Are Your Organization Charts Strengthening a Siloed RCM Culture?

Revenue Cycle Management Organization Charts
 Penetrate RCM Silos

​A siloed culture is detrimental to the overall effectiveness of Revenue Cycle Management. A high quality and economized Revenue Cycle Management process is essential to ensuring the organization can sustain the efforts required to delivering safe and effective patient services. End-to-end Revenue Cycle Management effectiveness and efficiency is directly influenced by the level of collaboration between all departments and stakeholders involved with the process.
A siloed Revenue Cycle Management culture exists when departments that should collaborate do not share information with other departments in the same organization. The overall goal of the company may be known but, as former Navy Seal and inspirational speaker Brent Gleeson wrote in his article 5 Ways to Destroy the Pesky Silos in Your Organization, “Talking about "more" collaboration and creating cross-functional teams is great, but this can also fail miserably without a clear shared understanding of the narrative behind the ultimate mission.” He continues, “The sub-cultures and ideas on how to achieve the goal may vary which leads to these departments, divisions or "cross-functional" teams to actually work against each other in many ways.” The link to Brent’s article is at the end of this discussion.

​Siloed Revenue Cycle Management negatively impacts the patient experience. Siloed Revenue Cycle Management increases the chances that your dissatisfied patients will seek alternative providers. Some of the symptoms are:

• Departmental information transfer delays
• Unnecessary redundancies
• Patients often having to correct misinformation or resubmit information again, and again, and again

Siloed Revenue Cycle Management increases the chance of claims being denied, extends accounts receivables, increases the cost per claim, and reduces the organization’s financial margins. Delays, errors, and unnecessary redundancies increase the number of times a claim is touched. Each additional touch is an increased cost, an operational inefficiency, and another charge against the bottom line.
Today’s workers and stakeholders are more visual. The Internet and mobile technologies are leading audience reading and learning transition from text-based to image-based . A picture is worth a thousand words is more easily delivered by today’s technologies and expected by readers.
For employees, one of the few easily recognized and understood corporate visual tools is the organization chart. The purpose of organization charts is to visually illustrate the corporate structure including reporting channels. A standard version of the organization chart contributes to a siloed Revenue Cycle Management culture. It illustrates a vertical reporting and communication structure and nor horizontal requirements. 

Executive leadership is responsible for the organization chart's message to employees. If the "authorized" communication path is vertical and the basis of budgeting, then a siloed culture should be expected. Cross-departmental sporadic collaboration may work on a voluntary basis, time permitting, and is only temporary. Well-intended cross-departmental committees will come and go.
​Visually aligning Revenue Cycle Management efforts requires a good understanding of the organization’s end-to-end revenue cycle process. Not the industry’s definition or another organization’s definition but your company’s actual process at work. The Revenue Cycle Management process below is that of the organization chart presented earlier in this article.
It was developed with the backing of leadership through workshops with most input from, as said in the military, the boots on the ground. The focus was on the process and not the structure of the organization. They defined three major revenue cycle components: Patient Engagement, Billing, and Follow-Up. These were further defined as follows:

• Patient Engagement
  • 1.0 Pre-Arrival
  • 2.0 Day of Visit
• Billing
  • 3.0 Charge Capture/Coding/Charge Entry
  • 4.0 Claim Production
• Follow-Up
  • 5.0 Financial Services
  • 6.0 Insurance Accounts Receivable Management
  • 7.0 Patient Accounts Receivable Management
  • 8.0 Credit Balance

Specific process workflows as well as the relationships between workflows were defined in these categories.

​During the workshops, inhibitors to the cross-departmental communication was discussed. The primary focus of employees is vertical reporting and performance measurement.
With the Revenue Cycle Management model defined, we looked at the organization chart. The goal here was to identify the departments that participate in the end-to-end Revenue Cycle Management processes and to align the departments in an organization chart aligned with the defined Revenue Cycle Management flow.  
The organization chart below illustrates the organization chart minus the departments that are not directly involved with Revenue Cycle Management. The organization chart has the chief financial officer and team members listed first. The chief operating officer and team members listed second, and the chief medical officer and team members listed third.

​We flipped the organization chart to align departments with the Revenue Cycle Management model.  We did not adjust the vertical reporting structure within the departments. The chief operating officer’s Practice Management department owns Patient Engagement, the front end of the company’s Revenue Cycle Management process. 

​To bring more clarity, the colors in the Revenue Cycle Management were placed into the organization chart. This Revenue Cycle Management organization chart serves as a better visual reference for employees.

Developing a Revenue Cycle Management Organization Chart aligned with the company's revenue cycle can be an important start, indicating leadership's commitment to eliminating silos. The Revenue Cycle Management Organization Chart should be used as a visual tool to assist in understanding and creating a culture of cross-departmental communication and management.
Another tool that accompanies the Revenue Cycle Management Organization Chart is Shared Responsibility Mapping. Shared Responsibility Mapping identifies roles and responsibilities for who delivers what to whom. It includes specifications for inputs and outputs as well as process performance measures. Shared Responsibility Mapping focuses on both inner-department processes and cross-departmental processes. Shared Responsibility Mapping is detailed in the LinkedIn article below: Mapping Revenue Cycle Management Cross-Department Roles & Responsibilities.
This is the link to the Shared Responsibility Mapping article: https://www.linkedin.com/pulse/mapping-revenue-cycle-management-cross-department-henry-draughon-/

Shared Responsibility Mapping
Defines
Revenue Cycle Management
Cross-Functional Accountability
Answering
Who Provides What, to Whom, and When?

This is the link to Brent Gleason’s article: 
5 Ways to Destroy the Pesky Silos in Your Organization
Silos suck. They inhibit collaboration and the ability to align a team behind a unified vision. Get rid of them.
​https://www.inc.com/brent-gleeson/5-ways-to-destroy-the-pesky-silos-in-your-organization.html