Revenue Integrity (RI) in healthcare is essential to ensuring that all revenue cycle processes are accurate, compliant and efficient. While RI can exist in the form of a department, role or organizational initiative, its sole purpose is to ensure that healthcare organizations receive accurate payments for the services they provide while minimizing compliance risks, reducing claim denials, and avoiding revenue loss.
Just as integrity, in a broader sense, is associated with trustworthiness, dependability and an adherence to set standards, revenue integrity is associated with dependable billing and coding practices that meet both regulatory and patient standards.
RI is essential to healthcare organizations’ financial sustainability and, ultimately, patient care. And with proper oversight and a holistic approach, it’s something you can achieve. Below are areas to consider as you work to establish and maintain revenue integrity.
Complete Documentation
Central to RI is the complete documentation of services rendered to patients. This assists in accurate coding, which includes the precise use of CPT and ICD-10 codes to reflect the provided services.
Claims Management
Once coding is completed, effective claims management is imperative, ensuring that claims are submitted promptly and any issues are resolved quickly to avoid delays or denials.
Continuous Training
Staff adherence to regulatory standards and payer requirements is essential to avoid denials and compliance issues and maintain RI. This makes ongoing education and training for staff especially important, particularly in the areas of billing practices, coding updates and compliance.
Data Monitoring
RI relies heavily on data analytics. By leveraging data to monitor trends, spot discrepancies and streamline processes, organizations can improve their revenue cycle and address the root causes of denials – ultimately enhancing RI.
Revenue integrity is not a one-and-done endeavor, but rather an ongoing process to protect your organization from compliance risks, claim denials and revenue loss. If you have questions or concerns about your revenue cycle or billing practices, our team is here and happy to help. Please reach out to start a conversation.
Gina Nuske is a Managing Director, RCM & Operations at Medic Management Group. She is responsible for oversight of MMG’s Revenue Cycle Division which provides outsource RCM services to clients including medical billing, coding and provider credentialing. MMG is a national provider of advisory and consulting competencies, transaction support services, and back office administrative support to independent and system owned physician practice groups.