Q&A: Defining revenue integrity's role in charge reconciliation

Q: How is revenue integrity involved in charge reconciliation at your organizations? Do you have a formal charge reconciliation policy?

Ashley Brown, CHRI, RH-RCMS, RH-CBS, CAH-CBS, CH-CBS, CH-RCMS, revenue cycle analyst at La Paz Regional Hospital in Parker, Arizona: Every department is responsible for their own charges for charge reconciliation and charge rejections, but in the past there were unwritten rules around these two functions. I am in the process of creating a universal rule for the departments to follow, but getting buy-in from the directors that have never been responsible for this process in the past has been our largest struggle here.

Kelli L. Howard, MS, CSPPM, senior manager of revenue integrity at Mayo Clinic in Phoenix, Arizona: While we do have a CDM hub team outside of the revenue cycle, the process is really that the revenue analysts know when a new service is coming online that would warrant a new code creation. We have an intake process where the revenue analyst fills out the information that’s associated with those services. It’s similar regarding the annual CPT load. We don’t just automatically load; we only fully build codes out when they are going to be utilized. Revenue integrity controls the aspects associated with the EAP builds, or procedure code builds, and then pushes it over to the CDM team to incorporate changes into the system.

Editor's note: Learn more about how revenue integrity programs are defining their role in charge reconciliation in NAHRI's 2026 State of the Revenue Integrity Industry Report.