Spotlight: Cheryl Ericson – From Silos to Synergy

The landscape of hospital revenue integrity is rapidly evolving, and the once-separate worlds of Utilization Review (UR), Clinical Documentation Integrity (CDI), coding, and Physician Advisors are now converging into a unified strategy. Cheryl Ericson, RN, MS, CCDS, CDIP’s career journey exemplifies this transformation. With experience in public health, nursing, insurance, and hospital administration, Cheryl witnessed firsthand how siloed functions led to inefficiencies and missed opportunities. Coders, nurses, and physicians often operate independently, unaware of how their work impacts the broader clinical revenue cycle. Claims data (also referred to as administrative data) both directly and indirectly impact hospital revenue as a function of reimbursement and value-based care.

The Power of Collaboration

Today, effective revenue integrity depends on structured collaboration. Cheryl emphasized the importance of regular meetings, case reviews, and open dialogue among UR, CDI, coding, and Physician Advisors. This collaborative approach breaks down barriers, fosters mutual respect, and ensures that each group’s expertise is leveraged toward shared organizational goals. It all begins with physician documentation; without physician support, we can’t achieve optimization. Having physicians actively involved is invaluable; sometimes, when you’re coding or working through cases, their direct input can clarify ambiguities and ensure that the documentation reflects the true clinical picture. Physician Advisors, once seen as peripheral, are now central to bridging clinical and administrative priorities. Their involvement ensures that physician intent is accurately captured; coding reflects true patient acuity, and documentation supports both reimbursement and quality metrics. Cheryl noted, “Physician Advisors have gained a lot more confidence and a lot more knowledge. I think before they used to be very dependent on CDIs and coders, and so they didn’t necessarily express their own opinions as much.” This evolution highlights how Physician Advisors now play a more assertive and informed role, contributing their own perspectives alongside the expertise of other revenue cycle teams.

Adapting to a Changing Environment

Hospitals today face pressures like shrinking margins and staffing shortages. Cheryl emphasizes that achieving sustainable revenue integrity requires integrating UR, CDI, coding, and Physician Advisors into a cohesive reporting framework. At many hospitals, UR, CDI, and coding report to different departments, creating silos and communication barriers. Cheryl notes, “Often departments are so focused on their own silo and trying to meet those metrics instead of considering how their metrics relate to organizational goals.” By integrating these functions into a single clinical revenue cycle structure, organizations can improve coordination, oversight, and accountability. This alignment ensures that committees, such as those focused on sepsis, readmissions, or mortality, make decisions that consider clinical functions and downstream impacts associated with patient status and coding, while supporting organizational goals such as the case mix index, denial prevention, and quality. Cheryl recommends practical steps, including unified leadership, transparent technology, and a shared culture of learning, to help teams work toward common objectives and strengthen both financial and clinical outcomes.

Looking Ahead

As outpatient volumes rise and inpatient cases become more complex, the need for integrated expertise will only grow. The migration of procedures from the inpatient to the hospital outpatient setting will be hastened by the elimination of the inpatient only list, likely resulting in an eventual shift to independent ambulatory surgical centers leading to significant loss of revenue for most hospitals. For example, the National Patient and Procedure Volume Tracker by StrataSphere® for 12/31/24 shows that inpatient primary knee replacement is down 21.2% in 2024 compared to 2023. Inpatient primary hip replacement is down 3.8% when comparing 2024 rates to 2023. The healthcare industry is changing more rapidly than at any other time, as payers fight to maintain profits by challenging hospital billing practices. In contrast, hospitals contend with new regulations designed to reduce fraud and waste. Cheryl’s insights and ongoing thought leadership reinforce a clear message: revenue integrity is a team sport, and success depends on breaking down silos in favor of unified, strategic, measurable action. The future of hospital financial health lies in the seamless integration of UR, CDI, coding, and Physician Advisors, ensuring hospitals remain viable, compliant, and focused on delivering high-quality patient care.