Andrew AdamsBeing a revenue cycle leader in health care is becoming an increasingly complex and challenging job. Leaders must prepare their organization's revenue cycle operations for an uncertain future, while using fewer resources and continuing to improve performance. The impacts of healthcare reform, evolving payment methodologies, and new regulatory requirements add a level of complexity that is enough to make a revenue cycle leader's head spin. Consider just a few of the imperatives faced by revenue cycle leaders, and their related action items. 

Preparing for value-based payment systems and accountable care. The value-based system of payment for health care is quickly becoming a reality, with deep implications for the revenue cycle. Patients who are members of accountable care organizations (ACOs) must be tracked and managed differently throughout the revenue cycle process. Meanwhile, new bundled payment arrangements are also having an impact on operations. Depending on the structure of the bundled payment model, there can be varying levels of complexity associated with submitting and adjudicating claims and distributing payments. Revenue cycle leaders must think strategically as they proactively prepare their operations for still-evolving payment structures.

Improving business intelligence. Many healthcare organizations have invested heavily in revenue cycle information systems. These systems have captured more data, but any organizations have yet to produce new actionable information to improve decision-making. Revenue cycle leaders play in important role in connecting financial data with clinical data, with the goal of improving the overall value delivered to patients and the community. Leaders will need to play an active role in the evolution from traditional planning and reporting on key performance indicators to driver-based analytical capabilities that support strategic decision making.

Continuing to enhance revenue. Optimizing collection performance and minimizing revenue leakage have long been focus areas for revenue cycle leaders. In the current environment, it is critically important that providers claim every dollar due. Leaders therefore must focus on fine tuning areas such as clinical documentation, denials management, and patient financial clearance processes.

Driving efficiency in revenue cycle operations. Providers are facing relentless reimbursement pressure, which is causing many organizations to sharpen their focus on cost cutting. The revenue cycle is becoming a popular target for CFOs, given that these operations often represent a large budget line item. Leaders must do more with less, and many are focused on maximizing productivity by redesigning and streamlining work flow. Another common strategy involves driving economies of scale through consolidation and centralization of revenue cycle operations.

Addressing the need for pricing transparency. Recently, the media has turned its spotlight keenly on variations in healthcare prices. Leaders must focus on developing defensible pricing strategies and adjusting the charge description master in the face of pressures to increase transparency. 

The challenges facing revenue cycle leaders are as demanding as they have ever been. Successful leaders will be those who think strategically and plan proactively, while motivating and managing their teams through turbulent times. It’s a tall order—and an exciting challenge.  

Andrew Adams is a senior manager in Ernst & Young LLP’s Advisory Health Care practice and is based in New York.

The views expressed herein are those of the author and do not necessarily reflect the views of Ernst & Young LLP.

Publication Date: Tuesday, October 29, 2013