As the industry evolves, provider organizations will need to continue to adjust to attain revenue cycle excellence. A provider’s financial well-being is nearly always tied to the revenue cycle of the clinical practice. Higher-performing organizations have high levels of stakeholder engagement “up and down” the organization creating cascading scorecards that build toward common organizational goals.

Elements of successful performance management include developing a common cultural foundation, creating the tools to measure and manage performance, and making measurable and quantifiable changes. High-performing organizations ensure a culture of accountability through constant communication, education, and reporting on revenue cycle performance.

Ok, so where to start?  We suggest that you start by creating a process improvement roadmap staring with a process gap analysis from two perspectives – a data process analysis, and a business process analysis.  This approach decomposes the revenue cycle process flow, tracing where data is created, updated, routed, and appended throughout the encounter-to-payment cycle and the underlying business rules. By “data,” we mean the packet of information that represents the to-be-processed claim.  The routing may be within a system, between systems and intersect with human workflows.

We then systematically take the individual steps of the process and simplify them by virtue of rethinking the process and identifying the automation methods that reduce exceptions and human bottlenecks.  The outcome of this exercise is that we will have identified:

      • Human data interactions that should be automated or simplified
      • Human workflows that should be automated or simplified
      • Organizational hand-offs that should be automated or simplified
      • Automated verification points that mitigate human errors
      • Process steps that evolved as workarounds and should be simplified
      • Data gaps that create inefficiencies
      • Exception causes that burden the cycle and where/how to eliminate them

This then becomes a blueprint for modernizing the revenue cycle process.  We then plan out how to phase in the improvements so we can “change the wheels” while “driving the car” – i.e., implement the enhancements so that clinical and financial operations are minimally disrupted.   This blueprint and the phasing plan collectively are the transformation roadmap for the revenue cycle process. The commitment to measuring and monitoring performance is key for making process adjustments and setting appropriate goals.