Children’s hospital revenue integrity department finds innovative ways to tackle education, communication, and audits

Wednesday, June 28, 2017

When it comes to revenue integrity, new challenges arise daily, but SSM Health Cardinal Glennon Children’s Hospital in St. Louis has a revenue integrity department that’s been meeting them head on.

Revenue integrity departments were created at each of the SSM St. Louis hospitals in 1996 after a series of audits revealed the hospitals had missed revenue. SSM Health Cardinal Glennon is part of SSM Health, which has hospitals in Missouri, Illinois, Wisconsin, and Oklahoma.

“With decreasing payments from Medicaid and Medicare, we need to catch every dime earned,” says Margie Ackermann, RN, revenue integrity/clinical revenue specialist at SSM Health Cardinal Glennon Children’s Hospital.  

Prior to her current role, Ackermann handled patient billing complaints and auditing for third-party payers at an adult sister hospital where she noticed missing charges. She worked with a team auditing multiple hospital departments for missed revenue opportunities. Then she moved to SSM Health Cardinal Glennon and helped develop the revenue integrity department there.

The initial challenge was figuring out what direction the department would go in as it built the team from the ground up. “I learned about revenue integrity from a relative who started a revenue integrity department at her hospital. She provided audit guidance and suggested where to look for opportunities,” Ackermann says. 

There is currently a clinical reimbursement specialist and a reimbursement specialist located at each of the SSM Health St Louis facilities. There are two claim review specialists, centrally located, who review claims for errors prior to sending them to the insurance company.

The greatest challenges Ackermann faces regularly are communicating internally and externally, ensuring everyone is educated in the rules and regulations for Medicaid and Medicare, and monitoring results through audits.

When communicating across departments, Ackermann is mindful of word choice. Words often have different meanings for different people. For example, shortening “statistical charge” to “stat charge” in the medical record created confusion among physicians, who thought the chart was in need of immediate attention, Ackermann says.

Word choice isn’t the only communication challenge; because members of the revenue integrity department work at different locations, it can be difficult to stay in touch, Ackermann says. To facilitate communication across locations, the department uses instant messaging or calls and meets in person monthly to compare notes at an audit team meeting.

During the monthly meetings, the revenue integrity staff discusses various challenges and issues impacting the hospitals, including network errors. “If it pertains to a network audit, we talk about what we’re finding for each facility. It helps each auditor to understand any issues that are occurring at their facility,” Ackermann says. “We then educate the clinical staff regarding the errors and assist with corrections.”

To ease the learning curve for clinical staff, the revenue integrity department created a series of tip sheets that help staff understand the importance of correct charging and charge reconciliation. 

One such charging tip sheet gives employees a step-by-step tutorial on adding charges into the Epic system. “We find that it’s a great tool for our clinical staff,” Ackermann says.