Revenue integrity staff can better understand systemic issues and deploy efforts to correct the root causes.Īligning with outsourced business partners By doing so, organizations can improve efficiencies in claims processing, improve timing to collect, reduce the cost to collect, and lessen the burden of claim corrections on staff. Organizations are using predictive analytics to proactively identify potential areas of revenue loss before a claim is processed. Technology can support organizations in centralizing and organizing data, allowing for greater transparency in revenue cycle performance.

Using technology to monitor quality and productivity

Opportunities in automation include review for underpayment and payer payment integrity, charge reconciliation and monitoring, rule-based charge capture reviews, and routing of exceptions to appropriate stakeholders. Organizations are looking to automation within the revenue cycle to reduce redundant tasks, increase productivity, and allow revenue integrity staff to focus on more complex issues. Leveraging automation to augment staffing Rather than replacing staff, they are renewing their staff with the needed skills to support revenue integrity functions and develop a career path. By realizing the potential of their existing workforce, organizations can increase their retention while also meeting their business goals. With the staffing shortages, provider organizations are looking internally to leverage the potential of their workforce to work across various roles. Short-term strategies to identify lost revenue are more of a priority as patient volumes and service offerings are recovering. A well-defined revenue integrity workplan set pre-pandemic may not have the same relevance today. Delays have been the result of impacts to service and payer mix, coupled with regulatory shifts. Provider organizations have found that priorities in the assessment and optimization of processes have been delayed throughout the pandemic. It is within the role of revenue integrity professionals to ensure that every chargeable procedure, item, or service is identified, captured, billed, and paid according to the terms of government and industry guidelines and payer contracts. Activities within revenue integrity are expected to focus more on process improvement and include those underlying processes most integrally involved in the front-end, middle, and back-end revenue cycle processes. Tasks may include those related to reviewing and releasing individual claims, abstracting procedural and diagnosis codes, and reconciling daily charge activity. Too often, revenue integrity professionals are pulled into daily operational tasks that prevent them from proactively identifying opportunities for improvement. Organizations have met the challenge in revenue integrity staffing through various strategies.Įffective models of revenue integrity clearly define scope and set boundaries. The overall need for qualified staff has certainly been difficult to fulfill. Throughout the pandemic, staffing shortages across healthcare have been highlighted as a top concern in clinical and nonclinical functions.

Integrity staffing