Building an Effective RCM Strategy for Healthcare Organizations

According to CMS, a core objective is to “advance innovative payment structures to move our health care system to one that incentivizes value by rewarding quality and performance, lower program costs, innovation and improved health outcomes… These models are designed to offer clinicians an array of new payment models that are designed to reward them for doing the job they were trained to do - spending time caring for patients.”

As organizations adopt these CMS initiatives, administrators and C-suite leaders are asking a critical question: How will these changes affect our business and revenue cycle strategy?

These reforms directly impact RCM planning, revenue predictability, and the day-to-day processes involved in collecting payment under new, innovative payment models. Leaders must understand not only the policy intent but also the operational consequences of shifting reimbursement structures.

One of CMS’s highest priorities is improving how provider quality is measured, tracked, and reported. This has created new documentation requirements that many organizations still struggle to incorporate into clinical workflows.

Previously, clinicians could see a patient, document the visit, assign the diagnostic code, and move on. Now, clinicians must capture additional quality metrics, outcome data, and value-based criteria adding to reporting complexity and raising the stakes for accurate documentation.

Healthcare organizations across the country are being asked to rethink how they deliver care, document services, and manage revenue. CMS initiatives are driving significant change, and many of these expectations are unprecedented. To keep up, organizations must adapt the way they bill, report, and use data often at a pace that strains existing systems.

To meet these expectations and build an RCM strategy that supports long-term sustainability, leaders must clearly understand what CMS is looking for. Electronic health records (EHR) and RCM systems need to be configured in a way that captures accurate, complete information on the front end. Doing so prevents costly rework, minimizes reporting gaps, and protects the organization from delays or denials later.

When systems are designed to pull value-based care data easily, organizations can submit cleaner claims faster and secure reimbursement that truly reflects the services provided.

However, one of the biggest challenges organizations face is not only knowing the requirements but understanding how to implement them within existing workflows without disrupting operations or risking revenue loss.

The good news is that many CMS initiatives come with financial support. Payment programs, incentives, and grant opportunities can offset the cost of adopting new systems or redesigning processes.

A strong RCM strategy must therefore identify:

• The most critical issues impacting revenue
• The root causes of those issues
• The steps required to resolve them
• The implementation path that moves the organization closer to value-based care

This work requires a multi-phase, multi-step approach balancing the need for improvement with the realities of implementation costs.

CMS has dedicated a full strategic initiative to ensuring “individuals who live in rural America have access to high quality, affordable healthcare through new and creative ideas.”

Across the country, underserved rural communities face persistent gaps in care access. To meet CMS's goals, healthcare organizations will need to think creatively about RCM strategy, staffing, service delivery models, and care access. This may include dedicating one day per week to a low-cost rural clinic or integrating new remote care services into an existing practice.

A major trend supporting rural access is the rapid expansion of telehealth. Telehealth not only increases convenience for patients but also transforms how rural and underserved populations can engage with healthcare.

For example, our team at John Lynch & Associates recently worked with a client who provided rural health visits twice a month. We helped them implement telehealth services and build structured schedules so they could see most of those rural patients more frequently without requiring long travel times.

As a result, patients with complex diagnoses or comorbid conditions were able to connect with their physicians regularly, improving overall care access and reducing the burden of traveling hours for appointments. Within six months, the organization moved from concept to implementation and saw measurable improvements in both care quality and patient outcomes.

To evaluate the impact, we conducted a four-month control and retrospective measurement period, engaging:

• IT teams to confirm system performance and maintain a positive patient experience
• Physicians to assess the value of the new service line and its impact on care delivery
• Patients, through surveys and direct interviews, to measure whether telehealth improved their daily lives

This measurement period confirmed significant benefits: higher satisfaction, stronger engagement, and improved access for rural patients.

With these outcomes, the organization expanded the program beyond the original patient cohort to include a broader rural population.

By aligning corporate strategy, functional strategy, and revenue cycle strategy, we helped the organization run a successful pilot and validate that the program would not only support long-term organizational goals but also bring high-quality care to more patients in need.

While the ongoing shift toward value-based care combined with CMS’s 16 strategic initiatives can feel overwhelming, meaningful progress is absolutely possible. Healthcare organizations are already stretched with day-to-day operations, yet these initiatives must be implemented with as little resistance, disruption, and rework as possible.

The key is developing a thoughtful, intentional strategy that reflects your organization’s mission, meets CMS requirements, and drives the improved outcomes we all want for our patients.

If you need support building this strategy, reach out to us. We will help you design the blueprint your organization needs to move forward with confidence and prepare for the future.