Revenue Integrity Industry Report Highlights Trends and Opportunities for Rev Cycle

As hospitals face more financial troubles and turn the focus toward ROI, many revenue cycle leaders have been developing revenue integrity departments to help remedy revenue leakage.

To uncover the scope and depth of revenue integrity professionals’ impact on their organizations and revenue cycle, the 2022 State of the Revenue Integrity Industry Survey Report, released by the National Association of Revenue Integrity (NAHRI), collected information on industry trends and departmental functions.

Revenue cycle leaders know the value of data. Understanding how traditional revenue integrity functions, such as chargemaster maintenance, are performed across the industry helps set standards and expectations.

As revenue integrity departments continue to grow, it’s essential for revenue cycle leaders to keep an eye on emerging trends and opportunities that allow their revenue integrity professionals to keep pace with change.

The survey, which alongside revenue integrity staff also collected responses from hospital CEOs, CFOs, presidents or vice presidents of revenue cycle, and revenue cycle directors, asked respondents to define their revenue integrity program’s level of involvement in a variety of revenue cycle functions.

Respondents specified whether each function is primary in their program, handled as a support function, or is not handled at all.

The top primary functions reported were as follows:

• Chargemaster maintenance (71%)
• Correcting claim edits (53%)
• Charge capture (52%)
• Education (48%)
• Charge reconciliation (44%)

Chargemaster maintenance, charge capture, and charge reconciliation are key components of a revenue integrity program, Lisa Stein-Pierce, director of revenue cycle operations at Maine General Health in Augusta, Maine, said in the report.

While revenue integrity departments are usually created to prevent recurrence of issues that can cause revenue leakage and/or compliance risks, they still provide key support to other revenue cycle departments in a variety of functions. The following were some of the most commonly reported support functions:

• Charge reconciliation (45%)
• Decision-support functions (44%)
• Charge capture (40%)
• Coding (40%)
• Denials management (39%)

Clinical staffing issues may require revenue integrity departments to provide support for charge reconciliation, according to Shawishi T. Haynes, EdD, FACHE, director of revenue cycle, managed care, and revenue cycle integrity at Valley Presbyterian Hospital in Van Nuys, California. This means the revenue integrity team needs to handle the analytics, run the reports, and identify any anomalies in the data.

What are other revenue cycle leaders focusing on for the future of these departments? According to NAHRI’s report, the top revenue integrity initiatives for 2022 and beyond include:

• Chargemaster and charge capture standardization
• Charge capture automation
• Charge capture controls
• Documentation improvement
• Formal work plan development
• KPI development
• Payer integrity
• Process simplification
• Staff productivity and quality metrics
• Standardized workflows
• Staff upskilling and reskilling