Demonstrating the value of revenue integrity

Thursday, June 6, 2024

During 2024 Revenue Integrity Week, NAHRI is focused on raising awareness of the value that revenue integrity professionals bring to their organizations. By shining a light on best practices, data, and forward-thinking strategies, we can help revenue integrity professionals demonstrate everything they contribute to the healthcare industry.

NAHRI asked members of the 2024 Networking and Events Committee to discuss how they define revenue integrity’s value. Here’s what they told us.

Q: What is the value of revenue integrity?

Kelly Bowley, RN, MBA, CRCE, senior director of healthcare business transformation, revenue cycle, FTI Consulting, Washington, D.C.: Revenue integrity is essential for financial stability, compliance, and operational effectiveness of organizations.  Some of the ways this is realized is through the following:

  • Financial health: Ensures charges for services rendered are properly captured, minimizing revenue leakage and supporting accurate reimbursement
  • Compliance: Promotes adherence to regulatory requirements and billing standards, thus reducing risks of penalties, fines, or other financial impact related to improper billing practices
  • Operational efficiency: Supports streamlined processes that optimize charging, coding, and billing which minimizes delays and errors in billing and reimbursement

Sandy Giangreco Brown, MHA, BS, CHRI, RHIT, CCS, CCS-P, CHC, CPC, COC, CPC-I, COBGC, PCS, director of coding and revenue integrity, CliftonLarsonAllen, LLP, Broomfield, Colorado: Revenue integrity is critical to any organization in healthcare! Those that don’t see the value run the risk of their facility or department having significant issues with getting paid properly for services rendered. Do you have people in chargemaster and revenue integrity roles who understand what are the procedures that are being performed at your facility? It is invaluable to have the proper Current Procedural Terminology (CPT©) codes and procedures set up and mapped to the appropriate department to facilitate appropriate reimbursement. If a facility or practice doesn’t have revenue integrity professionals and they have incorrect revenue codes, the wrong CPT codes set up for procedures, or maybe the providers are selecting a code that is close but not quite the procedure, the denials will be adding up and the revenue coming into the facility or practice will be trending downward. Having a strong revenue integrity team will help facilitate timely filing, accurate payments, and lessen denials!

Jennifer Gardiner, senior director of revenue integrity, University of Maryland Medical Center, Baltimore, Maryland: A well–planned revenue integrity team is invaluable to an organization. Revenue integrity protects revenue through proper monitoring and workflow optimization. Revenue integrity tends to be change agents and are able to move projects and processes forward to completion.

Lisa Kanivetsky, CPC, CHRI, revenue integrity advisor, University Hospital, Newark, New Jersey: Revenue integrity is an incredibly important team/role in a healthcare organization—this is the team that ties clinical and revenue.

Daphne Pell, RHIA, CHRI, vice president, Claro Healthcare, Chicago, Illinois: Revenue integrity helps bridge the gap and provide clarity of communication between the two primary, often disparate, groups within a health system: clinical operations and finance. Revenue integrity’s activities allow for continued and future investment into quality patient care.

Mia Reddick-Smith, MBA, PMP, AVP, revenue integrity, Lifepoint Health, Brentwood, Tennessee: Revenue integrity shows value by keeping daily charge capture flowing that result in proper payment. Revenue integrity also shows value by understanding proper operational workflow that leads to appropriate charge capture and proper reimbursement.

Tina Rosier, MS, PT, director of revenue integrity at Community Health Network. Indianapolis, Indiana: Ensuring that we maximize reimbursement for the services we provide. Every dollar is needed to help cover the ballooning costs of healthcare, devices, pharmacy, etc.

Stacie Smith, senior manager, Windham Brannon, Atlanta, Georgia: I believe that the value in revenue integrity is in the financial sustainability it creates. We optimize the charge capture process to minimize leakage; however, in doing this we have to be sure that we are compliant with all the rules and regulations and stay within the payer contracts.

Diane Weiss, CPC, CPB, CHRI, vice president of revenue integrity and education, RestorixHealth: Revenue integrity experience and knowledge are fast becoming sought after qualifications and held in high regard. With the external audit oversight that we’re all currently experiencing, strong revenue integrity skills are needed as our hospitals and providers wrangle with audits, coverage issues, and constant changes from payers.