Two key strategies for building your organization’s enterprise revenue cycle 

Our segment today is a follow up to June’s audio blog on Consolidating Revenue Cycles. If you’ve yet to listen to it, we recommend starting there. In that blog, Sandra Jacobs, Founder and CEO of Jacobus Consulting, discussed the industry changes driving organizations to consider developing an enterprise revenue cycle. Furthermore, she introduced the signs, signals, and steps for consolidating acute, outpatient, and ambulatory revenue cycles to create one enterprise-wide revenue cycle. Sandra left us with a very high-level roadmap of how to get started and some other strategic planning insights. Today, we will dig a little deeper and focus on two key strategies:

  1. Building the structure
  2. Culture integration.

These two foundational elements will ensure overall success in your enterprise revenue cycle project.



[0:00] Introduction

[1:07] Key elements in building the structure of an enterprise revenue cycle (ERC)

[3:42] How to approach enterprise revenue cycle leadership

[6:35] Defining the role of the ERC leader

[9:08] Standardization across functions & supporting technology

[14:04] The importance of culture in an enterprise revenue cycle

[17:02] Beginning the journey toward culture integration

[23:04] Defining your ERC vision

[28:10] Conclusion

GUEST: Sandra Jacobs


“Organizations that delay the trasition to this enterprise-wide look at their patient… will likely lose consumers to their patient-centric competitors who are already evolving and changing.”

Sandra is a recognized leader in revenue cycle transformation and is passionate about aligning healthcare information technology with people and processes.


Key elements in building the structure of an enterprise revenue cycle [1:07]

The structure and overall governance of the enterprise revenue cycle (ERC) are critical to achieving the organization’s vision.  There are four key elements to the structure and governance of an enterprise revenue cycle: 

  1. Leadership
  2. Standardization and supporting structure
  3. Process alignment focused on the patient
  4. Technology that supports operations

How to approach leadership structure [3:42]

Many organizations fail when it comes to ERC leadership because the structure was not strategically developed. There should be one leader at the top of your ERC. Their title should reflect a position of authority across the enterprise that is focused on the patient. The leadership position and title should reflect two things:

  1. A position of authority at the enterprise level
  2. A focus on the patient and their financial needs

The terminology of the title (“Patient Financial Services” versus “Revenue Cycle”) may cause some issues for many in the industry. It’s important to remember that the term “revenue cycle” is very internal, and not understood by most patients. The organization’s goal is to put the patient at the center, therefore it should be obvious to the patient that all of their financial services are consolidated under one leader. 

Defining the role of the ERC leader [6:35]

Individual skill set and experience are incredibly important when it comes to finding an enterprise revenue cycle leader. Often times a leader is selected because of their strength and experience in the acute setting, however, they may not have experience in the ambulatory and physician setting or vice versa. Knowledge, expertise, and experience in BOTH are key factors. If the designated leader doesn’t excel in both areas, the first six months on the job should include focused training and education on the missing components.  Additionally, mentorship and exposure of the administrators of both acute and ambulatory should be part of the learning process. Unfortunately, if the team does not understand acute and ambulatory well, there will be problems with reimbursement and denials.

Standardization across functions and supporting technology [9:08]

The structure of the enterprise revenue cycle should be aligned for Patient Access, Health Information Management, Case/Care Management, Business Office or Patient Accounts, and Revenue Integrity and Charge Master. In the last decade of evolution of the revenue cycle, it has been repeatedly proven that the functions within each of the aforementioned departments need to be aligned in terms of people and processes in order to work most efficiently and to the patients’ advantage across the enterprise.  

For example, under the traditional roles within Patient Access, it should be one unit in the division that includes Scheduling; Pre-registration/Registration; Patient Financial Counseling, Eligibility, Authorization and Referrals, etc. Scheduling should be done the same and standardized across the organization, regardless of whether it is done in the clinic, the hospital, the outpatient surgery area, or the physician office. The structure must support this with one leader, standardization of required data collection, and standardized processes. This structure also supports focusing on the patient, collecting the information one time for all entities, and sharing that information across the entities. 

The organization can then apply the same structure and standardization across Health Information Management, Care/Case Management, Business Office or Patient Accounts, and the ChargeMaster/Revenue Integrity. The images below depict a before and after in the most basic form.  This structure is the key to establishing a high functioning and highly productive revenue cycle across your organization focused on the patient.



The importance of culture in an enterprise revenue cycle [14:04]

Once the organization has the leadership and structure of the enterprise revenue cycle in place and the strategy aligned for the organization’s vision, the focus turns to the culture of the revenue cycle across the enterprise. This one element can make or break the success of your organization’s initiative.  As the saying goes, “Culture eats strategy for breakfast.” It is important to recognize that the acute and ambulatory cultures are very different from each other. Addressing the paradigm shift of putting patients at the center of the revenue cycle processes across your enterprise requires a cultural shift that embraces rapid change for everyone.

Beginning the journey toward culture integration [17:02]

The journey toward culture integration begins by coming together as an organization and recognizing two key things that drive to the mission of the organization:

  1. Understanding our patients and what they want
  2. Understanding that in the future, in order to thrive in healthcare, it is important to embrace and welcome change  

Patients may currently tolerate the hassle of having to call multiple providers and fill out paperwork repeatedly, but not for long. Millennials and generation Z-ers have already begun to demand faster access to care and a more streamlined approach to that care. Organizations that delay the transition to an enterprise-wide revenue cycle will likely lose consumers to their patient-centric competitors.

One of the most important parts of cultural integration is understanding the patient’s journey through the revenue cycle. For example, an enterprise revenue cycle could work like this for the patient: 

  • One place to call to:
    • schedule appointments
    • learn about pricing, funding, and paying 
    • talk about their bills no matter where the service was provided

This picture expands the organization’s thinking beyond where they “sit” today at the staff level.  This is a visioning exercise, and it’s integral to the success of the project as a whole.

Defining your ERC vision [23:04]

The next part of the visioning exercise involves developing and listing the shared values of the enterprise.  It is important to define the values of all the different entities. Jacobus really encourages everyone to talk about the values they live every day within their respective areas. One physician might really value a certain type of greeting to the patients and how the patient is checked out. Another department might value how schedules are arranged. Categorize these values into groups and discuss how to make them work across the enterprise. Values dictate daily behaviors so it’s vital to integrate the agreed upon values for the revenue cycle into daily processes.

Lastly, as the organization advances the enterprise revenue cycle, they must understand that different things happen in a provider/physician office than in a hospital department or unit. Jacobus recommends job shadowing and documenting the journey each team member takes. Next, the team should come back together and define the processes that need to be in place to support those differences, focusing on tasks that are done the same, using the same system, and with the same data gathering. Once each department understands the other’s culture, talk through shared values, and build the differences into the standards. 

Resources: If you’re interested in learning more about Enterprise Revenue Cycle, Jacobus has a number of resources available: