Defining core functions for revenue integrity

Q: How should revenue integrity’s core functions be defined?

Angela Cummings, MHA, BSN, RN, ACM-RN, director of revenue and documentation integrity at Duke University Health System in Durham, North Carolina: Definitely a robust chargemaster that also monitors the missing charges, such as with Revenue Guardian or whichever charge capture audit tool that you're using. And then I think revenue management by service lines. It's really important that someone has that bird's-eye view of what's going on with charges, receipts, adjustments, write-offs, and really digging into everything that we're adjusting off behind the scenes.

Kelly Henneman, vice president of revenue integrity at University of Maryland Medical System in Baltimore, Maryland: As it relates to any clinical and financial system build, maintenance, testing, and support, revenue integrity has to be integral in those meetings, planning discussions, etc. Because if it's touching charges, if it's mapping revenue to the ledger, if it's making sure things are captured properly, that has to be a revenue integrity concern. There has to be [revenue integrity involvement] related to that integration with clinical and system financial builds.

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