Revenue Integrity: Leveraging Data to Enhance Collaboration Across the Revenue Cycle
In today’s complex healthcare environment, hospitals and health systems and other provider organizations have little room for error within the revenue cycle. Faced with tight margins, growing labor and supply costs, and volatile markets, every dollar counts. Revenue integrity ensures all patient encounters are accurately converted into revenue in compliance with applicable laws and regulations. Through revenue integrity, organizations can identify and address systemic processes and procedures that lead to revenue leakage to ensure accuracy and appropriate reimbursement while also improving the quality of care. Health information (HI) professionals have an important role to play in this process. The American Health Information Management Association (AHIMA) and Protiviti convened a panel of HI and revenue cycle professionals to explore best practices in revenue integrity and the role of HI, as well as how organizations can leverage data to enhance collaboration across the revenue cycle.
|Mazette H. Edwards, MA, CDIP, CCS
Assistant Vice President, Revenue Cycle
Northwell Health System
NEW HYDE PARK, NY
|Kimberly Seery, RHIA, CDIP, CCS, CHDA,
Associate Director, Coding and Data Quality
Health Information Management Services
|Tami Montroy, MS, RHIA, CCS
Director of Central Fee Abstraction
University of Pennsylvania Health System
|Gina Sanvik, MS, RHIA, CCS, CCS-P
Practice Director, Revenue Cycle Management & Coding
|Caroline Znaniec, MBA, MS-HCA, CRIP
We need to leverage our technology and our AI to get clean claims out the door.
Upskilling and reskilling our workforce is a big recruitment and retention tool.
- Revenue integrity identifies and corrects systemic processes and systems that lead to revenue leakage, ensuring provider organizations receive appropriate reimbursement for all services provided.
- Revenue integrity reconciles critical billing, operations, and compliance functions to generate clean claims and proactively reduce denials.
- HI professionals play an integral role in achieving revenue integrity, managing patient data from point of access to final billing.