Healthcare revenue integrity expertise… Our time has come!

by Elaine O’Blenness, MBA, RHIA, CDIP, CHRI, CHP, CRCR

Healthcare revenue integrity has been defined by NAHRI as follows: “the basis of revenue integrity is to prevent recurrence of issues that can cause revenue leakage and/or compliance risks through effective, efficient, replicable processes and internal controls across the continuum of patient care, supported by the appropriate documentation and the application of sound financial practices that are able to withstand audits at any point in time.” 

While that certainly describes the aims, I see healthcare revenue integrity as the composition of all parts of the revenue cycle fitting together in an optimal way in very much the same manner as the clinical parts of the patient’s care fit together for the best outcome. Thus, I feel that effective healthcare revenue integrity requires that all areas of patient access, case management, health information management, charge capture, clinical documentation improvement, medical coding, patient accounting, compliance, and healthcare contracting fit together in an optimal and accurate manner for each and every patient encounter to assure the financial health of the patient care organization. 

For many years in healthcare, we have been auditing each of these processes, but from my experience these audits have been done separately and not in an organized and integrated manner. As we move forward with an integrated analysis acknowledging that each part of the revenue cycle impacts the others, we will be able to improve the operations of each part and in the end improve the financial health of the enterprise.

The new CHRI credential offered by NAHRI will ensure healthcare organizations that their credentialed employees have expertise and knowledge in each of these areas and will be able to analyze healthcare financial operations to ensure that the organization is legally and ethically obtaining the correct reimbursement for patient care services.