A large U. S. health system’s network of hospitals, outpatient and physician practices treats approximately one million patients a year. Ten years ago, the health network successfully undertook a major IT initiative to replace its electronic health record (EHR) system and improve patient outcomes, customer satisfaction and financial performance. In the years following the implementation, new functionality was released, and recommended practices for EHR systems emerged. However, the network’s systems did not always keep pace. This made it difficult to manage patient accounts, largely because hospital revenue cycle processes had increased in complexity.

Leadership recognized the need to restructure both revenue cycle operations and the IT support relationship to increase financial performance and patient satisfaction.

Strategy and Solution

The network engaged Accenture, to perform a comprehensive revenue cycle assessment, including a review of organizational leadership, Patient Access, Revenue Integrity (charging), Coding, Hospital Billing, Professional Billing, Collections, IT support, HR processes and Training programs. Accenture was a natural fit to assess the network’s revenue cycle due to its extensive experience with EHR optimizations, revenue cycle recommended practices, and helping clinical organizations enhance their performance.

The health system’s ability to drive strong revenue cycle performance was impeded by the creation of system-specific processes during the initial EHR implementation, the need for stronger accountability and limited reporting capabilities.

The Accenture team began the transformation project by creating a list of initiatives that could be implemented quickly and could lead to the greatest financial benefits. These initiatives spanned both the Revenue Cycle and IT departments. The team drew on its diverse technical knowledge to prepare a prioritized list of system optimizations and interactive reports. A primary focus was to maximize automation and use existing functionality to replace manual processes.

Transforming the processes

Accenture worked with the network to transform its revenue cycle based on the following goals:


accounts receivable (AR) and reduce net revenue leakage to increase cash collections.


revenue cycle processing times by reducing Candidate for Bill (CFB) backlogs, charge/billing lag days and days to final payment.


workflows and system tools to better utilize EHR system functionality and increase efficiency.


accuracy of patient financial clearance and Point of Service (POS) collection processes.


organizational structure that fosters growth, training, accountability, and change management.


and implement policies to help increase timeliness and accuracy of charge generation and coding.

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At the end of the project’s first year the client and Accenture teams had created significant organizational benefits by implementing new reporting capabilities, EHR system optimizations and industry recommended practices. They improved annual cash collections by $49M and reduced unbilled backlogs by more than 50 percent within months of beginning the engagement.

Positive Results

These initiatives helped the health system increase incremental cash collections


The health system generated $49M in incremental cash collections.


Gross AR days decreased by almost 14 percent.


CFB days have been reduced by more than 50 percent.

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