Troubleshooting KPIs to improve revenue integrity on the October NAHRI Quarterly Call

Wednesday, November 15, 2023
Revenue Integrity Insider

NAHRI members received association updates and solutions for common scenarios where key performance indicators (KPI) are underperforming on the October NAHRI Quarterly Call. Listeners also learned about how the various stakeholders within the revenue cycle, and their functions, are interdependent on each other to maintain organizational revenue integrity.

Association updates

The call opened with NAHRI Director Nicole Votta providing the latest news on the association.

The 2024 Revenue Integrity Symposium (RIS) will be held September 12-13, 2024, at the Hilton Chicago/Oak Brook Hills Resort & Conference Center in Oak Brook, Illinois. RIS is the premier event for revenue integrity, revenue cycle, and Medicare compliance education and networking. It is also a great opportunity to elevate your career and highlight your accomplishments by presenting an educational session.

RIS is expanding to three tracks in 2024, featuring a new track dedicated to denials management. Those who are interested in speaking at the event have until January 8, 2024, to fill out an application. Learn more about the application process and review suggested session topics here.

For those looking to get more involved in NAHRI, there are some additional opportunities open right now. NAHRI is accepting applications for  the following two committees:

  • The Networking and Events Committee, which works with NAHRI administration to identify education needs and review RIS applications and materials to align the event with the association’s core mission, the needs of its membership, and the evolving demands of the revenue integrity industry.
  • The Education Committee, which will be focused on tasks related to the upcoming NAHRI Scholarship program. This committee will be responsible for maintaining and updating the NAHRI Scholarship and application process, selecting scholarship recipients from a pool of applicants, and promoting continued education among NAHRI members and the broader revenue integrity community.

The application period for both committees ends on November 30. Apply to either or both committees here.

The NAHRI Scholarship will award registration to RIS. Those who are interested in being among the first to be notified when the scholarship application is released may sign up here.

The annual application period for the NAHRI Leadership Council is also open. The NAHRI Leadership Council is a unique networking platform that supports revenue integrity leaders and helps them stay on the cutting edge of strategy and thought leadership. To quality, applicants must be a revenue integrity supervisor, manager, director, or vice president directly employed by a healthcare provider organization. The application deadline is December 31. Read more about the benefits of Council membership and eligibility requirements here. Access the NAHRI Leadership Council application here.

Troubleshooting KPIs to improve revenue integrity

Following the association updates, NAHRI Advisory Board members Christian S. Gabriel, national director of revenue integrity at CommonSpirit Health, newly formed by the alignment between Catholic Health Initiatives and Dignity Health in Dublin, California, and Caroline Znaniec, MBA, MS-HCA, managing director in Protiviti’s Healthcare Business Performance Improvement Practice, provided insights on troubleshooting KPIs to improve revenue integrity.

Revenue integrity professionals are responsible for a variety of end-to-end revenue cycle functions, such as charge capture, utilization review, or claims management, as well as many sub-process steps. It’s important to understand how all of the pieces across the revenue cycle are interdependent. Znaniec and Gabriel defined interdependence as the following:

  • Stakeholders and stakeholder processes are mutually reliant
  • Trust is maintained to also provide for stakeholder independence
  • Support is given to other stakeholders for the benefit of all

To achieve interdependence, Znaniec and Gabriel recommended identifying stakeholders and defining independent roles and responsibilities. In addition, they believe it’s important to establish an interdependent multidisciplinary committee. When doing so, organizations should consider governance, charter statements, meeting frequency, structured agendas, and reporting.

It’s also important to understand how different metrics and functions affect others. For example, if an organization is experiencing a decrease in point-of-service payment, it should be able to determine not only what is causing the decrease, but also what the decrease will cause.

Znaniec and Gabriel also analyzed the following common areas where KPIs are underperforming:

  • Decrease in coder productivity
  • Increase in discharged not sent to payer
  • Increase in late charges
  • Increase in denials

A recording of the October Quarterly Call is available for NAHRI members here. Stream more past calls here. Listening to or presenting on Quarterly Calls awards one CHRI CEU. Register now for our 2024 series of calls. If you’d like to present on an upcoming call, please contact NAHRI at nicole.votta@hcpro.com.