Put The Focus on Measuring Productivity in Rev Integrity

As financial pressures put a strain on revenue cycle operations, many leaders are looking toward their revenue integrity departments for help protecting their bottom line.

As the revenue cycle continues to be an area of focus for organizations, 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.

Healthcare organizations are expected to end the year in the red, so now is the time to optimize all revenue cycle functions.

But where can revenue cycle leaders start and how can leaders make sure their revenue integrity departments are ensuring a ROI? The National Association of Healthcare Revenue Integrity (NAHRI) says the first place to look is at your productivity metrics.

Although the complexity of revenue integrity functions can be daunting to measure, the relative newness of many revenue integrity departments is another reason productivity metrics might not be used or streamlined yet, Kim Yelton, RHIA, CCS, CDIP, CHRI, revenue integrity director at WakeMed Health and Hospitals in Raleigh, North Carolina, told NAHRI.

When a revenue integrity department is first established, the primary focus is often dealing with immediate charging, billing, or compliance issues and defining the new department’s responsibilities.

Read on for more advice from NAHRI on productivity measures.

As a revenue integrity program becomes more established and clarifies its functions, revenue cycle leaders switch their attention to metrics for process improvement, and that’s when productivity starts to come into focus, Yelton says. The same metrics that are analyzed for process improvement, such as how to reduce touches on accounts, manage work queues, or reduce denials, can yield data for productivity metrics.

The systems and data that revenue integrity departments already use are valuable sources of productivity information, agrees Paula Twiss, MBA, CRCS-P, CRCS-I, supervisor of revenue integrity at Monument Health in Rapid City, South Dakota. Twiss has been experimenting with different data sets pulled from Epic to develop productivity metrics for implementation at the start of the next fiscal year.

Currently, Twiss uses a productivity report in Epic that monitors her teams’ activity in accounts. She runs the report weekly and reports on it monthly during one-on-one meetings with her team. However, the report is only as good as the data Epic captures, she says. In addition, her team works on a variety of projects and meetings outside of Epic. To fill those gaps, Twiss created a document that’s updated during weekly huddles and covers the previous week’s work.

“Every Monday we spend an hour with the team and fill out this huddle document that goes through what their goals were for the week, what work they’ve done, what meetings they were at, what work queues they were able to get into and complete, and the status of those,” Twiss told NAHRI.

To fill out potential productivity metrics, consider what already exists for at least some revenue integrity functions. For example, if revenue integrity staff are involved in denials management, some existing metrics, such as denial rate or completed appeals, can demonstrate productivity, according to Twiss.

Ideally, as much productivity data as possible should be gathered from existing systems, Yelton says. Although currently some manual data collection is unavoidable, best practice should aim toward finding ways to improve data collection through systems to reduce the need for manual collection.