Revenue Cycle as Strategy – Not Just Support

MedAxiom’s annual 2025 CV Program Top Priorities Survey Report provides a mirror for those of us navigating the complex world of cardiovascular operations. The 2025 results reaffirmed something I’ve been saying for a while now: revenue cycle is no longer a back-office function – it's a strategic pillar. If we continue treating it as secondary support, we risk compromising everything from financial performance to patient access and physician engagement.

The survey revealed that 57.5% of cardiovascular leaders rank revenue cycle – specifically charge capture, coding and provider education – as a top concern. That number reflects what I hear every week from the MedAxiom community. The common thread is this: we are leaving money on the table not because we are underperforming in the realm of billing and/or clinical coding, but because we are not aligned from an operational perspective.

In cardiology, complexity is built into the care model. Whether it involves structural procedures, complex electrophysiology (EP) services or advanced imaging, every step in the care delivery process presents both a potential clinical gap and a risk of lost revenue if not clearly documented, correctly coded and properly billed. The disconnect between clinical excellence and billing accuracy isn’t just frustrating – it’s costly.

Consider provider documentation: too often, we expect physicians to navigate nuanced billing rules without clear guidance on what matters most. I have seen incredibly skilled cardiologists perform high-value services only for charges to be missed due to vague language, incorrect assumptions or simple electronic health record workflow issues. That is not a physician failure – it's a systems failure.

And let’s not overlook the ramifications of missed or denied charges. . These oversights affect not only collections but also staffing plans, technology investments, quality reporting, capital requests and access for patients. If we want to expand services like EP or structural heart (top growth priorities according to 2025 survey results), we need revenue cycle processes that can keep up with that complexity. Growth without revenue integrity is a fast-track to margin erosion.

This is why we must elevate the revenue cycle to a strategic level. That means:

• Embedding charge capture and reconciliation of services directly into the care delivery workflow.
• Equipping providers with real-world, cardiovascular-specific education that connects clinical language with billing logic.
• Giving coders and revenue leaders a seat at the strategy table. Not just fixing issues after the fact but helping design processes that prevent them.
• Investing in analytics and data visibility so we can track missed charges, denial trends, lag times and net revenue yield as forward-looking levers for downstream feedback and improvements as opposed to retrospective metrics.

At a time when organizations are expected to do more with less, we cannot afford to treat revenue cycle as a support function. It is a strategic advantage that directly influences financial sustainability, physician engagement, and the ability to grow and evolve cardiovascular care.

The revenue cycle is no longer about capturing your charges and collections. It’s about performance, alignment and strategy. The organizations that recognize this now will be the ones that sustain the future of cardiovascular care and operational success.

Illustration by: Lee Sauer