Note from the speaker: Understanding revenue integrity’s role in revenue cycle metrics

by Caroline Znaniec, MBA, MS-HCA

Revenue integrity activities are expected to focus on process improvement.

Improvements must be identified by understanding how measures are calculated, what defined benchmarks they are compared to, and how performance is trending related to the measures.

In establishing a benchmark, a healthcare provider organization has various options. These options include using published industry benchmarks (e.g., NAHRI, AHIMA, HFMA, ACDIS), benchmarks based on professional experience, and/or benchmarks developed internally. Benchmarks developed internally provide consistent measures that reflect the organization’s unique processes, staffing roles, and technology. In contrast, industry benchmarks are best used as a reference point. Established benchmarks are not expected to frequently change. Instead, the measure that is compared to the benchmark is of greater importance. How does the measure compare to the benchmark? Is the organization underperforming? How does the measure trend in comparison to related measures?

The performance of the related metrics will help identify the root cause of underperforming revenue cycle measures, as well as help define the first steps to troubleshoot the underlying issue(s).

For example, if the clean claim rate is underperforming, this could be due to process breakdowns in medical necessity checks and insurance verification in the front revenue cycle and/or errors in charge description master maintenance in the middle revenue cycle. With an underperforming clean claim rate, there will be a direct and related impact to claim editing corrections. As the clean claim rate decreases, the claim editing correction volume and turnaround may increase.

Editor’s note

Learn more about interdependent revenue cycle metrics and revenue integrity’s role by attending Znaniec’s session “Analyze THIS! Healthcare Revenue Cycle Analytics and the Role of Revenue Integrity” on day three of Revenue Integrity and Reimbursement Strategies: A NAHRI Virtual Event, to be held October 6–8, 2020.

Ongoing learning and peer networking are critical to revenue integrity professionals—now more than ever. The novel coronavirus (COVID-19) has led to unprecedented revenue shortfalls and ushered in a flood of constantly evolving billing and reimbursement changes. Although many revenue integrity professionals continue to work from home  and most traditional networking and education opportunities are suspended, NAHRI is committed to providing the focused education and innovative connections they need in a new, virtual event.  This three-day virtual event offers the expert advice and analysis you need to maintain revenue integrity now and prepare for the coming year.

Our expert speakers will cover essential topics, such as charge capture and denials management, and will analyze the impact of recent regulatory changes and related guidance. Each day will close with a live Q&A session featuring speakers from that day’s sessions. Highlights of the agenda include:

• Overview of the 2021 IPPS final rule, the 2021 OPPS and MPFS proposed rules, and CMS’ COVID-19 interim final rule
• Tips for chargemaster maintenance
• Strategies for charge capture
• Key methods to address price transparency requirements
• Methods for analyzing revenue integrity metrics and KPIs
• Current payer audit targets and strategies to manage denials and appeals

View the full agenda here. Learn how you can save on your attendance, including group discounts and membership discounts, here.

Author bio

Znaniec is a managing director in CohnReznick’s healthcare practice. She has 24 years of healthcare industry and consulting experience with expertise in healthcare strategy and revenue cycle transformation. Znaniec works with various healthcare provider organizations, including hospitals, health systems, skilled nursing facilities, home health, physician groups and clinics, freestanding providers, payers, private equity groups, and investors of healthcare providers. She also serves as a NAHRI Advisory Board member.