Revenue Integrity is the Next Step in the Evolution of Revenue Cycle Management

Revenue Integrity is the Next Step in the Evolution of Revenue Cycle Management

In today’s modern healthcare industry, details matter—a truth perhaps most keenly felt in the revenue cycle management departments of hospitals and healthcare facilities across the country. However, attention to detail becomes increasingly complex as the industry continues to evolve at breakneck speed, challenging hospitals to increase revenue and meet ever-changing regulatory demands amid shrinking reimbursement rates and the move to value-based systems of care.

In fact, a new survey of 100 healthcare executives from Porter Research asked C-suite leaders about the top challenges facing their health system. Sixty-two percent of respondents ranked declining reimbursements as their top challenge, followed by 53% who cited patient experience and 48% nominating maintaining and upgrading IT equipment.

Though inter-organizational processes, workflow or technology shifts can be intimidating endeavors, the need to remain competitive and keep hospital doors open is compelling many healthcare providers to invest in revenue integrity solutions.

However, one distinct advantage not often discussed is the fact that revenue integrity is a truly evolutionary process, one that does not call for a complete operational overhaul. This means that healthcare organizations can develop and propel their revenue integrity department or program at their own pace, taking into careful consideration their unique challenges, limitations or needs.

And that’s good news considering the vast differences in revenue integrity stages that hospitals and health systems may find themselves; for instance, many are still unsure of how revenue integrity fits within their organization. According to a recent HFMA survey of 125 healthcare finance executives, 22% identified revenue integrity as the leading priority for their organizations, but only 44% have established revenue integrity programs.

Similarly, some providers may still use paper-based processes in their revenue cycle. A 2016 HIMSS Analytics survey showed that 31% still relied on manual processes to manage claim denials.

While the central goal of any revenue integrity program is to balance the drive to increase revenue with regulatory compliance, goals between organizations may still differ. For instance, workflow optimization and reduction of accounts receivable days may be primary concerns for one facility, while responses to third-party audit requests and improvement of documentation and charge redundancy may be top objectives of another.

Consider too the fact that the National Association of Healthcare Revenue Integrity (NAHRI) offers certification credentials and provides resources for launching revenue integrity departments or programs, but there is no established industry standard for revenue integrity design.

This inherent flexibility and lack of definition allows healthcare organizations to evolve in their own terms and at their own pace, while also watching for shifts in revenue integrity best practices. Implementing any revenue integrity initiatives or launching a revenue integrity department should be precisely tailored to meet the needs of your hospital or healthcare organization.

Though the revenue integrity process is an evolutionary one, this does not mean that there isn’t an element of risk in waiting too long to act. Instead of relying on a reactive approach to your revenue cycle management, resolve to take a more proactive approach with RI to deliver cost-saving solutions, reduce denials and optimize your workflow.