Decade-old revenue integrity department offers advice for new programs

Wednesday, May 24, 2017

Tasked with the impossible—reviewing 100% of charges before they go out the door—the revenue integrity department at Yale New Haven Health in New Haven, Connecticut, knows the importance of having a reliable staff to get the job done right.

Composed of coders, nurses, auditors, charge masters, and reporting specialists, 32 members make up Yale New Haven Health’s revenue integrity department. Two key players are Patti IannucciRN, BSN, CPC, manager of revenue integrity, and Donna Schneider, RN, MBA, CPHQ, CPC-P, CHC, CPCO, CHPC, system revenue compliance officer. Iannucci and Schneider place ample focus on education to ensure their fellow staff members are prepared for the job.

“It takes a lot of education for nurses to know what they do, how they document it, what supplies they’re opening and throwing away, and the cost of everything,” Iannucci says. “We spend a lot of time going out to the department and educating them on how to have compliant documentation.”

Yale New Haven Health honed its focus on revenue integrity in 2007 after an assessment of accounts and distribution-share levels showed that the ED wasn’t profitable. A look at orders, electronic health records, and CPT codes led to the realization that the facility was missing out on $6 million in revenue.  

Reviewing as many charges as possible is a large task, but Iannucci and Schneider have tools they use to help them through the review process. They have products that scrub tools to find errors on the back end and submit work queues in Epic on the front end to systematically look at the most important edits.

“We probably have 200 work queues,” Iannucci says. “These work queues can help you identify common trouble spots, and have the program pull these specific cases for you so don’t have to look at all of the claims.”

For younger revenue integrity facilities, Iannucci advises focusing audits on high-dollar areas. This may include oncology, the ED, wound care, the catheterization laboratory, and interventional radiology. Besides focusing on auditing charges identified by software as potentially problematic, Iannucci also suggests taking a hands-on approach.

Spend time watching procedures. Iannucci suggests observing what supplies physicians are using and comparing that to the list of supply charges to see if they match up. When usage and charges don’t align, work with physicians to reduce the likelihood of inconsistencies. Also, check to see if physicians are doing procedures that are not yet in the chargemaster and may need to be added.

Revenue integrity depends on having an accurate chargemaster. For Schneider, this means staying up to date on new payment methodologies and being intentional with hiring. “We prefer to make sure the organization is accountable with the documentation for the specific service we have provided to support the level of services billed,” she says.

Another core component of having a functional revenue integrity department is connecting with compliance, Schneider says. “Part of that work plan needs to encompass auditing new services. You’re looking at them not only from the billing and revenue perspective, but from the regulatory perspective,” she says.