Defining revenue integrity

Monday, June 5, 2023

Revenue integrity can be difficult to define on an organizational level—but having a clear, consistent, and practical definition is essential to a revenue integrity program’s success. NAHRI defines revenue integrity as the following:

The basis of revenue integrity is to prevent recurrence of issues that can cause revenue leakage and/or compliance risks through effective, efficient, replicable processes and internal controls across the continuum of patient care, supported by the appropriate documentation and the application of sound financial practices that are able to withstand audits at any point in time.

To learn what revenue integrity means to revenue integrity professionals and their organizations, NAHRI recently surveyed members. Following are some of their responses.

Q: In your own words, what is revenue integrity?

Stacy Heller, revenue integrity team leader at Bellin Health in Green Bay, Wisconsin: Revenue Integrity is the optimization of revenue capture and ensuring that revenues generated are accurate, compliant, and reasonable for the services provided.

Brittanie Smiddy, revenue integrity lead at Confluence Health in Wenatchee, Washington: Correct claim submission adhering to all regulatory guidance, coding guidelines, and payer specifics to get the most accurate and timely reimbursement available.

Michella Borden, RHIT, revenue integrity department supervisor at St. Charles Health System in Bend, Oregon: Revenue Integrity is a term used across the healthcare continuum as a giant blanket term for "everything charge related." To me, it means keeping the integrity of the health system's charging methodologies in check with CMS guidelines, payer contract requirements, and ensuring those applying charges understand them [as well as] possible.

Susan E. Lundgren, COC, CHRI, CPAR, senior revenue integrity auditor at Northside Hospital in Atlanta, Georgia: Revenue integrity is the bridge between the clinical and revenue departments to facilitate compliance, appropriate documentation, and revenue.

Found in Categories: 
Revenue Integrity