Find the right fit for revenue integrity at your organization

There’s no one-size-fits-all revenue integrity department structure. Finding the right revenue integrity fit for your organization can be challenging. Even for a well-established revenue integrity department, changes in the organization, the department’s mission, or staffing might call for a department retailor.

To find what works for your revenue integrity department, turn challenges into opportunities and use the organization’s mission as a pattern, says Chelsea Raukar, RHIA, manager of revenue integrity at Hennepin Healthcare in Minneapolis.

When Raukar was brought in to manage the revenue integrity department, she knew she would be leading a department in transition. Hennepin’s revenue integrity department was a standalone department led by a director of revenue integrity who reported to the vice president of revenue cycle. The team consisted of a revenue integrity manager with six revenue integrity analysts and three charge capture specialists. But when the director of revenue integrity left, that presented a gap—one that Hennepin’s leadership opted to take as an opportunity to evaluate the revenue integrity program and its place in the organization, Raukar says. Leadership began looking into whether the standalone structure of the revenue integrity department had caused it to become siloed, leaving it out of step with related departments, including coding and HIM, and missing opportunities to collaborate.

“It was a structure thing that caused problems with our ability to collaborate and get everyone on the same page,” Raukar said. “We want to work with each other, not against each other.”

Hennepin’s director of middle revenue cycle, Jessica Johnson, proposed moving revenue integrity under the umbrella of middle revenue cycle. Once the executive leadership team gave the green light, Johnson assumed responsibility for the revenue integrity department. Staffing changes had left a manager position vacant, so Johnson took the opportunity to invest in her current leadership team by asking Raukar to take on the revenue integrity manager position.

Raukar’s experience helping teams through transitions made her an ideal candidate for the role. Prior to becoming the manager of revenue integrity, she was Hennepin’s manager of professional fee coding reporting through middle revenue cycle. In that role, she led a restructure that merged coding liaisons from the documentation integrity team with her team of professional fee coders. That realignment allowed Hennepin to unify its documentation education, apply coding and documentation guidelines consistently, and improve collaboration.

As part of the revenue integrity restructure, coding liaisons were also brought onto the revenue integrity team.

Johnson’s goal for the revenue integrity restructure was to foster a culture of inclusiveness and cross-departmental alignment. As the department’s work was evaluated, Johnson and Raukar noted similarities between the coding liaison and revenue integrity analyst roles. They used this information to create efficiencies and leverage the staff members’ expertise to rebuild the revenue integrity program. Among the areas of crossover were shared workflows and Current Procedural Terminology code updates. By placing the right people in the right roles at the right time, Johnson and Rauker identified ways to leverage the skills of both revenue integrity analysts and coding liaisons while ensuring consistency in their work.

Under the new structure, the revenue integrity department has two branches reporting to Raukar: coding liaisons and revenue integrity analysts The former team is made up of six coding liaisons under a coding liaison supervisor. The coding liaisons are split up by specialty and provide coding and documentation education and support for providers in their specialties. The revenue integrity analysis team consists of five revenue integrity analysts and three charge capture specialists under a revenue integrity analyst supervisor.

A sixth revenue integrity analyst was moved to the contracting department and is now responsible for pricing strategies. This is a relatively new role that is still in development.

“We wanted to make sure that we’ve got someone who’s able to focus on not only the cost reporting and keeping those relationships fostered with the clinical areas but translating that into pricing strategies when we’re doing our annual updates,” Raukar says. “Making sure that we’ve got solid pricing strategies in place is going to be something that contracting is going to be able to leverage when they’re having those conversations with our payers. So that role is reporting under contracting but working closely with us to maintain our files and our charge description master.”

Although the changes have benefitted the organization, it’s been a major adjustment for the revenue integrity staff. Leading a team through a restructure isn’t easy, Raukar says. Managers who find themselves in that situation should keep in mind that their attitude sets the tone for their staff. Set a positive example and help staff focus on the goals that unite them. Take time to invest your staff, build and maintain team culture, and support your staff members as they adjust.

As the revenue integrity department settles into its new normal, Raukar is looking for more opportunities for improvement. The top items on her to-do list are to implement organizationwide revenue reconciliation, clean up work queues, and establish revenue integrity metrics and key performance indicators that will effectively monitor performance and be meaningful to her staff.

Raukar is considering separating the work queues primarily handled by the revenue integrity analysts from those managed by the charge capture analysts. She’s also looking into creating a separate work queue to track days in accounts receivable. These work queue adjustments would help the department track work and drill down into the root cause of issues that hold up accounts.

“Really what I want to do with the analysts and their work queues is do a deep dive into what’s falling in there,” Raukar says. “Because if we work those backwards and get to the root cause we can address it through education and partnering with the right people. The goal would be to prevent anything from falling in there at all outside of standard work. I see us as analysts, collaborators, and educators versus project managers.”

As revenue integrity’s role at Hennepin is further defined and clarified, Raukar believes the fit will be even better.