KPIs: Follow payment integrity for revenue integrity success

Monitoring revenue key performance indicators (KPI) is a hallmark of an established, high functioning revenue integrity program—and provides a crucial glimpse into the health of the organization. That’s especially critical as organizations fight to recover from the impact of the novel coronavirus (COVID-19).

At Sanford Health in Sioux Falls, South Dakota, payment integrity—appealing and recovering contract underpayments—is an important metric, according to Kim Amundson, MS, RHIA, senior director of revenue integrity at Sanford Health. Amundson uses the payment integrity KPI to monitor additional dollars recovered each month for the organization.

“We have a dashboard that shows our appeal and recovery metrics and displays them month to month so we can compare over time,” she explains.

The payment integrity dashboard was developed in-house and lives outside of Epic. At a high level, the dashboard contains hospital-based and professional fee-based data on separate tabs and displays the total number and dollar amounts of appeals and recoveries. Amundson can then drill down to see appeals and recoveries by user, as well as by location or service area. In addition, the top three payers are listed for appeals and recoveries. The payment integrity dashboard helps monitor the department’s success and ongoing work to capture as many recoveries as possible.

The dashboard is shared with the vice presidents of finance on a monthly basis for each of Sanford Health’s markets, Amundson says. The dollars recovered are also reported on the organization’s system level and regional level revenue cycle scorecards.

Amundson credits her revenue cycle analytics staff with helping the revenue integrity department, and the entire revenue cycle, report on their KPIs. The revenue cycle analytics staff report directly to Amundson and provide crucial support by maintaining and creating dashboards and generating ad-hoc reports for the various teams.

“They support not only revenue integrity but all of revenue cycle as far as reporting needs,” she says. “They’re integral to our KPI metric reporting and provide a valuable service to our revenue cycle as a whole.”