November 6, 2019

Reconciling your revenue reconciliation processes


Departmental Revenue Reconciliation is arguably one of the most important initiatives of Revenue Readiness and long-term organizational financial success.

Unfortunately, it’s also an area that is often neglected. And despite each organization having its own unique spin on things, the issues are quite common across the board.

Here are three key pain points seen at both well-established and newly live organizations caused by inadequate revenue reconciliation processes and commitment as well as what you can do to begin fixing these issues today.


Each department and/or service line should have an identified person or persons that will be in charge or reconciling revenue daily.

Make sure that the owner understands what it means to “reconcile charges” and that they know the charges that can be used in their department. Understanding what your department charges will help you ensure your revenue is truly accurate because on the surface it can look like a department is charging appropriately based on daily revenue expectations, but sometimes, there is more than what meets the eye.

This person will be the point person for identifying and escalating charging related issues for their department.

Communication Mishaps

Prices, charge generation methods, and charge codes change. It’s inevitable. But how you handle the change can make a huge difference.

This is why it is crucial to have a well-defined communication process in place to handle charging-related changes.

For example, if a price changes or a new service is added, have we accounted for this in our baselines and budget? Do users know how to charge to the new service?

Or if a new, automated charge generation method is in place and we don’t train or communicate, we run the risk of leaving users with old, outdated workflows that waste time or even worse, we could be duplicative charging.

Communication between IT, Revenue Integrity, Revenue Cycle Operations, and department heads is critical.

Incorrect Tools and Security

There are a myriad of different tools and reports, within Epic, that can be used for revenue reconciliation. Whether that be the Revenue and Usage Report (my personal favorite for its ease of use and simplistic format), Charge Router Reconciliation Report, or the more service line specific reports such as Surgical Logs with Unposted Charges Report for the OR or the Dispense but no Admin report for the Pharmacy.

The biggest issue we often find is not that these reports don’t exist. They typically do. It’s that the reports are either not tailored to the individual user or the user doesn’t have the correct access to view the report.

For obvious reasons, this can make it difficult and time consuming to pull needed data to reconcile revenue or not possible at all.

To account for this, ensure you have identified users within each department that should be handling the revenue reconciliation duties and meet with them on a regular basis (monthly) to review processes.

Employee Turnover and Ownership Transition Processes

As is the case with all organizations, staff turnover happens. It is important that when it happens though that you identify who will be the new person(s) in charge of revenue reconciliation if role is vacated by a department.

Related to the security and access point above, when a new member joins the team, make sure as part of on boarding they know the expectation of daily revenue reconciliation.

Too often, a previously identified owner leaves creating a void for that department when a charging issue happens. The problem goes undiagnosed for days, weeks, months, the issue is resolved sometime after that, and the backlog of work it turns a potential molehill into mountain.

It doesn’t have to be that way as long as you incorporate revenue reconciliation duties into your standard onboarding process.

If you are struggling with revenue reconciliation at your organization, and more specifically, any of the above items, you are not alone. And the good news is, it can be improved. If you are interested in outside assistance from industry-leading experts, reach out to us at The Wilshire Group.


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