Clinical research studies can offer enormous benefits for patients and provider organizations. But managing charges and submitting claims for clinical research can throw a curveball at revenue integrity teams. Without efficient charge and edit management processes, revenue integrity could find itself striking out.
More than 100 NAHRI members tuned in to hear expert advice on revenue integrity hot topics and get the scoop about exciting new NAHRI initiatives during our second members-only quarterly call on April 24.
There are two parts of maintaining correct audits: ensuring that the charges present on the claim accurately represent the care provided and documented and ensuring the claim is compliant with all applicable billing rules and regulations. One way to ease the process is to review the charges on the claim with an application or tool that can predict errors using the analytics from outpatient Medicare claim data.
Prioritization and time management are crucial when it comes to leading a revenue integrity department.Prioritization and time management are crucial when it comes to leading a revenue integrity department. Kimberly Yelton, RHIA, CCS, CDIP, AHIMA Approved ICD-10-CM/PCS Trainer, and director of revenue integrity at WakeMed Health & Hospitals in Raleigh, North Carolina, toldNAHRIabout her experience with this when planning and following-through with department initiatives.
Tasked with the impossible—reviewing 100% of charges before they go out the door—the revenue integrity department at Yale New Haven Health in New Haven, Connecticut, knows the importance of having a reliable staff to get the job done right.