Revenue Cycle and Financial Management Toolkit

Each toolkit includes a definition of the area being addressed, a checklist of recommended activities for that area an organization should consider in their move from fee-for-service to pay-for-value, and tools and resources associated with each line item.

For the purposes of this HIMSS Alternative Payment Model Infrastructure Toolkit, the definition of Revenue Cycle and Financial Management is as follows. Revenue Cycle and Financial Management refers to all administrative and clinical functions that contribute to the capture, recognition, management, and collection and distribution of patient services revenue, as well as overall financial management of expense control.  It includes on-going monitoring of financial performance to prepare the organization for retroactive reconciliation of risk-bearing contracts. Revenue Cycle and Financial Management also involves ensuring the leadership team has the information they need to determine appropriate strategic plans, and prepare the organization for future growth.  It does not include corporate financial activities, capital investments or shareholder value.

Components of Revenue Cycle and Financial Management may include (in no particular order):

  • Appropriate pricing of products and services
  • Budget planning to ensure all necessary equipment, supplies and personnel can be procured and operations allowed to continue running smoothly
  • Ensuring contracts can be supported from a technology, personnel, and business process perspective
  • Ensuring money is available to meet expenses, including payroll and contingency funds
  • Integration of clinical information as it relates to financial performance (See HIMSS Clinical and Administrative Checklist)  
  • Keeping expenditures within budget
  • Negotiating contracts with suppliers and tradesmen
  • On-going monitoring of financial performance
  • Complete and accurate capture and coding of clinical information