2 Tips for Optimizing Revenue Integrity in 2023

Since revenue integrity departments tend to be relatively new, many leaders wonder how to best elevate a revenue integrity program.

As the revenue cycle continues to be an area of focus for organizations looking to prosper in 2023, revenue cycle leaders have turned to streamlining (and even creating) revenue integrity departments to reduce the risk of noncompliance, optimize payment, and minimize the expense of fixing problems downstream with claim edits.

But, where should revenue cycle leaders start?

“The question is more urgent than ever, but changes in the industry due to budget constraints, available skill sets, reactive cultures, and the inability to measure performance—or even define what to measure—make answers harder to come by. At the end of the day, it comes down to: How do I do more with less and do so effectively?” Caroline Znaniec, managing director of healthcare business performance improvement with Protiviti Inc., told the NAHRI Journal.

Znaniec says two important items to focus on when looking to optimize a revenue integrity department are objectives and strategies.

Here’s what Znaniec had to say:

Objectives

Better-performing revenue integrity programs have clear objectives with defined roles and expectations. This prevents overlap between functions, including those of the billing office, compliance, internal audit, and clinical operations. Your revenue integrity program charter should include a clear objective.

Strategies

In addition to stating the objectives of the revenue integrity program, specific key strategies can help a program maintain focus to meet its objectives. Better-performing organizations employ these strategies in creating, implementing, and sustaining their revenue integrity programs.

When combined, these strategies create a culture of revenue integrity within a provider organization, which is vital to sustaining the program and its efforts.

The strategies are as follows:

• Create staff awareness at all levels on the individual and provider organization’s responsibilities through inclusion of responsibilities in job descriptions, on-boarding activities, and annual education
• Provide periodic reviews across the organization in a well-defined, documented, and thorough manner through the creation and implementation of an annual work plan
• Design and implement a monitoring program for identified high-risk areas; this program should include the development of review tools, analysis of results to identify root causes and develop corrective action plans, tracking of action plan implementation, and verification of improvement
• Create and maintain a revenue integrity committee (or similar initiative) to ensure the program is meeting its primary objectives
• Communicate findings of the revenue integrity monitoring activities to executive management