Revenue integrity: A team effort from start to finish

by Rayleen Kelly, RN, CCDS, CHRI, CIC, CRC

I am so excited to be a member of the National Association of Healthcare Revenue Integrity, and I think that having the Certification in Healthcare Revenue Integrity (CHRI) credential will show your commitment to the association and the profession.

Working on the CHRI credential committee was important to me and was a great experience as well! I enjoyed working with such a great group of professionals! The CHRI certification benefits both employers and revenue integrity professionals by promoting and recognizing their knowledge and experience in “healthcare revenue integrity.” The CHRI certification defines and validates the knowledge that we have of the revenue cycle and knowledge of the departments that play a major role in ensuring revenue integrity for any healthcare organization.

I remember attending the 2017 Revenue Integrity Symposium, which was so exciting for me! I learned so much that week, and I really enjoyed meeting the members there and the discussions that we had. Since then, I have become more involved exploring the components of the revenue cycle, as well as having a better understanding of the professionals involved in the revenue cycle.

I enjoy working with the providers, coders, CDIs, DRG validation and appeal specialists in my current role as medical documentation director, as well as using analytical tools to help keep track of the revenue process. I also find myself dealing with compliance and medical necessity when working with case management and the utilization teams.

I think the most challenging part of working in revenue integrity is keeping up with the CMS changes every year, in addition to meeting the expectations of the various state and federal regulations and accrediting agencies. Recently, CMS released its FY 2020 IPPS proposed rule. Have you heard about the changes? If not, I recommend looking at the document since it will affect your “CC” and “MCC” capture rate as well as your MS-DRGs. For those who have not had a chance to look at it yet, you can read it here.

You know the saying, “it takes a village”? Well, that’s right when it comes to the revenue cycle departments involved in ensuring revenue integrity! It is a team effort from start to finish!