On June 11th, we posted on our social media about honoring something called “Revenue Integrity Week”. This might seem like just another thing to commemorate, like National Lemonade Day (May 2), or National Nail Polish Day (June 1). Of course, while we have nothing against either lemonade or nail polish, as a leader in revenue cycle management, we are partial to revenue integrity and spotlighting its importance. We thought with this blog we would do that, explaining why it matters and how to determine the quality of a revenue integrity program.

What is Revenue Integrity?

Revenue integrity in healthcare ensures that all clinical encounters between providers and patients convert into revenue, by using systems and procedures that focus on effectiveness, compliance, and optimal compensation for services. As a part of revenue cycle management (RCM), it means that what is delivered is being billed and that what is billed is being delivered. All compensation owed should be captured in the most exacting and efficient ways possible.

Why is it important?

As with any business, ensuring correct compensation for services or products supplied is crucial to survival. If every day’s labor is not completely compensated, it makes it more difficult to compete. This difference between what should be paid and what is being captured is referred to as “leakage”. The metaphor is apt: imagine during freezing weather if a practice had their furnace turned up, yet in one or more rooms, unknown to everyone, windows or even doors were open to the harsh elements! Everyone now must work harder to achieve something that should take less cost and effort. By plugging these metaphorical holes, revenue integrity allows the providers to focus on delivery of service and positive outcomes with less exertion.

How is it achieved?

Revenue integrity should be achieved in a variety of ways, since reliance on only one solution can allow leakage. First, the simple act of creating, or employing, a revenue integrity system and manager is crucial. Next, utilizing automated processes are essential, due to their unwavering accuracy and speed. As bar codes and scanners made the checkout lanes at groceries less error-prone, so does automating the RCM ecosystem wherever possible. However, it is imperative to analyze all data relating to charges, encounters, and procedures against the billing. This is done through continual auditing. Targeted audits are valuable as well, which can be used to hone in on a specific area, process, or department of concern. Just as bar codes only work when things are being scanned by the cashier, the automated processes must be checked for correct inputs. Finally, reporting and automated reports are key components that should not be overlooked. There are many robust solutions that offer extensive documentation for this requirement. Returning to the example of the practice we described above, with areas exposed to harsh temperatures, these reporting tools would act like strategically placed “thermostats”, offering continual feedback and ensuring consistency throughout the site.

How can you ensure the integrity of a revenue integrity system?

As with any improvement process, there is the need for constant monitoring and adjustments, because of all the variables that are continually introduced to the system. These include new employees, regulatory, billing, patient, and procedural changes, or even just oversights and errors. Although the leakage rates sometimes dramatically decrease after initially implementing an RCM or revenue integrity system, the work should never be considered “complete”. In fact, a good measure of the system’s integrity can be measured by regular and subsequent leakage decreases, no matter how modest. As in our metaphor of the “drafty practice”, closing the doors and windows will be significant, but the smaller fixes, such as insulation, can really add up as well.

Advantum Health’s RCM team has a revenue integrity specialist team that plugs these holes, manages the reporting, audits, and analyzes the data for the practice, stopping revenue leakage however it escapes, and allowing the provider to focus on healthcare.