Q&A: Establishing revenue integrity benchmarks

Q: How can we select and establish benchmarks for revenue integrity?

A: In establishing a benchmark, a healthcare provider organization has various options. These options include using published industry benchmarks (e.g., NAHRI, AHIMA, HFMA, ACDIS), benchmarks based on professional experience, and/or benchmarks developed internally. Benchmarks developed internally provide consistent measures that reflect the organization’s unique processes, staffing roles, and technology. Industry benchmarks, in contrast, are best used as a reference point. It is not expected that the established benchmark will frequently change; the measure that is compared to the benchmark is of greater importance. How does the measure compare to the benchmark? Is the organization underperforming? How does the measure trend in comparison to related measures?

The performance of the related metrics will help identify the root cause of underperforming revenue cycle measures as well as help define the first steps to troubleshoot the underlying issue(s).

Editor’s note: For more information, see “Revenue cycle analytics and the role of revenue integrity,” by Caroline Znaniec, MBA, MS-HCA, in the July issue of the NAHRI Journal. Znaniec is also presenting the session “Analyze THIS! Healthcare Revenue Cycle Analytics and the Role of Revenue Integrity,” on October 8 at 3:20 p.m.–4:05 p.m. Eastern during Revenue Integrity and Reimbursement Strategies: A NAHRI Virtual Event.