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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
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Jeff Chester, senior vice president and chief revenue officer at Availity, shares his thoughts on "Revenue Cycle 2.0" and how to best meet its challenges.
Mitch Morris, vice chair and global leader, healthcare, Deloitte, and Michael O'Rourke, senior vice president and chief information officer, Catholic Health Initiatives (CHI), share perspectives on the need for transformational IT in health care today.
Brian Kueppers, founder and CEO, Apex, discusses the importance of a robust patient payment strategy in boosting organization revenue and enhancing patient satisfaction.
Brian Grazzini, CFO, HealthPort, describes the importance of efficient and compliant information exchange and audit management in helping HIM staff spend less time on paperwork and more on mission-critical projects.
Cindy Matthews, executive vice president, Community Hospital Corporation, discusses how rural and community hospitals can use collaborative partnering to position for success through tough market conditions.
Rick Heise, senior vice president, revenue cycle, at Cerner Corporation, discusses the importance of integrating clinical and financial data to excel in health care’s changing payment environment.
Russ Graney, founder and CEO for Aidin, and John Laursen, head of business development for Aidin, share insights on how to improve care transitions between acute and post-acute care settings and incentivize high-quality patient outcomes.
Scott Elston, strategic accounts manager, GE Healthcare Services, describes how substantial cost reduction in health care requires rethinking business strategy and asset use.
Robert Williams, MD, director, Deloitte Consulting LLP, and Arielle Freiberger, product strategist, ConvergeHEALTH by Deloitte, explain how sophisticated retrospective, real-time, and predictive data analytics can inform decision making to reduce costs and improve care.
Stuart Hanson, director of business development (healthcare solutions) at Citi Retail Services, discusses how improving the payment experience can benefit consumers and healthcare providers.
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