Q&A: Tips for implementing a revenue integrity program

Wednesday, November 11, 2020

Q: I have been tasked with implementing a charge capture/revenue integrity program. I would appreciate any suggestions or tips that anyone is willing to share to assist me in beginning this process—where to start, who to include, and how to be successful with this challenge.

A: One strategy that has been successful for me in getting departments involved in the entire process is to help them understand that charge capture, the CDM information, and charge reconciliation is vital to support the cost and resources involved in what they do. If we don't report and charge for the service and we don't ensure that the charge went through, then we are undermining ourselves as a hospital.

Nursing will get on board sometimes when they understand that we are in a position with many payers to be reimbursed for their services. Nurses have typically been educated that there is no reimbursement for what nurses do so, "Why charge for it if we don't get paid?" There is an opportunity to explain that we do get paid for all services, maybe just not for the individual charge. I find meeting with departments to be very helpful. It builds a team spirit, and they become comfortable with the CDM because a lot of them don't really understand how it works and why anyone is interested. For the charge capture/reconciliation, work with them on a process that works best for them regarding timing, reports, etc. Suggest that they not select only one person but have a backup because we know things happen. Emphasize the positives for them and their department. That will always make things go smoother.

Editor’s note: This question was answered in the NAHRI Forums. To have your question answered by a community of revenue integrity experts, visit the NAHRI Forums.

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