Revenue integrity staffing in 2022

Wednesday, June 8, 2022

by Caroline Znaniec, MBA, MS-HCA

Throughout the pandemic, staffing shortages across healthcare have been highlighted as a top concern in  clinical and nonclinical functions. The overall need for qualified staff has certainly been difficult to fulfill. Organizations have met the challenge in revenue integrity staffing through various strategies.

Redefining revenue integrity objectives

Effective models of revenue integrity clearly define scope and set boundaries. Too often, revenue integrity professionals are pulled into daily operational tasks that prevent them from proactively identifying opportunities for improvement. Tasks may include those related to reviewing and releasing individual claims, abstracting procedural and diagnosis codes, and reconciling daily charge activity. Activities within revenue integrity are expected to focus more on process improvement and include those underlying processes most integrally involved in the front-end, middle, and back-end revenue cycle processes. It is within the role of revenue integrity professionals to ensure that every chargeable procedure, item, or service is identified, captured, billed, and paid according to the terms of government and industry guidelines and payer contracts.

Resetting priorities

Provider organizations have found that priorities in the assessment and optimization of processes have been delayed throughout the pandemic. Delays have been the result of impacts to service and payer mix, coupled with regulatory shifts. A well-defined revenue integrity workplan set pre-pandemic may not have the same relevance today. Short-term strategies to identify lost revenue are more of a priority as patient volumes and service offerings are recovering.

Upskilling and reskilling staff

With the staffing shortages, provider organizations are looking internally to leverage the potential of their workforce to work across various roles. By realizing the potential of their existing workforce, organizations can increase their retention while also meeting their business goals. Rather than replacing staff, they are renewing their staff with the needed skills to support revenue integrity functions and develop a career path.

Leveraging automation to augment staffing

Organizations are looking to automation within the revenue cycle to reduce redundant tasks, increase productivity, and allow revenue integrity staff to focus on more complex issues. Opportunities in automation include review for underpayment and payer payment integrity, charge reconciliation and monitoring, rule-based charge capture reviews, and routing of exceptions to appropriate stakeholders.

Using technology to monitor quality and productivity

Technology can support organizations in centralizing and organizing data, allowing for greater transparency in revenue cycle performance. Organizations are using predictive analytics to proactively identify potential areas of revenue loss before a claim is processed. By doing so, organizations can improve efficiencies in claims processing, improve timing to collect, reduce the cost to collect, and lessen the burden of claim corrections on staff. Revenue integrity staff can better understand systemic issues and deploy efforts to correct the root causes.

Aligning with outsourced business partners

Organizations are aligning with business partners to improve workflows, deploy automation, build out technologic capabilities, and supplement staffing across the revenue cycle. This approach, when combined with the other strategies above, further reduces the staffing burden on the organization and allows the organization to focus on strategic initiatives to improve revenue integrity. The bottom line is that revenue integrity staff can be swifter and more engaged in the assessment of processes that drive improvements in revenue.

Revenue integrity programs have certainly felt pandemic impacts related to budgetary constraints, the move to a remote environment, rising operational costs, and staff retention. With the strategies provided, organizations can regain their momentum to improve revenue integrity as we continue through 2022 and beyond.

To learn more about revenue integrity program design, staffing, and data analytics, join myself and Christian Gabriel, system director of revenue integrity at CommonSpirit Health, at the 2022 Revenue Integrity Symposium.

About the author

Znaniec is a managing director and revenue cycle leader with Protiviti. Protiviti is a global consulting firm with over 6,000 professionals that helps companies solve problems in finance, technology, operations, governance, risk, and internal audit. She is also a NAHRI Advisory Board Member and Mid-Atlantic Chapter Leader.

Found in Categories: 
Program Management, Revenue Integrity