Blog, The Hospital Finance Podcast®

What is revenue integrity? [PODCAST]

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Hospital_Finance_Podcast smallIn this episode, Kristi Morris, Director of Revenue Integrity Services at BESLER Consulting, discusses what revenue integrity is and its importance within the healthcare finance organization.
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Michael Passanante:   Welcome back to the Hospital Finance Podcast. Glad you could be with us. I’m Mike Passanante.

Joining me today on the podcast is Kristi Morris.

Kristi is the Director of Revenue Integrity Services here at BESLER Consulting. And Kristi is going to help us understand more about what the revenue integrity function is and what it might look like going forward.

So Kristi, welcome to the show.

Kristi Morris: Thank you, Mike. Thank you for having me.

Mike: So Kristi, you’ve got a lot of experience in revenue integrity. And I know different hospitals and different healthcare organizations implement it in different ways and maybe look at it a little bit differently.

So, could you help us understand from your point of view what revenue integrity is?

Kristi: Yes. Well, basically, revenue integrity is a service line that has the function of ensuring integrity in revenue that’s being generated by the hospital. And that can include ensuring compliance, accuracy in encoding, appropriate charge capture and reasonable pricing for services that are being provided.

Now, we do have to keep in mind that healthcare providers implement revenue integrity in several different ways. The revenue integrity department may not look the same from one healthcare system to the next.

Mike: And that’s a good lead-in to the second question. I’m curious what the difference might be between what we might regard as the previous revenue cycle functions and what revenue integrity might handle today. Can you help delineate that for us?

Kristi: Definitely! Well, the difference with revenue integrity is that revenue integrity is having a concentrated focus on revenue and the integrity that’s there, and also, identifying the facets that could prevent a high level of integrity from being achieved.

But most importantly, the difference is a new way of viewing and working with one of our most important stakeholders in healthcare—that being our clinical partners.

Now, don’t get me wrong. There’s still an extreme value in the revenue cycle team. We definitely still need the backend team to make all this work efficiently. They are the experts in the area of denials, appeals, managed care pricing, our underpayments and our over-payments. And that’s just to name a few. The need for these services do not go away.

Revenue integrity is just enhancing the services by bringing education and the needed dialogue to the forefront. And therefore, they’re able to work hand-in-hand with our clinical partners to improve the efficiency.

Mike: Now, you’ve been around revenue integrity for a while, Kristi. What results have you seen as a result of having revenue integrity implemented into healthcare organizations?

Kristi: Well, I’ve seen a change in the openness of dialogue between the clinical space and the financial space. And that’s been the struggle for years, just having that open dialogue, being able to discuss different issues.

And now, our clinical leaders want us in the room. They want us in the room from the very first discussions of new service lines, new locations. And even, sometimes, they want us in the interview room, especially when they’re hiring new staff members whose duties may cross over to affect the financials of the hospital.

They do not see us as a separate department. They see us as a partner working to make healthcare delivery better for the patient. And that’s a common goal for all involved.

Now, through my firsthand experience of starting a revenue integrity department, I saw partnerships develop between the two—our clinical partners and the revenue integrity group. And in turn, we work together as partners to resolve issues and even became very proactive in several areas.

Mike: So Kristi, let’s switch gears and talk about how a hospital or a healthcare organization might implement a revenue integrity service line. And in your opinion, what would you say are the top three components in building a successful revenue integrity service line?

Kristi: Excellent question! I would say the top three components, first, you need to identify the service line’s primary objective. And that’s very important because you need to have everyone in the department, from the top down, to be on the same page. Everyone should understand their responsibility in achieving that objective.

And the number one objective to revenue integrity is really ensuring integrity in all revenue that’s generated.

The second component, I would say, is you need to recruit the right individuals to execute the objective. It does no good to have an objective, but you do not have the right team there to achieve it.

You need to recruit individuals that are experts in their area. And also, make sure to recruit great communicators.

That’s one of the differences between our revenue cycle functions and the revenue integrity function. Revenue Integrity communicates a lot with the clinical staff and internal customers. So you need to have great communicators and relationship-builders. They have to be able to trust you in order to come to you. So you need to be able to build trusting relationships with your clinical partners in order to be successful.

And lastly, I would say, you need to be forward-thinking in identifying industry opportunities and needs. Research new service lines that are going to generate revenue for your healthcare system.

Also, in the midst of doing that, learn about the billing and compliance guidelines that go along with that new service line. Do your homework and be prepared.

Mike: Kristi, are there specific skill sets that are needed in a revenue integrity department?

Kristi: Yes. You definitely have to have a staff of highly skilled and educated coders, charge master specialists and nurse auditors.

And then, in my opinion (although we don’t see it frequently), I see the value in having a patient access specialist who assists with frontend issues and education.

Part of my background is in the patient access arena, and I think that helped me out a lot in the revenue integrity area because I know the issues and the frustrations that we see from the frontend, from the patient access side, and how that can affect the backend.

So having someone there that’s able to verbalize the issues and the struggles that they see on the frontend, and then working with your backend folks to improve that, only makes the process run smoother.

Mike: Revenue integrity has been a burgeoning area for about the last eight years or so I guess. And we’re due for some changes perhaps in our healthcare landscape coming up. What do you think the new presidential administration’s impact might be on healthcare revenue and how important do you think revenue integrity will be to this transition?

Kristi: Well, I would say, for the last few years, the healthcare industry has been able to capitalize on more insured patients as a results of the Affordable Care Act. Now, one thing that is for sure is that our new president has vowed to repeal the Affordable Care Act and replace it with a new plan.

Now, with the uncertainty of the financial impact, one thing that providers can lean towards is ensuring a strong level of revenue integrity to help them through these times of uncertainty and new policy changes.

Revenue Integrity has become increasingly more important. Providers can’t afford to leave any reimburseable dollars on the table. Every dollar has always had importance, but now, more than ever before.

Now, everyone is trying to make predictions on what to expect in healthcare for the next four years, but no one knows for sure. Will healthcare change as we know it forever? Will it be for the better or will it be for the worse? We don’t know.

But one thing that we do know is that we must be diligent and be forward-thinkers when implementing processes to capture revenue.

Mike: That makes sense. Kristi, do you see revenue integrity as a tool to reduce redundancy and waste in healthcare-building?

Kristi: Yes, definitely. Revenue integrity is about partnering with our clinical partners to address current issues and being more proactive in resolving any potential and billing compliance issues. And that right there will reduce the redundancy, the re-filing that we have to do on claims. So it definitely will be a tool to help reduce that.

Mike: Kristi, finally, do you have any parting thoughts or additional comments you’d like to leave our audience around the idea of revenue integrity?

Kristi: Yes. I would just like to say to our audience that revenue integrity is and will continue to play a vital role in healthcare. It is crucial that we, as healthcare professionals, understand that, we need to understand what it is, why it is important, how to build a successful service line, and then what steps do we need to take to ensure that we take advantage of all opportunities to bring it forth.

Now, keep in mind that every organization will not be able to sustain a successful revenue integrity service line in-house. And in some cases, even an in-house revenue integrity service line cannot efficiently maintain all facets that are needed.

Now, this is when a trusted, competent and successful vendor or service partner is crucial. Don’t be afraid to ask for help. Understand what your organization can do well, and then trust the remainder to a vendor or service partner.

Mike: Great thoughts, Kristi. Thanks for stopping by today and helping us all understand more about revenue integrity.

Kristi: Thank you. I enjoyed it.


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