Revenue integrity: Command center for financial success

by Jennie Scruggs, BS, RHIT, CPC

An efficient revenue cycle process is essential to the financial health of a healthcare organization. Patient-centered care and other clinical programs should not suffer as a result of inefficiencies in revenue cycle services. However, if your organization does not have an effective revenue integrity department, it could place your organization in financial ruins. Revenue integrity is the key department needed as a command center for revenue cycle Services.

NAHRI explains the basis of revenue integrity as “to prevent recurrence of issues that can cause revenue leakage and/or compliance risks through effective, efficient, replicable processes and internal controls across the continuum of patient care, supported by the appropriate documentation and the application of sound financial practices that are able to withstand audits at any point in time.” According to a recent HFMA presentation, revenue integrity is that process or function that revenue is accurate in regard to coding, charge capture, and reasonable prices for services. A command center is defined as a centralized location that will gather, process analyze, display, and disseminate planning and operational data. According to Bruce Preston, director of revenue integrity for Grady Health System, in Atlanta, revenue integrity is that department that is linked to every service line in the hospital. Therefore, it could be an idea choice for proactively coordinating and reducing bottlenecks that impact reimbursement.

Some hospitals have also embarked on re-establishing/establishing their revenue integrity departments. Multidisciplinary collaboration has led to reviewing key performance metrics that has centralized both physician and hospital disciplines to improve reimbursement across the board. The ever-increasing regulatory environment dictates that now is the time that organizations should take advantage of the expansive technology and clinical innovation software that will increase efficiencies and reduce DNFB accounts and other errors that impact consistent financial sustainability. Thus, the challenge of enhancing revenue cycle services is identifying the central catalyst (department) within the organization, whereas, the overarching goal would be to cultivate financial accountability in the healthcare organization.