Overcoming Internal Threats to Revenue Cycle Performance

Kent Ritter via HFMA

The current era of health system growth and consolidation has bred internal disconnects that threaten revenue cycle performance. Maintaining a focus on accountability — providing clear expectations and tracking those measures — is essential for addressing these internal challenges.

The principle of accountability can be translated into concrete actions that apply to the entire revenue cycle, individual departments, and external vendors as well as to individual staff.

The Context: Growth Without Standardization

To grapple with new financial pressures and capitalize on the upside of consolidation, health systems today are acquiring hospitals and physician groups at a fast clip. Too often, this growth is not matched by the appropriate revenue cycle scale-up. Despite their adeptness at cultivating clinical alignment between hospitals and physicians, health systems have struggled to achieve similar alignment in the revenue cycle space. The additional complexity and volume introduced is left to be handled piecemeal, according to the idiosyncratic practices of the legacy organizations.

This disconnect can exist for various reasons: It can come from having conflicting ways of approaching the same process, from not having the right people in the right roles, or from gaps in the skill sets of executive leaders who are charged with managing the newly expanded health system.

For example, one health system’s transitional growing pains were a result of having 11 hospitals with each hospital being supported by four coding groups and four separate coding directors (for a total of 44 coding directors) who reported to the individual hospital’s CFO. That kind of fragmented organizational structure dilutes accountability and introduces confusion about prioritization and how performance measures will be evaluated.

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