Q&A: Defining primary functions
Q: What are your organization’s primary revenue integrity functions, and how is this defined? Do you have a formal scope of work?
Kelli L. Howard, MS, CSPPM, senior manager of revenue integrity at Mayo Clinic in Phoenix, Arizona: We do have a [formal scope of work] at Mayo Clinic. We went through a very intense activity a few years back to really take inventory of everything we did and categorize it. Based off that, it helped us to define what our standard core functions are and where there is overlap with other departments, [meaning] shared ownership or collaborative ownership within certain categories. Revenue analysis definitely fits as a top core function. There’s a lot of activity in that space: Charge reconciliation [and] charge capture are another core function. Education is a very large one for us. That education drives primarily back to the practice, but also points over to revenue cycle colleagues and other areas outside of revenue cycle. We do have CDM and fee schedule involvement as a core funtion where we are directing amendments but work in collaboration with our CDM and pricing team, so there’s that shared ownership. Denials liaison is another core function. Lastly payment integrity and work queue maintenance /management are core functions but primarily reside in dedicated sub teams. In summary, revenue analysis, charge capture/charge reconciliation, education, CDM, fee schedules and denials liaison are the core primary functions for our revenue integrity department. We do have several supportive functions identified as well.
Brenda L. Melone, MS, RN, CPC, senior director of revenue cycle at Sturdy Health in Attleboro, Massachusetts: This is a brand-new department. I oversee the hospital revenue cycle as well as revenue integrity for the hospital spaces. We have a very large outpatient footprint as well as for the ambulatory provider side. But the revenue integrity department is very niched, meaning that it’s strictly revenue integrity. What that involves is really charge description maintenance and management strictly. So in other words, anytime new charges come out or [there are] Current Procedural Terminology (CPT®) updates or deletions, things of that nature, this department is responsible for updating our CDM.
Editor's note: Learn more about how revenue integrity programs are defining their primary functions in NAHRI's 2026 State of the Revenue Integrity Industry Report.