Q&A: Primary and supporting functions of revenue integrity

Editor's note: This Q&A is included in NAHRI's 2020 State of the Revenue Integrity Industry Report. Click here to read the full report and participate in 2020 Revenue Integrity Week activities. 

The following is a question and answer session with Caroline Znaniec, managing director of CohnReznick LLP’s Healthcare Advisory Practice in Baltimore, on primary and supporting functions of revenue integrity as reported in NAHRI’s 2020 State of the Revenue Integrity Industry Survey. Znaniec is a NAHRI Advisory Board member.

Q. The percentage of respondents who have dedicated revenue integrity staff members has remained at 68% from our 2018 Industry Survey to our 2020 Industry Survey. Do you see a need for additional facilities to bring revenue integrity staff on board?

A. Yes, I am surprised that there has not been an overall increase. However, the amount of consolidation in the last two years could be why we haven’t seen a shift at a facility level. For those facilities that do not have dedicated revenue integrity staff, it could be that the size, region, or culture of the facility is not conducive to a dedicated function or department. The staff may reside in other departments such as compliance, auditing, or billing, and may have additional “duties as assigned.” These other duties cover the processes of what we consider to be revenue integrity, but the staff do not directly recognize themselves as working under revenue integrity. The survey may not reflect this occurrence as the survey may not reach these professionals.

I do continue to see the need for dedicated revenue integrity staffing. Recent experiences from the COVID-19 pandemic have shone a bright light on the need to be nimble, flexible, and timely in addressing operational changes. Facilities that are more likely to survive the pandemic financially have a foundation of revenue integrity and dedication to the objectives of the function.

Q. Chart auditing, charge capture, and chargemaster maintenance often top our respondents’ list of primary functions of revenue integrity. How and why should revenue integrity be primarily responsible for these functions?

A. Revenue integrity focuses on those processes to properly identify, capture, and report the items, services, and procedures rendered by the facility and providers. The primary functions indicated directly contribute to the ability to ensure the processes are sound.

Q. In 2018, most respondents (25%) reported 2‒4 full-time employees for their revenue integrity departments, a figure that increased to 5‒7 for respondents (18%) in 2020. What can facilities do to gain buy-in for creating or expanding revenue integrity departments and programs?

A. The ability to create buy-in starts with the ability to clearly identify the objectives of the revenue integrity department: What are the goals of the department? How will you look to achieve those goals? What resources are needed? What is the expected benefit?

And as the department operates, the ability to demonstrate how the objectives are met will also validate across the organization the need for the department.

Q. Most respondents (35%) report that their revenue integrity department, committee, or task force meets monthly. What meeting frequency would you recommend? What topics are essential to cover at such meetings?

A. Meeting frequency can vary across organizations based on various factors, including revenue performance and level of payer and regulatory scrutiny. Regardless of the meeting frequency, the more important factor is the effectiveness of the meetings themselves. Frequency alone does not provide action, follow-up, or awareness.