How to Evaluate Revenue Cycle Gaps: Executive Guide to Vendor Selection

Revenue cycle leaders are not struggling to identify problems. Most can list their top pain points without hesitation, the challenge is knowing what hurts doesn't tell you what to fix first, how to fix it, or whether the fix will actually work

Too often, the path from problem to solution skips the middle steps. Solutions are evaluated before problems are fully scoped and feature comparisons replace strategic thinking. As a result, organizations invest in tools that technically work but fail to deliver sustained operational or financial impact because the foundation was never built.

This guide outlines a practical four-step process for moving from known pain points to confident vendor decisions:

1. Audit and structure your problem space to create a clear view of where friction exists across the revenue cycle.

2. Prioritize initiatives based on impact, feasibility, and organizational capacity.

3. Evaluate solution approaches and vendors against objective outcomes, not feature lists.

4. Implement with accountability, using OKRs to ensure adoption and measurable improvement.

Each step can stand alone, but the strongest outcomes come from working through them in sequence.

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Step 1: Structuring the Problem Space

Most revenue cycle leaders already know where friction exists. What's usually missing is a shared, system-level understanding of how those problems interact, who they affect, and where breakdowns compound across workflows.

This step is not about discovering problems for the first time. It is about conducting a disciplined internal audit that converts individual pain points into a structured view of the system, one that supports clear prioritization and objective vendor evaluation.

When problems remain loosely defined, they compete for attention and are difficult to solve. When they are structured, they become opportunities that can be compared, sequenced, and addressed deliberately.

Building Your Decision Matrix

The output here is a clear inventory of your top revenue cycle problems in a consistent, comparable way. For each problem, document:

• Financial impact: Annual benefit from revenue recovery, cost avoidance, and labor savings

• Operational efficiency: Staff hours saved, cycle time reduction, throughput increase

• Data readiness: Availability, quality, and structure of required data

• Technical feasibility: Integration complexity and implementation lift relative to current systems

• Stakeholder alignment: Executive, clinical, and operational buy-in

• Compliance & risk: Regulatory exposure, risk mitigation value, or quality impact

This matrix does not require perfection. Ranges and assumptions are acceptable. What matters is that each problem is described using the same lenses, allowing you to see patterns and tradeoffs across the system.

List out your top 10 gaps as rows in the decision matrix

What This Reveals

Once structured, problems that previously felt equally urgent begin to differentiate themselves. You will see:

• Which issues create outsized downstream impact relative to effort

• Which problems are tightly coupled to data or EHR workflows

• Where the same constraint appears repeatedly across functions

• Which pain points are symptoms vs. root causes

At the end of this step, your goal is simple: a list of your top 8–10 revenue cycle problems, that reflects how your system actually operates. The format matters less than the consistency, this can be a spreadsheet, a slide deck, or a working session with your team. What matters is having a shared foundation for the decisions that follow.

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Step 2: Prioritizing Revenue Cycle Initiative

With a structured view of your problem space, the next question becomes: Which of these should we realistically take on now? Attempting to solve everything at once dilutes resources and delays results. Now aim to narrow your list to the 3–5 initiatives your organization is best positioned to execute over the next 6–12 months.

Scoring for Priority

Each problem in your matrix should be scored across a consistent set of dimensions.

Here is a typical scoring breakdown:

• Financial impact: 30%

• Operational efficiency: 20%

• Data readiness: 15%

• Technical feasibility: 15%

• Stakeholder alignment: 10%

• Risk and compliance considerations: 10%

Scoring forces tradeoffs into the open. Problems that feel important but lack data readiness or organizational capacity will surface differently than those that are ready for execution.

After filling in your decision matrix select the top scoring initiative to move forward with

Balancing Your Portfolio

From this scoring exercise, select 3–5 initiatives that balance:

• Speed to value: near-term impact that builds momentum

• Foundational value: capabilities that unlock future initiatives

• Strategic impact: meaningful financial or operational transformation

Different combinations produce different outcomes. A portfolio weighted toward quick wins may build credibility while a portfolio weighted toward foundational work enables scale. The right mix depends on your constraints and goals.

