Revenue Integrity

Improved revenue begins with mid-revenue cycle management. For immediate revenue lift, look toward a pre-bill MS-DRG review process. 

In times when many hospitals and health systems will face negative margins, employing activity-based costing principles that support a value-based healthcare economy provides essential information for healthcare leaders. Using this method to understand expenses associated with providing care exposes process inefficiencies, as well as capacity, across your value cycle. This is information that will help future-proof your organization.

When revenue integrity departments emerge from the revenue cycle, they often start out small. Filling your staff with key players is critical—every person has a role in ensuring the compliance and operations of your revenue integrity team. There’s no room for dropping the ball.

Once approval is given to launch a revenue integrity function or department, the program must be staffed to achieve its goals. In today’s healthcare world, roles in revenue integrity are popular. A recent scan of a popular recruiting website revealed nearly 9,500 revenue integrity position listings. The position titles ran the gamut, including auditor, analyst, assistant director, director, educator, liaison, manager, nurse, and specialist. Clearly, the revenue integrity role is broad and in need of professionals to fill a plethora of positions.

As summer winds down, many organizations see themselves planning and budgeting for the year ahead. Revenue Integrity and Reimbursement Strategies: A NAHRI Virtual Event is your key to ensuring you are well versed in regulations that will impact the upcoming year and have made professional connections that can help you navigate these complexities.

UnitedHealthcare’s (UHC) plan to require in-network, freestanding and outpatient laboratory claims to contain a unique code for most lab testing services is poorly timed and poses significant implementation hurdles, the American Hospital Association (AHA) said in an August 14 letter.

Learn tips to identify denials that are most likely to result in successful appeals and discover methods for monitoring and tracking your appeals process at Revenue Integrity and Reimbursement Strategies: A NAHRI Virtual Event.

Q: What tasks and policies should be covered in a charge capture audit process?

As outpatient care increases, providers are exploring the many benefits of dedicated pre-bill technology to proactively manage coding accuracy and revenue integrity from this growing business.