Supporting accountability for charge reconciliation

Thursday, June 6, 2024

Q: How can revenue integrity help clinical departments be accountable for charge reconciliation?

Angela Cummings, MHA, BSN, RN, ACM-RN, director of revenue and documentation integrity at Duke University Health System in Durham, North Carolina: We do send out late charge reports, but holding them accountable to timely and accurate charge reconciliation is a huge challenge. Here, the late charge reports go to the VPs, and they are very engaged and having those conversations. I think that the tide has turned a little bit and people are more interested in revenue than they have been in the past. The culture is changing. People are more interested in trying to go after their dollars and maintain what they’re supposed to have, so they’re much more interested in enforcing those changes.

Heather Dubois, director of revenue integrity at Lifespan in Providence, Rhode Island: We use a Revenue Guardian report. We require departments to go in and review accounts and then they have to indicate if they did review the account or not. Then we have a report, built in Crystal, that pulls in all that information from Epic and then we send it to everybody. It works for some departments, radiology clinics and areas like that, but we’re still lacking in areas like the OR and cath labs. The report’s great because we—revenue integrity—don’t hold departments accountable for their charge reconciliation. We expect their VP to hold their directors and managers accountable for charge reconciliation. So it gives us the chance to let them know who’s doing what and where things are being missed.

Editor’s note: This article was excerpted from the 2024 State of the Revenue Integrity Industry Survey Report. Read the full report here.