Is your revenue cycle performance sustainable?

Colleen O. Hall, CPC, CPMA, CIRCC, and Matthew M. Szaflarski
| 11/9/2021
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Traditionally, departments seeking help with performance improvement will engage a consulting firm to help identify or quantify issues and implement changes. Frequently, however, those revenue cycle departments find that within three to five years, their performance metrics are back to where they started – or worse. Many discover they need to enter into a consulting engagement yet again. And the cycle continues.

A primary reason for this continuous cycle is that these consulting engagements tend to focus on treating the symptoms of performance issues rather than the underlying causes. In a fluid and complex industry such as healthcare, revenue cycle departments need to adopt processes that promote stable, continuous performance improvement. They need solutions and tools that provide timely performance metrics that track the issues of greatest importance to their organization – not someone else’s. They need a framework to transparently discuss and resolve performance issues with all organizational stakeholders. They need performance insights that keep up with industry changes and help prevent a return to undesirable behaviors that can lead to poor revenue cycle performance. Following are several strategies for achieving a more sustainable revenue cycle performance.

Moving toward sustainable success

After conducting a revenue cycle performance assessment, revenue cycle departments can consider the following steps to successfully achieve sustained performance:

  • Develop a revenue integrity structure focused on performance improvement. Revenue cycle departments should consider forming a separate revenue integrity department or group to serve as a hub for the overall revenue cycle department. This group can help bring together disparate resources and standardize processes. The revenue integrity team should be charged with following up on goals and metrics and creating efficiencies across the revenue cycle.
  • Be clear on what is measured. Having standardized measurements and processes in place to continually monitor key performance metrics is vital to maintaining revenue cycle performance. The revenue integrity group, working closely with the CFO and other stakeholders across the revenue cycle department and organization, should decide which metrics should be monitored and reported. The group should then consider using tools such as a monthly standardized performance scorecard to keep track of monitored metrics (for example, comparing initial denials with final denials). If issues with performance are identified, the revenue integrity group should conduct a root-cause analysis to determine what is leading to poor performance and determine a plan to make performance trend upward again. The revenue cycle department also might consider designing work queues based on the performance scorecard to help staff prioritize daily workloads.
  • Practice clear and transparent communication. Communicating revenue cycle performance regularly is essential for sustaining performance. The revenue integrity group should consider holding monthly meetings with the CFO and other revenue cycle department leadership to review performance scorecards. Larger organizations might consider assembling a group of regional-level revenue integrity directors to communicate with system-level CFOs. Holding quarterly meetings with revenue cycle department leaders, including members of the revenue integrity group, senior leadership, and the patient financial services and health information management and coding teams, encourages transparent, effective dialogue and builds trust within the department.
  • Identify tech-enabled solutions to maintain performance. Technology can play an essential role in helping the revenue cycle department sustain performance results. Revenue cycle departments should seek out technology solutions that automatically monitor, capture, and track performance initiatives so staff members can focus their valuable time and resources on fixing issues and improving performance. The ideal technology solution should:

o  Help clarify which stakeholders are responsible for which performance initiatives, helping staff members avoid duplicating work.

o  Run reports that enable staff to share data with the leadership team, contributing to transparency and trust building.

o  Maintain an inventory of performance improvement initiatives that contributes to transparency and efficiency.

o  Feature helpful tools such as automated performance alerts that help monitor performance without taking time away from staff members’ day-to-day work.

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Aiming for continual process improvement

Working in a fast-moving industry with increasingly complex challenges, today’s healthcare revenue cycle departments should aim strategically for continual process improvement that promotes sustainability now and into the future. Implementing certain actionable strategies for lasting success is a good start. In addition, working with third-party revenue integrity specialists can be another asset in the journey toward sustained performance improvement. Such specialists can help revenue cycle department leadership develop a program that is specific to their organization’s needs and that initiates and maintains sustained revenue cycle performance improvement – and prevents performance backslide.

For more information on performance integrity, view the Crowe webinar “Collaboration, problem-solving, and performance integrity.”


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Colleen O. Hall
Colleen O. Hall
Managing Principal, Healthcare
Matt Szaflarski