Although patient care remains the primary concern during COVID-19, the financial effects of the crisis will linger for many months afterward. Maintaining good UR discipline may help hospitals emerge from this emergency in better financial condition and able to better serve their populations.
For the third consecutive year, NAHRI is hosting Revenue Integrity Week to celebrate the hard work, dedication, and remarkable achievements of revenue integrity professionals across the country. As part of Revenue Integrity Week, NAHRI takes an in-depth look at trends across the industry with the 2020 State of the Revenue Integrity Industry Survey Report. The survey explores the roles and responsibilities of revenue integrity professionals, their backgrounds, and the key functions of the job.
Get your team together for a round of Revenue Integrity Family Feud! The game can be played virtually. All questions and answers are based on the 2020 State of the Revenue Integrity Industry Survey Report, so be sure to review the report before setting up your game.
Q. Nearly 20% of respondents use a vendor-built tool integrated with their EHR to identify revenue leaks. What kind of revenue leakage should revenue integrity aim to identify through the use of this technology?
A. Vendor-built tools can help identify revenue leakage in multiple clinical areas. When starting with a new tool, create a plan to address your hospital’s high-dollar or high-volume areas, as well as specific areas of known concern.
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.
