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What is Revenue Cycle Optimization, Really?

Julie CorcoranBy Julie Corcoran

Most people assume that revenue cycle optimization is making sure that your revenue cycle operations are working at full potential and benchmarks are met or exceeded on a regular basis. This is true. However, how do you really know if the broad spectrum of revenue cycle operations (front end to back end) is truly optimized?

Recently, a client asked us to perform a revenue cycle assessment even though all of their metrics (days in A/R, denial rates, etc.) were better than average. However, the client had a “feeling” that something was “not quite right.”  How many of you have ever had a hunch but could not prove it?

This client proved it, all right. We dug deeper into their processes and found that they were missing $7 million in charge revenue!

Revenue cycle optimization means delving deeper into workflows and processes to elucidate issues. This uncovers what you do not know and truly improves operational outcomes – and the bottom line.  Industry leaders are beginning to embrace this approach.  Those systems that set standards for quality, outcomes and financial strength are models for all of us.  However, these same systems do not settle for better than average metrics. They take the approach that there is always room for improvement and a more efficient way to deliver desired results.  This is true revenue cycle optimization. If you have the luxury of stellar performance in these challenging times – dig deeper!  You will find opportunity for improvement, which will positively affect the bottom line. 

We all know it is the right thing to always assess, improve and enhance.  However, in reality, we are busy, managing several high priority agendas and tend to leave “well enough” alone.  In an era of payment reform, unprecedented rules and regulations and interoperability demands – transformative change is only achieved through digging deep into revenue cycle workflows and processes to identify every opportunity for improvement.


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