From underpayment erosion to contract underperformance, three leaders shared with Becker’s the revenue cycle challenges they believe deserve more attention:
Paul Chausse, Jr. Senior Vice President of Revenue Cycle and Chief Revenue Cycle Officer at Tampa (Fla.) General Hospital: One issue that does not get enough attention in revenue cycle is the quiet erosion of reimbursement through underpayments. Many organizations track denials closely, yet significant dollars are lost when variances are buried inside contractual adjustments and never reconciled against the expected reimbursement on the EOB. The problem is compounded when payer policy changes occur without clear contractual protections for material financial impact. If these shifts are not actively monitored and trued up, they gradually erode the effective rate organizations believe they negotiated.
MariaRita Genovese. Director of Revenue Cycle and Business Operations for MD Anderson Cancer Center at Cooper (Camden, N.J.): Contract underperformance (not just contract management).
Most organizations focus on:
- Negotiating contracts
- Loading fee schedules
But fewer actively monitor:
- Whether they’re being paid as expected per contract terms
- Variance at the CPT/DRG level
- Payment logic issues (multiple procedure reductions, bundling, carve-outs)
Impact:
You can have strong contracts on paper and still lose millions due to execution gaps.
Brett McMillan. Vice President of Revenue Cycle Operations at VCU Health (Richmond, Va.): Cost to collect is challenging to calculate, benchmark, and explain, so it often goes underreported and underappreciated.
Think about it: Do you include RCO department actual vs. budgeted expense metrics in your monthly status reports to your supervisor or governance committee alongside traditional KPIs like net collection rate or days revenue outstanding?
We’re finding opportunities to reimage core workflows (e.g. self-scheduling, automated appeals, billing customer service delivered by autonomous agents, etc) that directly translate into a smaller required investment in the RCO budget.
Rather than just report on the operational metric of “self-scheduling rate”, we’re also tying this to the P&L by tracking “schegistrar labor cost per arrived ambulatory appointment,” which is itself a subcomponent of cost to collect.
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