Zen and the Art of Revenue Cycle Maintenance

In 1974, Robert Pirsig wrote a popular philosophical novel (Zen and the Art of Motorcycle Maintenance) that dealt with the concept that “Quality” and striving for perfection is an important practice and lifestyle that contributes to spiritual growth. The author felt that the metaphysical question “What is best?” is at least as important and the more popular “Why are we here?” He believed that beauty and personal gratification could be found in the effort of perfecting a process. In his book, he says “Quality is Buddha” and compares striving to improve a process to the scientific effort to determine “the truth”, like the effort to determine a unifying theory in physics. The author takes these grandiose metaphysical concepts and provides practical examples. He shows that changing your concept of your environment can create positive change. By looking at things in a new way, you can see things you did not see before and make things better.

In business, we often take the path of least resistance. We develop processes to support business transactions and then we repeat them over and over until they experience some sort of major failure that requires a correction. If someone asks, why do we do things this way? The answer is most often “this is the way it has always been done”. We rarely take the time to review our processes at a fundamental level and ask ourselves philosophical questions like “why do we do this?” or “is this the best way?”

Dealing with healthcare financial transactions is often referred to as “revenue cycle management”. Many of us that deal with this process every day believe that we understand what it means. Some of us even consider ourselves to be experts. If we apply some of the concepts of this novel to this process, we might create more questions than answers. The point is that this method of thinking is beneficial and productive. It can create new solutions that were never considered before and improve the “Quality” of the revenue cycle management process.

As an example, consider the question “what is the revenue cycle?” What does it mean? If it has a definition, then it has a beginning and an end.

If this is true, what is the beginning of the revenue cycle? You might say that it is when a bill is created for all the services associated with given healthcare provider/patient encounter. If this is the beginning, then no aspect of the revenue cycle exists before this event. If this is true, then is there a value in checking insurance eligibility? What about the process associated with prior authorization of services? If these events occur before a claim is created and they effect the ability to collect your revenue, are they not part of the revenue cycle?

When does revenue cycle management end? Some may say it is when a claim associated with a patient account is fully paid and/or adjusted to a zero balance. What about learning from payment and adjustment data? Can the results of these transactions teach us anything about adapting our system to deal with new and existing business rules? If this is so, then the Revenue Cycle does not end with a transaction, but with the analysis of these transactions and turning this analysis into new and modified actions. Your Revenue Cycle should be viewed as a living entity. To survive, it must adapt to its environment, constantly changing to thrive in the presence of new situations while others, less aware of their environment, slowly perish.

Some people may feel that revenue cycle management is tedious and boring number crunching. You may feel that you are simply another tool in the process, taking a transaction from the “in box”, processing it, and placing it in the “out box” and repeating the same process over and over again.

If you can take a step back with an open mind and look at what you are doing, how it fits into the big picture and what the big picture is, you might see a different view of this process and your role. Maybe you can change something that will make it better. If you can, you will change your environment for the better and experience the satisfaction associated with it. Whether or not you believe that this effort has any spiritual impact on you as an individual, these changes can produce practical benefits for both you and your organization.

By Kalon Mitchell, President – MEDTranDirect