It’s a Fact: Revenue Integrity Programs Increase Net Revenue

Is your revenue integrity program performing at full capacity?

Perhaps more important, do you have a revenue integrity program (or department) at all?

A survey conducted by the Healthcare Financial Management Association (HFMA) reports that less than half (44%) of providers contacted have a revenue integrity department to track accurate coding and charge capture, establish reasonable pricing for services, ensure legal and regulatory compliance, and develop effective financial reporting. Yet those that have established revenue integrity programs have realized an overall increase in net revenue.

So where is the disconnect?

The hearts, minds and resources of hospital and health system CFOs and revenue-cycle executives are often in the right place. Many organizations focus on technology to drive their revenue cycle management (RCM) improvements. Others focus on physician and clinician documentation, business intelligence and analytics, EHR workflow and reporting, self-pay management, coding, labor utilization, staff training and incentives.

Any and all of these initiatives are likely to add value through increased efficiencies, improved functionality and workflows, and stronger buy-in from physicians, professionals and staff. But unless there is a concerted, consistent, comprehensive and committed approach to revenue integrity, such gains are likely to be limited and possibly even short-term in nature.

What can a revenue integrity department or program offer your organization?

• Shorter accounts receivable cycles
• Accurate charge capture
• Fewer claims denials
• Better cash flow, with a focus on high-value claims
• Reduced overlap and redundant effort
• Higher-quality reporting

Written by Mark Spehar, CPA, FHFMA, PMP, CGMA, Senior Vice President, Financial Services at Panacea.

To learn more about how Panacea can help you establish and implement an effective revenue integrity program, please contact Mark Spehar at mspehar@panaceainc.com.