Revenue integrity: an evolving function for hospitals and health systems

Revenue integrity as an enterprise function is evolving into a broader concept of charge capture, acuity documentation, and quality achievement all culminating in reimbursement performance. This function should evolve with market dynamics, including the growth of hospital-employed physicians, technological advancements with electronic health records, value-based payment models, analytics and the constantly shifting regulatory environment.

Revenue integrity is a top priority for healthcare leaders, CFOs and revenue cycle management executives. Yet a survey conducted by HFMA and Navigant found that, as of 2017, not even half of responding executives reported having established a revenue integrity program.a This situation is problematic because such programs encompass critically important areas tin terms of both value and focus, including physician and clinical documentation and business intelligence analytics critical to performance in value-based payment.b

Healthcare organizations should not only develop and revenue integrity program but also ensure it evolves in step with the evolution of healthcare markets, driven by dynamic factors such as regulatory changes, mergers and acquisitions and advances in healthcare technology. Traditional revenue integrity programs have focused on hospital charges that have a high revenue yield. Today, however, there is a heightened need for such programs to focus on physician revenue capture and coding due to the increasing number of employed physicians, which increased by more than 63% from 2012 to 2016, in a trend forecasted to continue.c

See related article: 3 key enablers to implementing a successful clinical revenue cycle operating model

Footnotes

a. Navigant and HFMA, The Future of the Revenue Cycle: A Survey of Provider Executives About the Next Generation of Revenue Cycle Management, June 2017.

b. LaPointe, J., “Revenue Integrity Top Hospital, Health System Exec Priority,” Practice Management News, June 29, 2017.

c. Finnegan, J., “Hospitals Are Buying Up Physician Practices at a Record Pace,” FierceHealthcare, March 19, 2018; and Finnegan, J., “Regulatory Changes and Technology Demands Will Drive Physician Practice Mergers and Acquisitions In 2018,” FierceHealthcare, Jan 31, 2018.