Black Holes the Watchlist Doesn’t Even Know About

What’s more dangerous than a black hole of accounts not assigned for anyone to work? A population of accounts that appear as if they are assigned, but are not being managed at all. This is what we call an “invisible black hole”. This might seem like a rare or abstract concept, but these are actually easier to create than one might think, and the more complex the system – the more likely they are to occur. Here are a few (of the many) ways these can occur:

  • Someone leaves the organization and their workqueue (WQ) is not reassigned/inactivated
  • Someone is assigned to a WQ that that they are unaware of 
  • Accounts are on multiple WQs and each owner assumes someone else is working the account
  • Accounts are on WQs that are not actively managed (reporting only, vendor outsourcing)
  • Accounts are on an active WQ, but are not ever worked (the account never qualifies as a priority on the worklist – this is more of a gray hole, but still poses a risk)

So, why are these more dangerous than the standard black hole? Accounts in a typical black hole (meaning they are not assigned to any WQ in the system) should be easily identified using the existing watch list in the Epic dashboard (or other reconciliation devices). Monitoring the volume and the impact of any fixes, is pretty clear. If you make a change to a WQ, and the indicator on the watch list spikes, you have a problem. Simple. The reason the invisible watch list items are so dangerous, is that they can be caused so many ways (see above) and can be very difficult to identify and monitor. 

So how do I reduce the risk of this potential threat? The first step is to ensure you have the appropriate checks, balances and structure. What exactly does that mean?

  • Structured approval/review process for system changes (wq, assignments etc.)
  • Structured testing and sign off process for system changes and implementations 
  • Defined approach to WQ naming and assignment convention 
  • Clear expectations for WQ management at each responsible level 
  • Tested and functioning dashboards/WQ reporting at the director, manager and staff level
  • Periodic audits of WQ assignments, ownership and rollups 

All of these will help reduce the likelihood that one of these invisible black holes has been created. 

So how do I know if I’ve created one and what to do with it? This is the tricky part, and unfortunately – there isn’t a one size fits all silver bullet solution for this. There are two general approaches to consider. 

  • Creating a reporting mechanism that identifies accounts that are not on any ACTIVELY managed worklist. This usually takes time and involves individual account sampling and workflow/workqueue review. It requires the creation and maintenance of a list of actively managed and monitored workqueues.  Eventually, the goal is to setup a report that will kick out accounts that are not on an actively managed workqueue (that should be). 
  • The second (and somewhat more comprehensive approach), is to create reporting that identifies accounts that have not had any user activity in an extended period (E.g. 90 days). This will help highlight breakdowns in system builds, as well as breakdowns in operational design/training (accounts aren’t worked because there aren’t enough staff, they aren’t a high enough priority). This is a somewhat more comprehensive evaluation of risk, but requires detailed exploration to identify the true cause of why accounts are not being worked. 

Overall, as the industry moves toward more complexity in its technical solutions, workflow and automation capabilities – it also introduces a higher level of risk associated with workflow and system gaps. These tips are intended to provide a light framework to manage and mitigate these risks. For more in-depth information on revenue cycle workflows, system configuration or reporting capabilities, please reach out to Brian Felland, who has led black hole rescue teams, at

Getting the Most from Your Interim Revenue Cycle Leader

Some people view an interim leader as a stop gap between an outgoing revenue cycle leader and the next leader to fill the permanent role; someone to manage the day-to-day and maintain performance. We would contend that, in the Revenue Cycle space, interim leaders should also have the experience and skillsets needed to rapidly identify and execute changes to improve performance.  Despite the need for interims to drive value, many times interim revenue cycle leaders maintain performance at best. 

Below are a few ideas to get the most out of your choice for interim revenue cycle leadership:

Before bringing in an interim leader, ask the team:

  • What expertise would benefit the team?
  • What must be maintained or fixed to keep forward momentum?

Ask the right questions when talking with a potential interim leader:

  • What is their leadership style?
  • How do they engage staff to support initiatives?
  • Discuss their experience working with other departments to support revenue cycle initiatives
  • What does success look like in an interim leadership role?
  • Do they have experience transitioning initiatives to new leader mid-stream?

Outline an initiative-based work plan the interim leader is expected to manage forward throughout the contract:

  • Identify quick wins to demonstrate progress and gain buy-in
  • If an established initiative work plan is not available, set the expectation that a rapid assessment be completed in the area(s) they are over and tie progress to milestones in their contract

Set up a structure for success:

  • Note the metrics when the interim begins to monitor progress
  • Ensure metric monitoring is in place so you can course correct as necessary
  • Identify the executive who will regularly check in to ensure the interim’s progress

If you are in need of an interim revenue cycle leader or would like to discuss the approach outlined above, please contact Andrew Jacobsen at to discuss further.