Whichever industry you are in, revenue integrity stays crucial. But the question is, how important
it is in healthcare billing services? Understanding revenue integrity that is multifaceted is a
crucial step to its realization. Sustainable healthcare billing services entirely depend on the
involvement of stakeholders from every part of the healthcare organization.
And for that to come in to existence, healthcare organization needs to make a commitment to
transparency. In healthcare billing service companies, revenue integrity is a way of expanding
business and separating organizations that grow and thrive from those that merely survive. By
promoting communication throughout the hospitals, healthcare professionals will be able to see how
their view of revenue integrity coincides with that of other stakeholders.
Every stakeholder at an organization will have unique definition of revenue integrity based on their
perspective.
What is Revenue Integrity in healthcare billing services? Why is it important?
Revenue integrity means using ethical business standards, practices and policies in order to achieve
operational efficiency, compliance and optimal earned revenue payments.
It’s essential for healthcare billing services and healthcare organizations to maintain these three
components and keep them as the top priority.
If healthcare billing services wants the operations to be centered around revenue integrity, then it
should create a specific set of guidelines and procedures for healthcare professionals, employees
and especially for revenue cycle management teams.
Healthcare billing services or organizations can also include coding services in a way that provides
and optimizes legitimate reimbursement.
If the organization is compliant in medical billing and coding services, the risk of external audits
and payment denials will be less. At the same time, it saves time and money for the entire
healthcare billing services company.
A better revenue integrity program will also catch underpayments as well as over payments.
Revenue integrity is critical to ensure accurate revenue in coding and charge capture. It is also
reasonable for services provided, and that complies with laws and regulations.
If any of the healthcare billing services or healthcare organizations are yet to imply revenue
integrity, they must hurry in doing it.
In a survey, about 125 hospitals and health system CFOs along with revenue executives of nearly
one-quarter (22%) cited revenue integrity as their top priority.
But 44% established revenue integrity programs in their organizations. Those organizations that have
implemented the programs have experienced eye opening results.
The results stated:
68% Increase in net collection
61% overall gross revenue capture
61% reduction in compliance risk.
Without an establishment of revenue integrity, revenue cycle performance will not be as effective as
it should be.
According to Jake Morris, managing director at a healthcare organization, “Revenue integrity is a
bond that binds clinical operations along with coding and billing functions. It’s also proven that
healthcare professionals with established revenue integrity programs benefit and expand their scope
that yields long-term financial reporting reliability and operational efficiencies.”
Another way of understanding revenue integrity is by imagining revenue cycle as the vehicle that
drives the entire organization and revenue integrity is the steering as well as the windshield that
healthcare billing services look through to drive.
How to achieve revenue integrity in healthcare billing services?
Though many organizations have learned about revenue integrity, there is a big question mark in
their minds, how to achieve it?
Initially, a successful revenue integrity program requires stakeholders from every part of the
organization. Transparency as well as communication acts as vital role to any revenue integrity
program.
Healthcare billing services must work on the reimbursements carefully and properly for the services
rendered by healthcare professionals.
Revenue integrity requires healthcare organizations to comply with legal and contractual policies
and ensure if they are ready on that.
Simultaneously, revenue integrity is also about balancing the desire to increase revenue payments
accompanied with responsibility to comply with rules.
Keeping up with the legal and contractual compliance that’s complex in nature, achieving it isn’t
that easy and would need the support of each and every employee of the organization.
Reasons to achieve revenue integrity in the organizations include:
Reduces the risk of external audits.
Reduces denials of payments.
These both reasons save time and money for the entire healthcare billing Services Company or
healthcare organization. The major goal of achieving revenue integrity would be setting a right path
for operational efficiency, compliance and optimal revenue payments through ethical business
practices and policies.
It’s much more possible to achieve revenue integrity with the help of accurate processes, innovative
tools and expertise.
How technology helps to meet revenue integrity goals?
Technology, of course, pay a crucial role in helping healthcare organizations to maintain processes
that aligns with revenue integrity goals.
As an example, automated revenue cycle management solutions can set space to the office staff, so
that healthcare professionals can concentrate more on patients.
Automatic scanning also can enable office staff to analyze medical coding before submitting the
claims to insurance companies.
In addition to it, comprehensive automated Medicare reporting and analytics provide greater insight
into healthcare billing services as they easily can spot medical billing issues that negatively
impacts Medicare claims and follow up efforts.
By checking the eligibility in real time right from the Medicare system can actually can stop
revenue halts before they arise.
With the help of innovative tools, it’s always possible to clear up organization’s finances and
encourage revenue integrity.
How do various stakeholders review revenue integrity?
For a Quality officer, patients are the center of revenue cycle. To achieve revenue integrity,
quality officer has to ensure that patient experience along with quality of care and requested
reimbursement is reflected accurately in the bill.
True revenue integrity depends on strict rules and regulations. It’s the compliance officer’s
responsibility to develop reports that show how new regulatory developments impact the healthcare
organization’s processes and entire
revenue cycle management, and work
with each stakeholder accordingly.
The coding team also focuses on compliance. Coding director must support coding staff and clinical
documentation improvement programs that align with revenue integrity.
Healthcare professionals play an important role in revenue cycle process. The billing process
actually starts with their documentation. Healthcare professionals have to optimize patient
engagement by accurately documenting care and quality measures, and interfacing with the coding
department, if necessary.
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