Q. Most respondents (35%) stated that operational departments are responsible for reconciling their own charges with regular support from revenue integrity. What recommendations do you have for revenue integrity team members and operational departments involved in the charge reconciliation process?
A. I think 35% is a great start; however, I would encourage all revenue integrity teams to work directly with the operational leaders to design and support charge reconciliation at the cost center or department level for 100% of revenue-producing departments.
Q. Nearly half (48%) of respondents structure their chargemaster maintenance by assigning a team to this responsibility. What should teams be aware of when maintaining their chargemaster?
A. Chargemaster teams should have representation from various areas, including ancillary departments, compliance, coding/HIM, finance, physician leadership, if possible, and of course, revenue integrity. These teams should be cognizant of the changing healthcare landscape both internally and externally—this year especially due to COVID-19—and the impact this has had or may have on chargemaster structure, pricing, charge capture, and overall compliance. Moreover, they should be positioned to take a proactive rather than reactive approach to the constant barrage of data, new code sets, and shift to a “hospital without walls” mentality.
Q. The percentage of respondents who have dedicated revenue integrity staff members has remained at 68% from our 2018 Industry Survey to our 2020 Industry Survey. Do you see a need for additional facilities to bring revenue integrity staff on board?
A. Yes, I am surprised that there has not been an overall increase. However, the amount of consolidation in the last two years could be why we haven’t seen a shift at a facility level.
Q. Nearly 85% of respondents hold one or more credentials. What value can credentials bring to revenue integrity professionals and the overall state of the industry?
A. Credentials are a great way to demonstrate proficiency and understanding that sets one apart from their peers. Adding a professional credential can especially aid the addition of more junior staff to a growing industry such as revenue integrity where their knowledge is obtained on the job more than a classroom. Adding a credential supports the knowledge obtained but also enforces how to translate that knowledge in a broader perspective.
Adirondack Health came to TruBridge after discovering they could save money over their previous clearinghouse. Due to the seamless integration to Meditech as well as other product capabilities, the several benefits revealed themselves.
Q: Under the introductory section of the CPT Manual’s Organ or Disease-Oriented Panels section, third paragraph, it is stated, "Do not report two or more panel codes that include any of the same constituent tests performed from the same patient collections." I am seeking clarification as to whether this literally means the same blood specimen collection or if it more generally means the same date of service (DOS) collection. In the hospital setting sometimes constituent tests are performed on the same DOS on an outpatient encounter, so it might lead one to report an applicable panel code. However, sometimes the constituents are not ordered at the same time, and the tests might be run from separate blood specimens drawn at different times, but still on the same DOS. Is there any guidance or reference that could clarify this?
Calling all Revenue Integrity Investigators! Revenue Integrity Week (June 1‒5) is just days away and NAHRI has a lot in store to ensure we all recognize the dedication of revenue integrity professionals while taking some time for education, networking, and most importantly fun.
