In a recent Hayes Management Consulting blog, Sondra Akrin and Robert Freedman review what revenue integrity is and why it's so important.
Google the term “revenue integrity” and you get 790,000 results. Refining it to “revenue integrity in healthcare” narrows it down to 380,000 results. That still doesn’t help much. The fact is there isn’t one, universally accepted definition of the term.
One thing that isn’t in question is the importance of revenue integrity to healthcare organizations in the current difficult environment. Financial challenges headed the list of hospital leaders’ top concerns in 2016, according to the American College of Healthcare Executives annual survey. It was the twelfth consecutive year CEO’s identified finance issues as their most pressing worry.[1]
That should come as no surprise in a time when hospitals and physician practices are facing shrinking top and bottom lines. The crushing weight of financial worries continues to increase because of the many challenges organizations face in the uncertain healthcare landscape.
New value-based care financial models, increased payment responsibility for patients, more intense regulations and the auditing that goes with it and continued merger and acquisition activity are squeezing the resources of healthcare organizations and jeopardizing their overall financial health.
Which brings us back to revenue integrity. According to an HFMA Survey of 125 hospital and health system CFOs and revenue executives, only 44 percent of respondents say their organizations have established revenue integrity programs. This forward-thinking group has benefited significantly. The result of these revenue integrity programs has been a 68 percent increase in net collection, 61 percent overall gross revenue capture and 61 percent reduction in compliance risk. [2]
We know revenue integrity programs are effective, but there are still multiple definitions of what it is. Here are how some healthcare leaders view revenue integrity.