Revenue integrity professionals are front and center as HealthStream joins the National Association of Healthcare Revenue Integrity to celebrate Revenue Integrity Week.
This is the time to honor the professionals whose diligence and dedication ensures the smooth operations of healthcare providers across the entire patient-care continuum. It’s also a great opportunity to discover ways to help them increase efficiency and performance, says nThrive, a HealthStream partner providing healthcare entities the payment-infrastructure and revenue-cycle resources needed to fully support their operational goals of providing outstanding care.
A recent nThrive blog offers that “Making improvements to the revenue cycle is an evergreen effort for healthcare providers who understand the importance of continual outcome growth and patient satisfaction. Key to strengthening revenue cycle performance is a strong revenue integrity program.”
There are seven key strategies in the middle of the healthcare revenue cycle—primarily within Clinical Documentation Improvement (CDI), Charge Description Master (CDM), and Charge Capture Audit or Improvement (CCA or CCI). These following strategies can result in accurate and true reimbursements, consistent compliance, and positive quality reporting:
Clinical documentation quantifiably affects the revenue cycle. DRG assignments and medical coding affect medical billing and, if assigned erroneously, can lead to denied claims or inaccurate reimbursements. How thorough is your physicians’ documentation?
In a typical CDM, about 30 percent of items are coded and about 70 percent are not, creating the potential for lost revenue. It is possible that some non-coded items should be coded, and valid codes are only half the answer to a best-in-class CDM. The other half is ensuring codes are correct, which can be an overwhelming task given their number and constantly changing nature.
Most patient accounting systems lack the ability to link the cost of supplies to the CDM, resulting in missed revenue opportunities. Disparate databases and operating silos, however, are not acceptable when every dollar counts.
There is plenty of healthcare pricing data available publicly; the problem is that most of it is 12 to 18 months old. To establish a defensible pricing strategy, your health system is better served by accessing current, relevant data that enables custom comparison-to-market pricing results. This helps a healthcare organization quantify the revenue impact of pricing scenarios and establish your audit trail to substantiate pricing changes. A sound pricing strategy compares pricing to CMS, national, state, hospital, and custom benchmarks; cost and relative value unit (RVU Medical Data), and fee schedules. New codes should be introduced in your system annually.
The CDM is a complex, dynamic part of the revenue cycle that must be continually tracked, updated, and accessed by multiple departments. Manual processes that are inefficient and error-prone can lead to delayed or incorrect reimbursement; it is essential to improve performance through automation. With automation, staff can request changes and additions to the CDM, streamline approval and tracking processes, consolidate multiple CDM information sources, and track and audit requests status and change history.
A charge capture improvement program automates the review of 100 percent of patient bills to look for missing charges, overcharges, and coding errors on services rendered before claims are submitted. When errors are found, the technology suggests changes, quantifies potential revenue impact to aid prioritization and connects the right parties to solve problems before billing—thus avoiding rework and late charges. Best practice processes and reporting open the door for the revenue integrity staff to identify trends upstream in the billing process so they can prevent future issues—an important feature in adapting to regulatory changes.
A charge capture-improvement program does what a thousand nurse auditors cannot: Using guidelines from multiple sources to provide standard and custom rules, it implements as-needed rule modifications, adds new rules regularly, and maintains the specialized coding rules, including Medicare Recovery Audit Contractor focus areas.
“Fix your CDI and Charge integrity issues and you improve revenue integrity,” nThrive advises. “Improve revenue integrity and enhance your revenue cycle, positioning your organization to step up your quality of patient care and health solutions—a critical differentiating factor in this value-based healthcare arena.”
For these reasons and many others, the importance of revenue integrity, and supporting those tasked with it, cannot be overstated, adds Susan Gurzynski-Wells, MS, RHIA, Senior Product Manager, Revenue Cycle, for HealthStream.
“Revenue integrity aligns for all hospitals with the need to be ethically mindful and morally upright,” she says. “While being fully compliant in coding and billing practices, this reduces the risk of costly downstream efforts, such as managing external audits and even payment denials. Revenue integrity brings operational efficiency and workforce harmony.”
HealthStream honors and applauds the hardworking revenue integrity professionals, in every organization, who rise to the complex challenges of their profession every day. Supporting them with the best tools and platforms is paramount to their success.
For more information on HealthStream’s Revenue Cycle Solutions. click here.
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