Stop Chasing Fires: BSA for Revenue Cycle Management

Business Self Assessment Vision

Over the last twelve months I’ve had the real pleasure of sitting in on a number of Healthcare Financial Management Association (HFMA) and American Association of Healthcare Administrative Management (AAHAM) presentations.  From my perspective, the presentations are always first class – knowledgeable and insightful speakers, relevant topics, and real solutions to real problems. It’s also easy to see that the events are consistently well attended and that the audiences are always highly engaged.

I got to thinking about this blog because I’ve noted a number of these presentations 1) cover the same recurring list of topics 2) convey a high degree of urgency (what needs to be done, needs to be done now) and 3) carry a degree of obvious (everyone seems to know the problems and everyone seems to know the solutions).  Whenever I’ve had the opportunity to speak with a presenter I’ve always asked questions to understand what’s holding so many organizations back from executing what needs to get done. The answer is almost always the same: so many Revenue Cycle Management personnel are simply chasing fires and resolving crises as they crop up.

Business Self Assessment (BSA) is one solution that might help Revenue Cycle Management teams separate the forest from the trees and gain more of a strategic look at overall operations.

Click here for a sample BSA template   


 What is BSA? 

  • A comprehensive risk management strategy that breaks an operation down into functional areas of responsibility and measurable working parts.
    • Conceptually says that if all the working parts of a functional area of responsibility are performing as expected, then the functional area of responsibility should be operating at an optimal level.
    • A source document that:
      • Gives each line item of work an actionable definition.
      • Defines expectations for each line item of work.
      • Defines tolerances for negative variances.
        • Tolerances are negotiated variances that – based upon degree of risk – define acceptable levels of negative variances.
  • Defines methodologies for testing results.
  • Measures actual results.
  • Defines line item variances.
  • A business management tool Revenue Cycle Management teams can use to see global operations and quickly flag parts of an operation that are not meeting expectations.
    • Negotiated expectations and tolerances create clear targets and calls to action.
    • Quantifiable, objective criteria simplify management discussions on how to best allocate limited time and resources.
    • Line item detail lets managers drill down and identify problems fast.
    • A performance management tool Revenue Cycle Management teams can use to trend the performance of functional teams and the progress of corrective actions.

How can a Revenue Cycle Management team establish a BSA program?

Building BSA:

Revenue Cycle Management Planning

To start, BSA works best when there’s a champion leading and managing the process. Success in a BSA program relies on building transparency in process, negotiating performance targets, problem solving and ongoing open communication. It also relies on frequent and regular interactions with management teams. Needless to say, a BSA champion needs to be credible within an organization and have agency to manage face time with managers. 

Job number one is to have the Revenue Cycle Management team’s BSA champion work directly with each functional area of responsibility manager to:

  • Break each functional area of responsibility down into logical working parts
    • Working parts should define jobs in quantifiable, action oriented statements.
    • Negotiate what’s expected to happen with each working part and define tolerances for negative variances.
      • Tolerances should be set according to degrees of risk -- what happens when there’s an exception or defect? And, what volumes of exceptions or defects are acceptable?
      • Tolerances should give managers guidance that says when to keep going (exceptions within tolerance) and when to stop (exceptions outside of tolerance).
      • Define testing methodologies
        • Testing methodologies lay out criteria to objectively evaluate the performance of a working part.

Managing BSA:  

  • Functional area of responsibility managers should report their respective test results (actual results and variance to tolerance results) to the Revenue Cycle Management team’s BSA champion on a quarterly basis.
    • Report outs should include variance analysis that: 1) explains negative variances and 2) establishes corrective active plans.
    • The BSA champion should use compiled BSA results and corresponding report outs to develop a single report out that can be published to stakeholders on a quarterly basis.
      • Red, yellow, green reporting strategies can be used to quickly identify areas of concern.
      • A trending report can be used to evaluate the [positive/negative] progress of working parts.
      • On an ongoing basis, the BSA champion should update and renegotiate work standards, expectations, and tolerances.

If it’s set up the right way and if it’s properly managed, BSA can be a solution to help Revenue Cycle Management teams comprehensively manage ongoing operations.

Please feel free to e-mail me with questions or comments at 


Business Self Assessment

Topics: Revenue Cycle Management