Sequencing and Dependencies

Before moving forward, clarify:

• Which initiatives depend on shared data or infrastructure

• Which compete for the same resources

• Which must occur sequentially versus in parallel

This creates a short, sequenced initiative roadmap grounded in reality not aspirations.

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Step 3: RCM Vendor Selection — Finding the Right Approach

At this point, you should have a short list of priority initiatives with clear success criteria and baseline metrics already established. The goal now is determining how each initiative should be solved and who is best positioned to deliver it.

Most revenue cycle initiatives fall into one of three execution models:

• EHR-augmented: extending native EHR capabilities

• Hybrid: EHR for core transactions with specialist vendors for advanced functions

• Vendor-first: a specialized platform owning the initiative end to end

Choosing the right approach creates a fair comparison set. Only once the approach is clear does it make sense to evaluate individual vendors.

Evaluating Fit

Use the outcomes and key results defined earlier directly compare each solution and identify the top option. For example compare:

• Financial viability: expected payback and benefit confidence

• Speed to value: time to go-live and stabilization

• Organizational fit: IT capacity, change tolerance, governance maturity

At this stage, you should be validating assumptions not discovering them as baselines, metrics, and targets should already be known.

Risk Checks Before Committing

Pressure-test vendors and solutions against a short checklist:

• Are integration plans documented and owned? Is IT involved early?

• Are success metrics tied to your baseline data, not benchmarks?

• Is adoption explicitly addressed, not assumed? Do staff trust the solution?

• Are SLAs, performance expectations, and exit terms clearly defined?

If a solution cannot withstand conservative assumptions or lacks clarity on execution, it should not advance regardless of features or demos.

As a result you are left with a clear go / no-go decision on a specific solutions, grounded in outcomes rather than optimism.

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Step 4: Implementing Revenue Cycle Solutions with OKR-Based Accountability

Execution is where most initiatives succeed or fail. The most effective way to manage that risk is to anchor implementation to OKRs(objectives and key results). These align teams, vendors, and leadership around the original problem you set out to solve.

Start with OKRs

Define:

• One Objective: the business outcome you are driving

• 3–5 Key Results: how success will be measured

Baselines should be locked before implementation begins. Key results should cover adoption, performance, financial impact, and compliance where relevant.

For example: "Reduce admin waste and increase revenue in denials using Cofactor, with targets: 44% faster appeal time, 42% overturn rate, $1.8M net revenue by Month 9, and 80% team adoption."

These OKRs become the source of truth for internal incentives and vendor accountability.

Driving Technology Adoption in Revenue Cycle Teams

Technology does not create impact, your teams do. Process owners should be involved early, frontline staff should understand how their work changes, and adoption expectations should be explicit. Sustained improvement requires that teams trust the system and see its value reflected in their daily work.

Implementation Milestones

Implementation should be gated by clear checkpoints:

1. Data readiness confirmed

2. Integration stability validated

3. Workflows tested and signed off

4. Users trained and supported

5. Performance tracking live against OKRs

Knowing When You’ve Succeeded

You've succeeded when financial and operational key results are achieved or trending within range, adoption is sustained, quality and compliance remain intact, and teams are confident enough to scale the model to the next initiative.

At that point, the framework repeats, faster and with fewer unknowns.

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Moving Forward

Vendor selection isn't a procurement exercise. It's the final step in a process that starts with understanding your system, defining what matters, and holding execution accountable to measurable outcomes. When you do that, vendor decisions become clearer and results follow.

If you're ready to start this process or want to see whether Cofactor is the right partner for one of your initiatives, we can help. We've guided dozens of revenue cycle leaders through this framework, from problem definition through implementation and beyond. Whether that partnership makes sense depends on your specific situation, but the conversation starts with understanding where you are and what you're trying to solve.

Schedule a conversation with our team to explore how we approach complex denials, or use our ROI calculator to model what improvement could look like for your organization.

Start the Process →