Fix the system, not the symptom.

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Revenue cycle does not start with the claim.

Revenue cycle is often treated as back-office work that begins after care has been delivered and a claim is ready to be coded. My recent conversation with Rebecca Napier, MBA, FACHE, (Enterprise) VP for Finance & Administration at The University of New Mexico Health Sciences Center, on Reworked challenged that view. Revenue cycle begins much earlier, when a patient is scheduled, registered and guided through the requirements that determine whether care can move forward and reimbursement can follow.

That is also where much of the rework begins. Rebecca has worked across payer, provider and enterprise healthcare leadership. Our conversation reinforced something I see repeatedly: when an organization encounters the same problem again and again, the answer is rarely to find a better fixer. The answer is to understand why the system keeps producing the problem.

Repeated problems are often designed outcomes. | Repeated Problems, Designed Outcomes

Revenue cycle teams frequently focus on solving the immediate issue. A claim is stuck, a payment is delayed or documentation is incomplete. Someone steps in and resolves it. The immediate problem disappears, but the conditions that created it remain.

Systems function perfectly as they’re designed to operate.
Rebecca Napier

If an organization consistently experiences the same outcome, leaders need to examine the design behind it. The right question is not simply, “How do we resolve this case?” It is, “Why does our system keep creating cases like this?” That question moves the conversation from correction to prevention.

Heroic effort can hide a weak system. | The Cost of Heroic Effort

Every organization has people who become known as fixers. They know which claim needs special attention, whom to call and how to navigate exceptions that are not documented anywhere. Their expertise is valuable, but the organization can become dangerously dependent on it.

Rebecca described how these individuals repeatedly solve the same problem until they become the center point for the work. We often see this in revenue cycle. An experienced coder may repeatedly correct documentation, coordinate with physicians and rescue claims before submission. The work protects revenue, but it does not correct the system that keeps creating the issue.

We should value expertise without building operations that require heroics to function. Strong revenue cycle operations convert individual knowledge into better training, workflows, decision rules and accountability.

Technology can get us to the chaos faster. | Technology and Data Foundations

Our conversation naturally turned to technology and AI. Rebecca’s view was direct: technology can support a strong operating architecture, but only after an organization has completed the foundational work.

Are the data clean? Are definitions consistent? Are teams measuring performance in the same way? Do internal measures align with the benchmarks being used? Is it clear who has the authority to make a decision?

Without that groundwork, technology does not resolve confusion. It processes the confusion faster. Rebecca recalled hearing someone express excitement that AI would help the organization reach solutions more quickly. Her reaction was that unclear rules and poorly structured data could simply help the organization “get to the chaos faster.”

Before introducing AI, healthcare organizations must determine whether they have selected the right problem and created the conditions required to solve it. Otherwise, technology may amplify the same inconsistency, fragmentation and rework it was meant to remove.

Data should support a decision.

Healthcare organizations have no shortage of dashboards. The harder question is whether the information changes what anyone does.

Once you see the data, what are you going to do with it?
Rebecca Napier

Data should support a management decision. It should help leaders improve quality or efficiency, understand whether performance is moving in the right direction and determine whether the result aligns with the organization’s strategy. The goal is not to build the most detailed dashboard. It is to make better decisions.

Revenue cycle work makes care possible. | Connecting Revenue Cycle to Care

One of the most meaningful parts of our conversation focused on an early payer negotiation in Rebecca’s career. The financial analysis showed that accepting the proposed contract would put the provider organization under serious pressure. Supported by a leader who trusted her expertise, Rebecca recommended ending the contract and anticipated that the payer would return to the table. They did.

The deeper point was not about defeating a payer. It was about protecting the operating margin needed to care for patients today and in the future. Revenue cycle can look administrative from a distance. In practice, it helps create the financial conditions that allow healthcare organizations to continue serving their communities. Helping teams see that connection gives greater purpose to the work.

Getting the front end right reduces downstream rework. | Getting the Front End Right

We brought the conversation full circle by discussing where revenue cycle begins. It begins when the patient is scheduled.

Registration, insurance requirements, documentation and coding are connected parts of one process. Errors at the beginning can lead to delayed care, reimbursement problems and significant downstream effort. The more we get right the first time at the front end, the less work teams must repeat at the back end.

Reducing rework requires more than asking people to work harder or introducing another technology.

It requires leaders to understand the complete process, correct the system producing the problem, establish reliable data and connect every role to the mission of care. That is how we build a stronger and more sustainable revenue cycle.

About Reworked. 

Reworked  is a Vee Healthtek podcast about the healthcare leaders who refuse to accept avoidable revenue cycle rework as simply “how things work.” In each concise episode, I speak with one leader about a specific operational problem, where work was being done, undone and redone, and what it took to create a more resilient process. 

The conversations move beyond broad claims about AI and transformation. Guests share the process they re-engineered, the technology they introduced, the team behaviors they changed and the measures that showed whether the work improved. The goal is simple: every listener should leave with at least one practical idea they can take back to their own revenue cycle team. 

Continue the conversation.

Watch my full conversation with Rebecca Napier, MBA, FACHE for practical insights on payer-provider relationships, system design, data, leadership and reducing avoidable work.