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This is a sample tool from HFMA’s CFO Forum. Learn more about the CFO Forum and HFMA’s other Forums here.
1. Purpose: To serve as the governing council for the revenue cycle function of the Health System. To ensure sustainability, the Revenue Cycle Governance Council (RCGC) will execute system-wide revenue cycle initiatives and drive optimization by identifying where opportunities exist, determining best practice, and driving to implement standard process for hospital, physician group, and home care operations.
2. Definition: The revenue cycle is the set of activities in our health care environment that brings about reimbursement for medical care, supplies, and treatments. The primary focus is on Patient Access and Billing Office responsibilities across the organization. It also covers or intersects with other core functions such as admitting and registration, financial counseling, case management and utilization review, health information management (coding and documentation), charge capture, billing compliance, accounts receivable, cash posting, customer service, collections, underpayment review and audit, analytics, and the business systems used to maintain the aforementioned tasks.
3. Guiding Principles:
When making decisions and recommending policy changes, the Revenue Cycle Governance Council will adhere to the following guiding principles:
4. Roles and Responsibilities:
a. Voting Members:
i. Include one member from each regional affiliate, one member from physician group, one member from home care and one member from hospital central billing office. That member should be the highest-ranking person who has the operational responsibility for the revenue cycle.
ii. Current voting members include:
c. Meeting Frequency
iii. Meetings in person or via V-Tel.
iv. Other meetings may be required as needed.
d. Member Roles/Responsibilities
i. Attendance at meetings is expected. Designees are allowed if circumstances prevent member(s) from attending or voting.
ii. Read and review relevant materials and outside literature.
iii. Work between meetings may be required.
iv. Represent the needs of the member organization.
v. Serve as a communication link between RCGC and all interested stakeholders at the member organization.
vi. View decisions and vote according to what is best for the entire health system vision.
vii. Following the vote’s outcome, members will take accountability and ownership for RCGC’s decision regardless of personal/affiliate position.
viii. Sponsor major initiatives or projects chartered by Affinity Group.
ix. Member is accountable for implementation of best practice at the affiliate location.
x. Members will adhere to the Guiding Principles.
xi. The Executive Sponsor is a member of the Senior Leadership Group (SLG). This position will provide system leadership for the RCGC under the guidance of SLG.
xii. The Facilitator is a Management Leadership Academy (MLA) or Physician Leadership Academy (PLA) graduate. They are not a subject matter expert, but will help support the Executive Sponsor, Chair and RCGC as needed. The Facilitator will also organize the meeting agendas and annual planning and will facilitate the meetings. They can also handle minutes and follow up items if necessary.
i. Scope of Authority:
1. RCGC will make recommendations to CFOs for final approval:
a. Changes to Health System Policies
b. Changes affecting the patient statements or patient collection/bad debt/financial assistance process
c. Unbudgeted expenditures
d. Significant changes (up or down) to cost to collect
e. Selection of vendors
f. Requests for new technology
g. Changes to organizational structure (i.e., centralization of function)
2. RCGC will make the following decisions, and keep CFOs informed, as appropriate, via site Revenue Cycle representative and/or on CFO call:
a. Changes to process impacting revenue cycle components: registration, HIM, CBO, etc.
b. Implementation of best practice
c. Changes to/optimization of software to improve work flow or implement best practice
ii. Decisions will be made in a timely manner.
iii. The group will work toward consensus.
iv. When a vote is called for: 1. A super majority (60%) of voting members is required. (7 of 11, unless someone abstains)
v. Some issues or decisions will require multiple affinity groups to weigh in before decisions/processes can be finalized.
2. Members should vote in the best interest of the system.
3. Once a vote passes, the change will be implemented across the entire system. There are to be no exceptions.
4. When a vote needs to occur, a motion will be made at the monthly meeting, but the vote will not occur until the following month’s meeting to allow time for discussion/research. The motion will again be stated on a draft agenda that will go out in advance of the meeting. A vote can be in person, V-Tel or via email. Designees to stand in for a voting member will be allowed if the voting member cannot participate at the time of the vote.
i. The members of the RCGC will be informed of a vote at the monthly meeting before the vote will occur.
ii. Members should submit their agenda items to the Facilitator at least three business days in advance of the scheduled monthly meeting.
iii. The agenda and other pertinent documents will be distributed via email to members two business days prior to the scheduled meeting.
iv. Minutes of each meeting will be documented by the Executive Assistant of Revenue Cycle and shared with the RCGC members, as well as each affiliate’s Finance Director and CFO. The Facilitator will handle minutes of the meeting if needed.
v. RCGC members are expected to share the RCGC’s work, decisions and outcomes with their Finance Directors and CFO’s and other appropriate persons, including physicians, following each meeting.
vi. RCGC will report to health system’s CFO Leadership group as needed/requested.
vii. RCGC will report on an annual basis to the health system SLG via RCGC’s Executive Sponsor.
viii. RCGC may choose to have sub-committees manage some projects, but progress on these will be communicated at monthly meetings.
6. Organizational Chart
a. RCGC reports to the system’s CFO Leadership group.
b. The following affinity groups report up to RCGC:
i. RAC Affinity Group
ii. Health Information Management (HIM) Affinity Group 1. CDI Specialists
iii. Registration Affinity Group (known as State Registration Managers)
iv. Revenue Cycle Directors (meets on ad hoc basis)
v. Utilization Management will have a designated member from their group serve as a non-voting liaison on RCGC.
