Hayes' Healthcare Blog

6 Steps to an Effective Revenue Integrity Program

Posted by Vasilios Nassiopoulos on December 6, 2017 at 9:00 AM

Each year, the American College of Healthcare Executives surveys healthcare industry CEO's, CFO’s, COO's, Revenue Cycle Managers and Compliance Leaders to name their top concerns. For the past 12 years, financial concerns have topped the list.

That should not come as a surprise considering the turbulent environment healthcare organizations face today. Pressure on top and bottom lines, transition to value-based care, growth of consumerism in the industry and tightened oversight by outside entities are forcing healthcare organizations to change the way they operate.

Organizations have been focusing on revenue cycle management for years, but forward thinking leaders are reexamining this siloed approach. They are coming to recognize that ensuring revenue integrity requires considering the entire revenue cycle – front end, mid-cycle, back office – to more appropriately address the challenges they face today.

But where do you start? Here is a six-step process for establishing an effective revenue integrity program.

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Topics: revenue integrity, healthcare compliance

What is Revenue Integrity and Why It’s So Important

Posted by Sondra Akrin and Robert Freedman on October 4, 2017 at 9:00 AM

Google the term “revenue integrity” and you get 790,000 results. Refining it to “revenue integrity in healthcare” narrows it down to 380,000 results. That still doesn’t help much. The fact is there isn’t one, universally accepted definition of the term.

One thing that isn’t in question is the importance of revenue integrity to healthcare organizations in the current difficult environment. Financial challenges headed the list of hospital leaders’ top concerns in 2016, according to the American College of Healthcare Executives annual survey. It was the twelfth consecutive year CEO’s identified finance issues as their most pressing worry.[1]

That should come as no surprise in a time when hospitals and physician practices are facing shrinking top and bottom lines. The crushing weight of financial worries continues to increase because of the many challenges organizations face in the uncertain healthcare landscape.

New value-based care financial models, increased payment responsibility for patients, more intense regulations and the auditing that goes with it and continued merger and acquisition activity are squeezing the resources of healthcare organizations and jeopardizing their overall financial health.

Which brings us back to revenue integrity. According to an HFMA Survey of 125 hospital and health system CFOs and revenue executives, only 44 percent of respondents say their organizations have established revenue integrity programs. This forward-thinking group has benefited significantly. The result of these revenue integrity programs has been a 68 percent increase in net collection, 61 percent overall gross revenue capture and 61 percent reduction in compliance risk. [2]

We know revenue integrity programs are effective, but there are still multiple definitions of what it is. Here are how some healthcare leaders view revenue integrity.

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Topics: revenue integrity, healthcare compliance

Developing the ROI for Your Business Office Consolidation: 5 Key Questions

Posted by Revenue Cycle Transformation Team on September 13, 2017 at 9:00 AM

Merger and acquisition activity, the demand for cost reduction, and the need for better efficiencies have forced many healthcare organizations to implement a business office consolidation. While this may appear to be a logical step to meet the budgetary challenges facing hospitals and physician practices, you will still likely need to justify the disruption and expense of implementing the project. Before taking the plunge, you will need to calculate the ROI for the move.

Here are five questions to ask to help you develop the ROI for your business office consolidation project.

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Topics: revenue cycle management, revenue integrity

3 Benefits of a Data Driven Approach to Billing Integrity

Posted by Robert Freedman on September 6, 2017 at 9:00 AM

Six trends affecting the healthcare billing industry in 2017 have been identified by MedicalBillersandCoders.com. They include the transition from ICD-9 to ICD-10, implementation of CPT codes, evolution of EHR management, the rise of money managers, cognitive computing and onset of block chain technology.[1]

As the healthcare industry continues to evolve, more focus is being placed on revenue integrity. This means more intense scrutiny on every element of the revenue cycle from the front end through the mid-cycle to the back office. No aspect of the revenue cycle is receiving more attention than the billing function.

Organizations must deal with these trends while at the same time ensuring the quality of their billing function. Many rely on auditing to monitor their billing processes and make sure billing departments are being run effectively. However, the key to proper billing is identifying root cause issues and applying appropriate corrective action. Auditing is simply a tool to help accomplish that, not an end in itself.

To ensure billing integrity, organizations must develop a process that is supported by a system. Auditing is only one element of an oversight system that also includes analysis and corrective action. Taken together, this system supports a data-driven approach that can enhance billing integrity. The system should effectively translate patient encounters into proper coding to ensure full payment and maintain compliance – making sure you get to keep what you have collected.

The system ultimately needs to be driven by data, since data gives you analysis that provides insight necessary to implement improvement. Here are three key benefits of a data-driven approach to ensuring billing integrity.

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Topics: revenue integrity, mdaudit, Revenue Cycle Health, compliance risk

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