Revenue integrity is an important concept in the increasingly complex healthcare environment. But what is revenue integrity in healthcare? More importantly, why does it matter?
According to the National Association of Healthcare Revenue Integrity (NAHRI), revenue integrity focuses on preventing the recurrence of issues that can cause compliance risks or revenue leakage. The goal is to align your contract management, compliance, and coding and billing processes to improve cash flow.
Let’s further unpack the question, “What is revenue integrity in healthcare?”
Whether you’re managing a small clinical or a multi-location healthcare system, revenue integrity should be at the core of your financial operations. It ensures that every service provided to a patient is accurately documented, coded, and billed. Revenue integrity also promotes reimbursement accuracy to protect your cash flow.
Risks associated with poor revenue integrity include the following:
A strong revenue integrity program can help you uncover gaps in your processes, increase upfront collections, and ensure your payer contracts are working for — not against — you. Revenue integrity has become even more important in light of the No Surprises Act, as you must be more transparent and accurate with your billing practices.
To fully unpack the question, “What is revenue integrity?” it’s important to break the concept down into its five core components:
Error-free coding processes set your billing team up for success. Your billing department must efficiently process the information submitted by the coding team and ensure compliance with ever-changing rules from Medicare, Medicaid, and private insurers. Some key areas of concern include the following:
Even small mistakes can trigger a denial and negatively impact your revenue cycle. Revenue integrity depends on billing teams knowing the rules and applying them correctly every time. But let’s face it. Even the most diligent billing teams are going to make mistakes from time to time.
Automating parts of the billing process can help reduce errors and ensure faster reimbursement. Integrating billing tools with your EHR further accelerates the process.
In healthcare, compliance is a foundational part of revenue integrity. Your revenue cycle must adhere to state and federal regulations. Noncompliance can trigger an audit and damage your organization’s reputation. The long-term consequences of even seemingly minor compliance violations can threaten business continuity and drive away patients.
Strong compliance processes bridge the gap between billing and timely payment. You can ensure that all payer forms and patient communications are submitted in accordance with the latest regulations, thereby decreasing the risk of penalties or cash flow disruptions.
Managing payer contracts is essential for understanding how much your organization should be reimbursed for services rendered and whether insurance companies are honoring the terms of your agreement or not.
These contracts define everything from negotiated rates to reimbursement policies, but they are complex and inconsistent across payers.
Without visibility into your contracts, it’s easy to miss underpayments. Revenue integrity requires a clear view of contracted versus actual payment performance. The goal is to identify discrepancies and hold payers accountable. You can also use payer performance data to negotiate better rates and protect your organization’s bottom line.
Patient financial responsibility continues to grow. Therefore, your organization must address patient payments in its revenue integrity strategy.
The first step involves providing patients with clear cost estimates and convenient payment options ahead of time. Patients are more likely to pay on time and in full when they know what they owe and why.
Another strategy involves collecting patient payments before service. Accurate pricing tools help your patients avoid surprise bills and simplify upfront revenue captures. These solutions can also promote compliance with the No Surprises Act.
Make it easy for patients to pay their bills. Offer digital payment methods and automated reminders to improve collection rates.
Despite its importance, maintaining revenue integrity in healthcare can feel like an uphill climb. Most organizations deal with barriers and headaches, such as:
Many healthcare organizations are stuck patching together multiple tools and using manual oversight to keep up with basic revenue processes. Fortunately, Revenue Diagnostics from Rivet Health can provide a better way.
Revenue Diagnostics provides a real-time glimpse into your financial health so you can track and optimize cash flow. Learn more about Revenue Diagnostics, our revenue cycle management software, and how it can help you overcome these revenue integrity challenges.
Rivet offers a clear path toward better revenue integrity. Our solutions specialize in healthcare revenue cycle management and deliver the insights you need to optimize cash flow. Rivet stands out for its exceptional customer support, powerful features, and smooth onboarding.
With Rivet Health’s intuitive platform, achieving revenue integrity doesn’t have to be so complex. Our solution gives your team the tools they need to track denied claims, enforce payer contracts, and provide transparent patient pricing. Schedule a demo with Rivet Health today.
