Q&A: Building blocks of a successful revenue integrity program

Wednesday, January 6, 2021

Q: I am facing the challenge of starting a revenue integrity program at my organization. What are some of the most important steps for me to take at the beginning of this process?

A: Please excuse me if this is too elementary. It’s critical to start off on the right foot so I am starting with the basics. The key is building rapport and mutual respect with clinical departments. One way to get buy-in is to let the clinical department know you are working as an extension of their department to reduce leakage and improve charge accuracy. Do your homework and gain knowledge on what’s charged and what’s not. Start by doing a chart-to-charge audit, review denials, review edits, and trend the results. Create a list of discussion points and schedule a meeting with the department manager. During the first couple meetings, explain your purpose and value to the department (usually in terms of revenue optimization and reduce leakage / denials) and ask questions about their charge capture process to learn about pain points and trouble areas. An Effective approach requires an organized, methodical approach based on data and regulatory guidelines.

Editor’s note: This question was answered in the NAHRI Forums. NAHRI members can share ideas and strategies with peers through the Forums.

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