A leading academic cancer center, nationally recognized for excellence in cancer care and research, embarked on a major operational transformation in early 2025 by implementing Epic. As part of this transition, the organization formally established a Revenue Integrity (RI) function—staffed by experienced professionals and led by a seasoned Vice President of Health Information Management and Revenue Integrity—to ensure financial accuracy, compliance, and operational stability during and after go-live.
Recognizing that Revenue Integrity would be critical to the success of the EHR conversion and long-term revenue cycle performance, the organization partnered with Impact Advisors, deploying a specialized Revenue Integrity “SWAT” team. The objective was not only to stabilize operations, but to rapidly reduce growing backlogs, protect revenue, and establish a scalable RI operating model aligned with Epic best practices.
The Challenge: Revenue Integrity at the Center of Go-Live Complexity
As with most large-scale EHR implementations, go-live introduced significant complexity across people, process, and technology. The organization faced challenges including:
- Cost center and department routing changes
- New charge code record and fee schedule build
- Preference list re-education and charge capture redesign
- Provider documentation updates and clinical integration
- Revised reporting, dashboards, and workqueue logic
- Interface issues impacting downstream billing workflows
In the weeks following go-live, Candidate for Bill (CFB) and Pre–Accounts Receivable (Pre-AR) balances surged, peaking at over $170 million. Left unaddressed, these backlogs threatened cash flow, delayed billing, increased compliance risk, and diverted staff from higher-value work.
Why Revenue Integrity Matters—Especially During Transformation
Revenue Integrity plays a foundational role in a high-performing revenue cycle. It ensures that services are accurately captured, priced, routed, and billed—bridging clinical
operations, HIM, Patient Access, IT, and Billing. During periods of change, such as an EHR implementation, RI becomes even more critical.
A mature RI function:
- Prevents revenue leakage through accurate charge capture and pricing
- Enables clean claims and faster reimbursement
- Establishes clear ownership and accountability across functions
- Identifies and resolves issues proactively before they become systemic
- Provides leadership with transparent, actionable performance data
For this organization, strengthening Revenue Integrity was not optional—it was essential to protecting financial performance during the transition to a new system.
Impact Advisors’ Approach: Why It’s Different
Impact Advisors brought a holistic, outcomes-driven Revenue Integrity approach grounded in deep Epic expertise and real-world operational experience. Rather than focusing solely on backlog cleanup, the team aligned people, process, and technology to drive both immediate results and long-term sustainability.
Using Impact Advisors’ Prepare, Lead, and Improve framework, the RI engagement focused on:
1. Preparing the Organization for Sustainable RI Performance
Impact Advisors provided comprehensive Epic training, clearly defined workflows, role-based tipsheets, and interactive working sessions. During go-live and stabilization, the team delivered daily at-the-elbow support to reinforce best practices and accelerate adoption.
This preparation ensured the RI team understood not just what to do, but why—building confidence, consistency, and long-term capability.
2. Leading Through Clear Ownership and Operational Design
A critical success factor was establishing clear ownership of Revenue Integrity. Impact Advisors worked with leadership to define RI’s core responsibilities, including:
- Charge code and CDM build
- Revenue code assignment and pricing
- Cost center and department mapping
- CPT/HCPCS guideline expertise
- Coordination with clinical build and documentation workflows
Clarifying boundaries across RI, Billing, HIM, Patient Access, and IT reduced duplication, improved collaboration, and allowed each team to operate at the top of its license.
3. Improving Performance Through Data, Workqueues, and Transparency
Impact Advisors partnered with RI leadership and IT to optimize Epic workqueue configuration, assignment logic, and routing rules across hospital and professional billing.
The team implemented disciplined daily monitoring of:
- Workqueue volumes and trends
- Baseline performance thresholds
- Emerging anomalies requiring root-cause analysis
Custom reporting and dashboards—leveraging Epic Workbench, SlicerDicer, and tailored analytics—enabled real-time visibility into performance and faster issue resolution.
The Results: Measurable, Rapid, and Sustainable
Within eight months of go-live, the organization achieved significant and measurable outcomes:
- CFB and Pre-AR balances reduced from over $170M to $48M
- Accelerated billing and improved cash flow
- Cleaner claims driven by improved charge capture and routing
- Reduced rework and manual intervention across teams
- Improved operational confidence during a high-risk transition
Equally important, the organization emerged with a stronger, more mature Revenue Integrity operating model—one capable of supporting ongoing optimization, future growth, and continuous improvement.
A Model for Revenue Integrity Excellence
This engagement demonstrates that Revenue Integrity is not a back-office function—it is a strategic capability. When supported by the right expertise, governance, and technology
alignment, RI becomes a powerful driver of financial performance, compliance, and operational resilience.
Impact Advisors’ differentiated approach—combining Epic-certified expertise, embedded operational engagement, and a relentless focus on outcomes—enabled this organization to achieve speed-to-value while laying the foundation for long-term success.
As healthcare organizations continue to navigate complex transformations, this example underscores a critical lesson: investing in Revenue Integrity is investing in the financial health of the enterprise.
