It’s likely that you have heard some buzz around healthcare revenue integrity. It’s needed, it’s desired, it’s around, but many continue to ask, what is it? What does it look like? Where do I start?
The basis of revenue integrity is to prevent recurrence of issues that can cause revenue leakage. A successful revenue integrity model will provide for a holistic view of the revenue cycle, with support from leadership and technology, with an emphasis on process improvement. Together, these processes function sequentially to produce the desired patient outcome and to generate the bill for services related to that outcome.
Revenue integrity can be intertwined within your daily culture, a distinct and dedicated program, or its own department. In any format, revenue integrity activities focus on process improvement and include those processes most closely involved in the front-, middle-, and back-end revenue cycle processes. In addition to reducing revenue leakage, these activities are also intended to help reduce potential customer scrutiny, whether payer or consumer.
Sound revenue integrity activities can provide for the following:
- Identification and correction of the processes and systems that lead to lost revenue opportunities, through the creation of processes to ensure the accurate capture and reporting, translation, and use of data to support strategic initiatives
- Assurance that every chargeable procedure, item, or service is coded, documented, captured, billed, and paid according to the terms of government guidelines and payer contracts
Don’t just start a revenue integrity program – build and maintain a strong one
Key strategies for successfully obtaining revenue integrity within a provider organization include the following.
- Create staff awareness on the individual and provider organization’s responsibilities through inclusion of responsibilities in job descriptions, onboarding activities and annual education.
- Provide tools and/or guidance specific to those processes of the revenue cycle.
- Design and implement a monitoring program for identified high-risk areas, including the development of review tools and analysis of results to identify root causes and develop corrective action plans, track corrective action plan implementation, and verify improvement.
- Create and maintain a means for oversight and reporting to leadership.
As important as designing a revenue integrity program is sustaining the program. Key stakeholders must understand the objectives of the program and what factors are fundamental to its success. Provider organizations with the greatest success actively engage key stakeholders from Patient Access through to Patient Financial Services. These same stakeholders see the revenue cycle holistically, breaking down silos, opening lines of communication, and working collaboratively toward identification, correction, and continual improvement.
Depending on your specific organization's needs, existing processes, and technology infrastructure, employing the right revenue integrity strategy can help you avoid revenue leakage by controlling or mitigating the issues that cause it. Connect with our team to discuss how CohnReznick can help you implement a proactive revenue integrity strategy, as well as refine your change-management program to help ensure that the processes and responsibilities are well understood and adopted.
On-Demand Webinar: COVID-19 Revenue Cycle Response and Strategies
InsightHow hospitals and health systems can use price transparency to become more patient centricThe new price transparency rule, which took effect January 1, 2021, presents hospitals and health systems with opportunities to drive greater patient centricity, improve patient outcomes and deliver a value proposition that justifies premium charges and builds public trust. The objective of price transparency is to become more patient-centric, and the final rule is just one step to getting there.
InsightHealthcare industry prognosis: The outlook for investors and M&A activityRead perspectives on technology, government factors, M&A, and other healthcare industry trends to watch and plan for in 2021, from CohnReznick’s Claudine Cohen.
InsightFor FQHCs: Top considerations for recipients of Provider Relief Funds and other COVID-19 fundingSteven SchwartzRead what to know about using and reporting Provider Relief Funds and HRSA and FCC COVID-19 funding, Single Audit implications, and more.
InsightTop considerations for for-profit recipients of Provider Relief Funds: Reporting, compliance, tax impacts, and moreSteven SchwartzLearn when and how to report on use of the federal COVID-19 healthcare funding, the tax and Single Audit implications, and other information for providers.