Due to significant changes in healthcare delivery, cost and coverage, payments, legislation, high deductible plans, and a large increase in patient responsibility, providers are looking for better ways to stop revenue leakage. As a result, revenue integrity (RI) and the advancement of revenue cycle management is a top priority for hospitals and health systems.
According to RevCycle Intelligence, about 68% of hospitals and health systems reported that a revenue integrity program increased their overall net collection. Further, 61% stated that it improved overall gross revenue capture. Below are the key concepts that help improve RI:
- Improving Reimbursements – the gap between what you are billing and the revenue to which you are entitled. A robust contract management and claims management solution are imperative in understanding with 100% accuracy that you are getting your expected reimbursement and that your hospital has clean claims going out the door for expedient payment.
- Increasing Operational Efficiency – the gap between current processes/systems and industry best practices to ensure your clinical and financial departments are in alignment and running efficiently. It is imperative to analyze your EHR and patient accounting system(s) and ask the following questions: (1) Are there several bolt-ons that you are managing?; (2) Are there gaps in your system(s)?; and (3) Is your system outdated?
- Minimizing Risk – the gap between your current cost of non-compliance, and a reduction in recurring compliance exposure, take-backs, and underpayments.
Reducing revenue leakage by increasing your revenue integrity has proven positive outcomes for providers.