7. Escalation Process
a. The Escalation Process for any issues will follow the Organizational Chart outlined above. If the issue or risk cannot be resolved at the level where it has been identified, it will be the responsibility of the respective chair to escalate the issue to the next higher level committee in the governance structure. It is expected that these issues will be escalated at the next regularly scheduled meeting of the higher level committee.
b. If the issue or risk requires immediate attention, the chair of the reporting committee will note the level of urgency to the chair of the higher level committee so that a special meeting can be called. It will be the prerogative of the higher level committee chair to determine if the issue or risk warrants that an extra meeting be held in person or via conference call, or if the issue should be resolved via e-mail.
c. It is expected that any issue or risk that is escalated will be placed on an open issues list by the Executive Sponsor who will keep a current status on the item. The open items will be identified and placed on the agenda for discussion at each subsequent meeting until resolved.
8. The RCGC Charter will be formally reviewed six months after adoption and annually thereafter.
Source: Reprinted with permission from a large U.S. health system that did not want to be named.
Publication Date: Tuesday, May 14, 2013
In this Business Profile, Bruce Haupt, president and CEO of ClearBalance, discusses how a patient loan program can increase patient collections, reduce bad debt, and speed cash flow.
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
In this Business Profile, Jerry Bruno, principal with Deloitte Consulting LLP, discusses the importance of choosing revenue cycle solutions that help an organization meet the challenges of a quickly evolving healthcare environment.
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
In this business profile, Lane Jackson, a partner in the Grant Thornton LLP Health Care Advisory Services practice, with extensive experience in overseeing system implementations and revenue cycle reorganizations, discusses best practices for elevating revenue cycle performance during an EMR implementation. Grant Thornton LLP is a sponsor of the Large System Controllers Council Affinity Group.
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
In this business profile, Amy Gross, senior vice president of Key Government Finance, discusses the benefits of private placement transactions to support large-scale financing projects.
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
In this business profile, Doug Polasky, executive vice president at Xtend Healthcare, explains the importance of having sound workflow processes in a consolidated business office to ensure optimal performance and reduce costs.
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
In this business profile, sponsored by SSI, Jay Colfer, vice president of sales and marketing, shares how patient access solutions are reversing the trend toward increased bad debt resulting from the rise in high-deductible consumer health plans.
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
In this business profile of Deloitte Consulting, Matthew Hitch and David Betts explore the potential benefits of elevating the customer experience and outline strategies to change service delivery.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
TriMedx helps health systems control costs and uncover savings opportunities by optimizing the clinical engineering function.
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
Announcements from several commercial payers and the Centers for Medicare and Medicaid Services (CMS) early in 2015 around increased efforts to form value-based contracts with providers seemed to point to an impending rise in risk-based contracting. Rather than wait for disruption from the outside in, health care providers are now making inroads on collaborating with payers on various risk-based contracting models to increase the value of health care from within.
Yuma Regional Medical Center (YRMC) is a not-for-profit hospital serving a population of roughly 200,000 in Yuma and the surrounding communities.
Before becoming a ZirMed client, Yuma was attempting to manually monitor hundreds of thousands of charges which led to significant charge capture leakage. Learn how Yuma & ZirMed worked together to address underlying collections issues at the front end, thus increasing Yuma’s overall bottom line.
Kindred Hospital Rehabilitation Services works with partners to audit the market and the facility’s role in that market to identify opportunities for improvement. This approach leads to successes; Kindred’s clinical rehab and management expertise complements our partners’ strengths. Every facility and challenge is unique, and requires a full objective analysis.
As the critical link between patient care and reimbursement, health information enables more complete and accurate revenue capture. This 5-Minute White Paper Briefing shares how to achieve cost-effective revenue integrity by your optimizing HIM systems.
Speedier cash flow starts with better CDI and coding. This 5-Minute White Paper Briefing explains how providers can improve vital measures of technical and business performance to accelerate cash flow.
Qualified coders are getting harder to come by, and even the most seasoned professional can struggle with the complexity of ICD-10. This 5-Minute White Paper Briefing explains how partnerships can help improve coding and other key RCM operations potentially at a cost savings.
The point of managing your revenue cycle isn’t just to improve revenue and cash flow. It’s to do those things effectively by consistently following best practices— while spending as little time, money, and energy on them as possible.
How Lucile Packard Children’s Hospital Stanford increased payments received within 45 days by 20% and reduced paper submission claims by 70% by using ZirMed solutions.
The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to 22 percent. Read about how predictive modeling can detect meaningful correlations across claims denials data.
Emergency Mobile Health Care (EMHC) was founded to be and remains an exclusively locally owned and operated emergency medical service organization; today EMHC serves a population of more than a million people in and around Memphis, answering 75,000 calls each year.
Since the Physician Quality Reporting Initiative (PQRI) introduction, CMS has paid more than $100 million in bonus payments to participants. However, these bonuses ended in 2015; providers who successfully meet the reporting requirements in 2016 will avoid the 2% negative payment adjustment in 2018, so now is the time to act! Included in this whitepaper are implications of increasing patient responsibility, collections best practices, and collections and internal control solutions.
Getting paid what your physician deserves—that’s the goal of every biller. Yet even for the best billers, achieving that success can be elusive when denials stand in the way of success, presenting challenges at every turn. Denials aren’t going away, but you can learn techniques to manage and even prevent them.Join practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, to: Discover methods to translate denial data into business intelligence to improve your bottom line, determine staff productivity benchmarks for billers, and recognize common mistakes in denial management.
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.
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