensure charge correction procedures are functioning correctly.


This blog is for you if your organization is implementing an EHR and getting ready for go-live. We aim to provide some guidance around the charge correction process: who’s involved, what their responsibilities are, and a sample tool for accountability.


People at all levels of the organization must understand and agree to charge correction processes and procedures:


Charging Leadership: Leadership needs to recognize the importance of defining charge correction workflows, and to empower the IT team to make decisions and act on them. A charge correction workflow is a workflow that allows users to flag accounts that have incorrect charges so downstream billing users can correct the accounts. Like most things, without adequate buy-in from leadership, your charge correction workflow will not be ready to succeed.


IT Team: After leadership approves the correct workflow, your IT team should be involved in modifying your EHR correctly to ensure that it supports the desired workflow. Without a smooth workflow, your end users will be reluctant to engage in the process.


Operational Managers: Operational managers will need to monitor their areas’ charges during go-live to ensure that they are acting quickly on charges that were missed and encouraging their staff to follow your charge correction process as quickly as possible when errors are noticed.


Training Team: The best workflows and organizational support in the world will not be of any use if your end users have not been properly trained. Be sure to engage your EHR training team early and often so they can incorporate your decisions and include lessons about how to spot lost revenue and how to act on it.


Operational End Users: All users whose workflows include charging will need to buy in to your process and be able to complete it easily. Charge correction is often the last thing on your users’ minds during a go-live so you must ensure that they are reminded and aware of the process for when they do notice charges being missed in their departments.


With this type of top-down organizational engagement, proper charge correction processes trickle to all levels of user involvement, and become a core aspect of one’s workday thus preventing potential revenue loss at and after go-live.


If you are nearing go-live and have outstanding questions or are not confident about your organization's charge correction process, it is important to confirm the tasks above are planned, assigned, approved, and communicated thoroughly.


Tools for Assigning Charge Correction Tasks


There are several project management tools to help identify and assign ownership for these tasks. One that we have found particularly effective is the RACI Diagram. RACI stands for Responsible, Accountable, Consulted and Informed, and the tool is a responsibility matrix to clarify task ownership. Using this tool forces teams to identify who is responsible, accountable, consulted, and informed for necessary tasks. Obtaining signoff on a RACI matrix reduces confusion or ambiguity. By clearly identifying who is responsible for certain parts of the charge correction process it is easier to identify who the correct decision makers are if a problem arises during your go-live.





Involving the groups listed above and defining, communicating, and training a charge correction process will prove invaluable to your organization during go-live, when the chances of incorrect workflows and missed charges are the greatest. By following the above processes, your organization will avoid losing revenue by identifying missing and errant charges in a timely fashion.




Consultant Spotlight: Heather Lautman

Courtney Patterson - Wednesday, July 19, 2017


Heather Lautman is a Managing Consultant who specializes in revenue integrity and charging. 


What projects have you focused on at Sagacious Consultants?


My projects most recently are focused on supporting our client’s Revenue Integrity (RI) areas: the department in middle revenue that sits between clinical and billing operations. In these engagements, we assess the people, process, and technology for Revenue Integrity. We look at clinical charging workflows, late charge data, analysts’ daily tasks, and revenue monitoring strategies, for example.


With the transition to new EHRs, charge producing workflows are heavily dependent on front end, clinical input. Due to this often large, cultural shift in organizations, we see the need for an augmented focus on revenue management and oversight. What was once known as a one-person CDM team is now a larger, more strategic revenue department focusing on overall revenue management in addition to CDM maintenance responsibilities.


What project are you especially proud of?


In the past two years, I have worked on four different Revenue Integrity projects and I do not know if I can pick a favorite! Each RI manager or director was fantastic to work with, and for each engagement I was most motivated by their enthusiasm. The directors and managers were excited to receive attention in their area and have a resource to discuss their process and operational questions. I am proud of the support I have been able to provide to these directors and managers in each assessment.


How have you seen the healthcare industry change during your six years of working with EHR systems?


The healthcare industry is fluid, with changes spurred by new regulations or new advances in technology. What I see most is the need for clients to dedicate the time and resources to Revenue Integrity. This is often an overlooked area of the revenue cycle as we typically see engagements strictly focus on the true back-end: follow-up, coding and denial workflows. The middle-revenue cycle is the connection point between clinical and billing that, once mature and strategic, can really reduce operational headaches.


What are your best skills you can offer to healthcare clients?


The best skills I can offer consist of my problem solving skills combined with my experience with operational and EHR complexities as they relate to Revenue Integrity. With moving pieces and multiple levels to issues, assessing and addressing opportunities within RI is a complex task and where my problem solving skills come in most handy!


What was your most challenging feat in the last two years, and how did you overcome it?


Designing the methodology for the RI assessment was a personal challenge for me. The effort was well worth it when we had our first client. We have refined parts of the process since then; for example, expanding on the operational indicators and key performance metrics used to quantify the net revenue and cash acceleration opportunity that exists at each client and would be obtained through an RI optimization project. Our clients come away with a clear understanding of next steps for implementing improvements through our methodology.


How do you like to spend your time when you’re not working?


Skiing in the winter and biking in the summer! Colorado is a wonderful playground!


Any big goals for 2017?


My number one goal for 2017 is to continue work within Revenue Integrity. I am excited to see who we will be able to assist next.




Improving the Revenue Cycle by Managing Referrals

Courtney Patterson - Tuesday, June 27, 2017



by: Kristen Hill


Healthcare organizations are always looking for new ways to improve revenue cycle performance. In recent years, the focus on patient access initiatives has moved further upstream to address the physician referral process. Having a strategic and coordinated approach to referral management will not only improve the financial performance of the organization by increasing referral capture and conversion, it will also improve the patient’s experience through better coordination within the system.


There are two key measures to track when evaluating and monitoring your organization’s referral management process:


Referral Capture: Referral capture has two components – the first is improving the rate at which physicians refer patients into the system. One approach that has yielded organizations measurable results is with physician scorecards that quantify key performance indicators and highlight referral patterns. These metrics can then be used to have meaningful conversations with physicians about removing referral barriers and increasing referrals into the organization by improving electronic health record (EHR) build and processes.


The second component of referral capture is improving the organization’s ability to turn an order or referral into a scheduled appointment. Better utilization of technology, improved workflows within scheduling, and increased accountability acting upon referrals within patient access will all help improve referral capture.


Referral Conversion: Referral conversion relates to the rate at which a scheduled appointment becomes a realized visit. Improving the no show and cancellation rate will directly impact the referral conversion rate and increase the number of patient visits within the organization. Initiatives that focus on improving patient communications, streamlining financial clearance processes, and optimizing scheduling workflows & technology will all have positive impacts on the referral conversion rate.


Referral management is a key step in the patient access process that has an impact on many downstream functions. Optimizing and streamlining the people, process, and technology that enables this function is critical to the overall health and success of the revenue cycle.


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