Revenue Integrity: Healthcare’s Growing Need

Revenueintegrityensuresthatallclinicalencountersbetweenprovidersand patientstranslatetorevenue.Toaccomplishthis,allworkflowcomponents andprocesses,fromclinicaloperationstobilling,areanalyzedtoensurethey areintegrated,efficient,andcompliant.Revenueintegrityisimportant becauseitensurestherevenuecycleisoptimizedandcompliant,andthat processesareefficient–eliminatingrevenueleakage.

Inatimewhenhospitalsarefacingshrinkingmargins,increasedcosts,slower reimbursements,andhigherdenials,containingrevenueisessential.Asthe industrylookstotransitionfromICD-10toICD-11andthecodingcomplexity increases,thereisagrowinglikelihoodthatdaysinA/Rwillalsoincrease.For healthcareorganizationsusingAItoolssuchascomputer-assistedCDIand computer-assistedcoding(CAC),theA/Rriskislower;however,other externalforces,suchasinflation,willcontinuetoputpressureonprofit margins–hinderingorganizations’abilitiestoadvancetheirmissions.

Revenue Integrity Programs

Manyhealthcareorganizationsareimplementingrevenueintegritypolicies andguidelines.InarecentHFMAsurveyof125healthcarefinanceexecutives, revenueintegritywasnamedthetoppriorityfor22%oftherespondents' organizations,butlessthanhalfofthoserespondents(44%)havecreated revenueintegrityprograms.

Forthoseinterestedincreatingarevenueintegrityprogram,identifyaleader withextensiveknowledgeofcompliance,operations,andbillingdepartments. Thispersoncanspearheadtheprogram.Duetothedivisionofpeople, processes,andplatforms,thesethreedepartmentsarefrequently undermined.

Foryourrevenueintegrityprogramtobeaseffectiveaspossible,theremust befluiditybetweenthesedepartmentsthroughouttheentirepatientcare process.Butoncearevenueintegrityprogramisimplemented,theresultsare considerable.

ArecentHFMAsurveyfoundthatofalltheorganizationsthatparticipatedin thestudyandimplementedrevenueintegrityprograms,68%sawanoverall increaseinnetcollections,61%overallgrossrevenuecapture,anda61% reductionincompliancerisks.

Key components of revenue integrity programs include:

• Examineeverystepofyourworkflow,frombillingtoclinical operations,toensuretheyarecompliant,effective,andfluidthroughout thedepartments.

• Proactivelymanagedenialsastheyleadtosubstantialrevenueleakage.

• Ensurerevenuecyclecomponentsareintegratedandfunctioning.

• Useadvancedtechnologysuchasautomation,artificialintelligence(AI), andmachinelearningtominimizehumanerror.

Revenueintegritycanreassurehealthcareexecutivesthattheirrevenuecycle ishealthyandcompliant,andleakageiseliminated.Anunhealthyrevenue cyclecancosthealthcareorganizationsmillions.

Therighttechnologycanchangeeverythingaboutrevenuecyclemanagement, frompredictiveanalyticsthathelpssolveproblemsbeforetheyoccur,to intelligentautomationthatremovesmonotonoustasksanderrors.Withthe helpofAGSHealth’srobustautomationrevenuecyclemanagement technology,weensurehighrevenueintegrityoutcomeswhileyourstaff concentratesonwhatmattersmost–providingexcellentpatientcare.

Source of content: AGSHealth Blog - Revenue Integrity: Healthcare’s Growing Need