NAHRI survey offers revenue integrity insights

Accurately charging, coding, and billing claims is critical to the financial stability of a healthcare organization. The National Association of Healthcare Revenue Integrity (NAHRI) recognizes the importance of ensuring that services rendered are appropriately and fairly reimbursed and the critical role that revenue integrity professionals play in a compliant process. To start to gain insight into how your facility’s revenue integrity practices compare to those of your peers, NAHRI conducted a survey of revenue integrity professionals in December 2016.

As you’ve likely noticed, revenue integrity as a profession is on the rise. More than two-thirds (69%) of the more than 100 survey respondents work in a facility that has dedicated revenue integrity staff members. Additionally, 58% have a revenue integrity department. Another 58% of facilities reported having a distinct revenue integrity program. Of those with a revenue integrity department, 34% employ 2–4 FTEs in the department, whereas 15% have 5–7 FTEs, and 18% have a revenue integrity department that supports more than 20 FTEs.

More than one-third of respondents (38%) with a revenue integrity department stated that the department reports up to the vice president or director of revenue cycle. Approximately 15% report to the chief financial officer and another 15% report to the vice president or director of finance. Others departments report to the chief executive officer (2%), compliance director (2%), or HIM director (7%).

Generally, respondents have held their current position for 10 years or less. More than one-quarter (27%) of respondents have held their current position for 3–5 years whereas 24% have held their position for 6–10 years. Approximately 28% are brand new to their roles, having been in their positions for two years or less.

While few respondents reported more than 10 years in their current position, a larger number reported many years of experience with revenue integrity. Consider the following:

• Less than one year of experience: 3%
• 1–2 years: 3%
• 3–5 years: 10%
• 6–10 years: 27%
• 11–15 years: 25%
• 16–20 years: 13%
• 20 or more years of experience: 19%

The average salary reported by respondents was $80,000–99,999, though respondents held a wide variety of titles and worked at many different types of facilities with varying levels of experience. (NAHRI will examine this subject more fully in the future.)

One of the goals of NAHRI is to define revenue integrity standards both in terms of what the profession currently entails and where it is headed. NAHRI asked survey respondents to describe what revenue integrity means to them. It’s no surprise that compliant billing, charging, and coding came up numerous times. Here are just a few of the descriptions of revenue integrity offered up by respondents:

• “The integrity of all charges are carefully monitored during the charging process.”
• “Ensuring we are charging for everything we can and doing so in the most compliant way possible.”
• “Ensuring the quality and correctness of the revenue cycle, and being the guardian of rightful revenue.”
•  “Revenue integrity focuses on processes to prevent revenue loss and/or scrutiny from external sources.”
•  “It means charging, coding, and billing consistently, accurately, and compliantly for all services provided to patients.”
•  “What we charge, how we charge, education related to charging, pricing, charge capture, and the compliance related to charging.”
• “Helping to maintain the financial stability within the organization in a compliant manner. Streamlining processes.”
• “Making sure that the hospital is charging and billing appropriately for services rendered, and making sure that the hospital is reimbursed appropriately by payers.”
• “Ensuring our facility is maximizing our charge capture and reimbursement while remaining compliant with governmental and payer guidelines.”
• “Operational and financial processes that accurately record the services provided to patients, including scheduling, authorization, registration, charge capture, billing, reimbursement, and denials management.”

What does Revenue Integrity mean to you?

Want to get involved with NAHRI? Contact Andrea Kraynak, director of NAHRI, at akraynak@hcpro.com to make sure your voice is heard.