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.
Charter for 2013
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:
- System Sustainability: RCGC will ensure financial viability through a culture of financial discipline and adoption of best practice and business process. RCGC will focus on areas to improve results related to the revenue cycle, including lowering costs, increasing cash collections and decreasing days in A/R.
- Patient Centered: RCGC will advocate for processes which enable care coordination and seamless process from a patient perspective.
- Cost to Collect: RCGC will focus on standardization and implementation of best practice to drive down total cost to collect in the Central Billing Offices.
- Standardization/Standard Work: RCGC will support and advocate for standardization of process, use of technology, and other ways in which we can reduce variation across operations of the revenue cycle at all sites and care settings. This will include standardizing software systems and vendors. We recognize there are differences in best practices in hospitals, home care and physician groups. While best practice should be integrated when possible, they could be unique based on the care setting.
- RCGC recognizes there may be differences in the rural affiliates based on billing offices and IT resources used. The local Senior Affiliate RCGC lead will be the point person to share best practices and standard work processes with them. However, RCGC is not the authority to change the tools used by these rural affiliates.
- Best Practice Implementation: RCGC will support, advocate for and execute implementation of best practices as evidenced by HFMA or other literature, HFMA MAP Keys, MGMA Resources, and/or other respected professional organizations in each industry as well as internal metrics.
- Compliance: RGCG will support policies and processes with are compliant with all health system compliance policies, all laws – with heightened awareness of fair collection practices, and governmental regulations.
- Mitigation of Risk: RGCG will support policies and processes which balance effective and efficient process with mitigation of risk for patient complaints or any undue legal exposure.
- Use of Technology: RCGC will maximize the capabilities of our software systems to use them most fully and to the highest levels. RCGC recognizes that not all affiliates are currently on the same common platforms, but will aim for long-term implementation of standardized technology to enhance process or eliminate manual work and potential for human error.
- Research: RCGC will support and encourage seeking best practice through literature review, peer networking and educational sessions to bring innovation and potential new technology solutions to the health system.
- Documentation: RCGC will prepare business proposals as needed or summary information for documentation purposes around implementing best practices or process/policy changes. RCGC or assigned delegates will collaborate with appropriate persons to further the process of developing business plans as needed.
- Contracts: RCGC will understand the contractual obligations affiliates may have to current vendors and take that into account when making decisions.
4. Roles and Responsibilities:
- Strategy: RCGC’s strategy is to o Research and implement best practice,
- Reduce variation across health system affiliates through standardization and standard work process, and continually increase awareness of changes in the industry or regulations for which the health system needs to be prepared so that the health system can proactively implement compliance changes.
- Annual Planning: Develop annual plan objectives to achieve the RCGC strategy. Regularly review annual plans to ensure achievement of objectives in specified timeframes. Take corrective action when necessary.
- Metrics: Establish a systemwide scorecard and annual targets to ensure revenue cycle competencies. Regularly review core metrics.
- Implementation of Best Practice: Individual members of RCGC will ensure that best practice is implemented at each affiliate. Best practices will also be evaluated after implementation to ensure objectives are being met/sustained over time.
- Communication: RCGC members are expected to share the RCGC’s work, decisions and outcomes with their Finance Directors and CFOs and other appropriate persons, including physicians, following scheduled meetings to keep other key stakeholders informed.
- Networking: Meet with peers to creatively address issues and also to have a support group for challenges being faced across the system.
- Establish necessary standing or ad hoc groups to carry out the work of RCGC and appoint members to these groups.
5. Membership
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
i. Monthly
ii. 9AM-2PM
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.
e. Decisions
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.
f. Communication
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.
