For most of her life, Anne Robertucci’s road led towards a career in healthcare. And while a calling to help others mobilized her, she knew that she lacked the stamina to deal with the direct patient care aspect. Fortunately, the role of a close family friend within the health information systems industry presented a different possibility—one that intrigued Robertucci and inspired her to join the healthcare field using her strongest skill set.
After earning both her bachelor’s and master’s degrees in health information systems from the University of Pittsburgh, the Panther alum went on to spend nearly twenty years at the University of Pittsburgh Medical Center then five at Optum, before taking a position at Prisma Health in March 2021.
Today, as the vice president of clinical revenue cycle of Prisma Health, Anne Robertucci drives initiatives to ensure the quality of care is reflected appropriately in the claims submitted to the payer. It is critical that the codified claim represents the clinical story of just how sick the patients are, and that Prisma is appropriately reimbursed for the great care provided.
“It’s about making sure we are being innovative and forward thinking in all of the work we do with the goal of driving down the administrative costs in our work,” Robertucci shares. “I feel in today’s world, you can’t do things the way you’ve always done them, so we need to look at how are we using technology to drive change and improve efficiency.”
“I feel in today’s world, you can’t do things the way you’ve always done them, so we need to look at how are we using technology to drive change and improve efficiency.”Anne Robertucci
For instance, Robertucci proved instrumental in creating an outpatient ambulatory CDI program, focusing on HCC capture improvements. With the continued CMS movement from fee-for-service payments to fee-for-value, it should be on every healthcare organization’s key priority list.
“We created this ambulatory CDI approach to ensure our patients’ RAF scores make sure we have all of their chronic conditions accounted for,” she offers. “From a managed care perspective, that’s really how you are reimbursed.” Using strong technology to support the team and reduce inefficiencies in the process remains key to their program.
Another initiative she’s excited about is Prisma Health’s work around clinical documentation improvement and coding in the acute care space.
“We’re making sure we are reviewing cases appropriately, that we are aligning with the providers concurrently with our CDI process, and ensuring we are looking at the right case at the right time,” Robertucci says. “That ties back to the work and innovation I drove on the vendor side.” Established over a decade ago, Brundage Group supports the team with end-to-end CDI and revenue cycle solutions, helping improve documentation accuracy and optimize revenue cycles.
Having experience on both the health relationship management and vendor sides allows Robertucci to establish a fair and balanced approach to her current job.
“When I worked on the provider side, I really focused on the goals and tasks at hand, and you’re so focused on your organization and how you do things that you don’t have time to gain external insight. And while we were very innovative at UPMC, moving to the vendor side really allowed me to engage with other innovative and strong healthcare organizations to see what their best practice was,” Robertucci recalls.
“This helped me expand my professional horizons and gain an entire tool kit of new best practices to drive improvements.” As a result, the VP implemented some additional key, innovative processes at Prisma Health she expects will help move the needle further.
“Coding and coded data has a halo effect on patient quality outcomes. It can impact your expected length of stay, reimbursement levels, and overall severity of illness.”Anne Robertucci
“Coding and CDI in the past was very financially focused,” she notes. “Over time, and in more recent time, the focus is on bringing the impact of quality metrics and outcome discussion into this space.”
Technology, she says, makes the job easier and people shouldn’t be afraid to embrace it and take advantage of all it can do to improve quality outcomes.
“How we look at the consumer (patient) publicly available data, a lot of those metrics are based on what’s submitted on the claim—the diagnoses codes and procedure codes—and if you’re not ensuring comprehensive code capture, it has a major impact on how you look from an overall quality perspective,” Robertucci explains. “Coding and coded data has a halo effect on patient quality outcomes. It can impact your expected length of stay, reimbursement levels, and overall severity of illness. If you’re not accurately capturing the story on the claim, you’re not going to be reimbursed appropriately and portrayed appropriately in the public eye.”
With costs rising in every aspect of care, Robertucci emphasizes the importance of determining different ways the company can support its operations in a more efficient and cost-effective way.
Thanks to her five direct reports, Robertucci has moved things towards a more service line management structure.
Robertucci relays a story about caring for her father who had terminal pancreatic cancer, helping him go through the entire process, and watching the different disciplines of the healthcare engine work as he went through chemo and dealt with extreme health circumstances.
This not only allowed her to take a step back and realize what is important from a life perspective, but also gave her the opportunity to see every aspect of the healthcare continuum from start to finish. She saw what works well, what does not, and how to incorporate that insight into her own piece of the healthcare puzzle and drive change in her work.
“My father’s healthcare experience helped me learn how to balance work and life,” she explains, “similar to how we, in the clinical revenue cycle, have to balance the work we do from both a financial and quality perspective.”
Anne Robertucci is thankful for her career path taken and how these experiences have opened the door to so many different opportunities.
Brundage Group is proud to partner with Prisma Health to provide revenue cycle staffing solutions for efficient, higher-quality care. Our CDI nurses deliver documentation excellence and coding accuracy, and with our suite of physician advisory services, hospitals can optimize the revenue cycle, driven by documentation integrity. Get quality talent and proven results: brundagegroup.com.