Q&A: Revenue integrity department changes

Thursday, June 10, 2021

Q: What changes has your department seen in the past year in terms of revenue integrity functions and roles?

Paula Twiss, supervisor of revenue integrity at Regional Health in Rapid City, South Dakota: The only thing that’s really changed for our team over the last year is that we’re getting more. We had a team of three, and now we have a team of five. So, over the past year, we are now getting more involved in our claim edit concerns or issues and doing deep dives into those claim edits to make sure we [understand]: 1) [whether] we need the claim edit, and 2) what workflow do we need to put into place to prevent hitting that claim edit to try and reduce some of those edits.

Alisha Rohrer, CPC, COC, CRCP-I, director of revenue integrity at WellSpan Health in York, Pennsylvania: Ours has changed a little bit over the last year. We’ve re-concerted that revenue assurance will be handled with the clinical departments and their controllers and business managers, so that role is taken from us, which is nice because they already have the established relationships because of reviewing budgets and so forth. We have taken a more active role in the defense audits. With our commercial payers, with our defense audit team, and then also with claim edits, we’ve been asked to get involved in the ending revenue cycle for denials and claim edits where we can put measures on the front side to prevent them from occurring or can put insight into any process improvement [across the revenue cycle] for claim edits or denials.

Frank Cantrell, CHRI, system director of corporate revenue integrity at Penn Highlands Healthcare in DuBois, Pennsylvania: Due to the pandemic, telehealth, the COVID-19 vaccine, and monoclonal antibodies, it’s like the entire facility called us but nobody knew anything about anything, and suddenly everybody’s having to learn—and then the rules kept changing with some regularity. So that increased our workload quite a bit. Trying to keep up with all that and then educate all the different hospitals and all the different pharmacies and the lab suddenly [became overwhelming, compared to when it] used to take up no time in our day. That was not necessarily new, but certainly increased our work as a department.

Editor's note: This Q&A was excerpted from the 2021 State of the Revenue Integrity Industry Survey Report. See the full report to learn more about chargemaster approval processes and the impact of COVID-19 on revenue integrity departments.

Found in Categories: 
Program Management, Revenue Integrity