Financial health is tightly linked to operational efficiency, regulatory compliance, and coding accuracy. Hospitals and health systems can achieve financial health by ensuring collaboration between billing compliance, coding, and revenue integrity departments.
While each team operates in its realm of expertise, collaboration between these departments is essential to drive both patient care quality and financial sustainability. Here are some best practices that foster collaboration between these critical teams, helping healthcare organizations thrive amid regulatory scrutiny and evolving payer demands.
- Establish Clear Communication Channels
Open and ongoing communication is key to collaboration, and this can be difficult to execute in busy day-to-day operations. Regular cross-functional meetings between billing compliance, HIM/coding, and revenue integrity teams should be a priority. By doing so, all teams remain aligned on shared goals, current regulations, and potential challenges.
-
- Best practice tip: Implement a shared communication platform that provides transparency and quick access to updates on new regulations, audit findings, or coding changes. Allowing all teams to collaborate efficiently.
- Create Unified Compliance and Revenue Integrity Policies
While each team has specialized responsibilities, all must adhere to the organization’s overarching compliance and revenue integrity policies. A well-documented policy manual that addresses coding standards, billing protocols, and audit procedures can help streamline workflows and eliminate conflicting approaches.
-
- Best practice tip: Conduct periodic reviews of compliance and revenue integrity policies involving all three teams. This helps ensure that guidelines stay current with new regulations from entities like the Office of Inspector General (OIG) or changes in coding practices.
- Leverage Technology to Automate Processes
Manual processes are prone to errors, leading to compliance risks, revenue loss, or inefficiencies. Automation through technology solutions can help reduce these risks and free up time for higher-value activities. For instance, using technology to automate billing compliance audits can allow auditors to focus more on educating physicians and coders, improving overall accuracy and adherence to regulatory standards.
-
- Best practice tip: Integrate a comprehensive platform that offers continuous risk monitoring and reporting so that each team can access real-time data and analytics. This helps identify potential areas of concern early and minimizes compliance risks.
- Foster a Culture of Continuous Education
Education is crucial to staying compliant and maintaining revenue integrity. Today’s demands make the education component challenging to integrate into daily workflows. HIM/coding professionals, billing compliance teams, and revenue integrity specialists need a bridge for healthy dialogue and rebuttal processes.
-
- Best practice tip: Using real-time audit data can make educational sessions and conversations more relevant and engaging.
- Promote Collaboration in Risk Identification and Mitigation
One of the primary goals for billing compliance and revenue integrity is the early identification of risk. To achieve this, teams should share insights and data highlighting potential issues, such as common coding errors, audit flags, or claims denials. By working together, the teams can proactively address these risks before they lead to significant revenue loss.
-
- Best practice tip: Use a SaaS (software as a service) platform for continuous risk-based auditing, which can streamline the detection of anomalies, determine root causes, and ensure collaborative mitigation efforts across all departments.
- Set Common Performance Metrics
There must be common goals and performance indicators for true collaboration between teams. Aligning metrics like claims denial rates, audit accuracy, and revenue leakage across billing compliance, HIM/coding, and revenue integrity teams create a unified focus on improving financial performance and compliance.
-
- Best practice tip: Define key performance indicators (KPIs) that apply across departments and track them regularly using shared dashboards or reports. This fosters accountability and provides a clear view of progress toward shared goals.
- Engage Physicians in the Process
Physician education and engagement are crucial for ensuring coding accuracy and proper documentation, impacting revenue integrity and compliance. Auditors and coders should regularly provide feedback to physicians on their documentation practices, helping to correct issues and prevent future mistakes.
-
- Best practice tip: Leverage automated tools to track documentation trends and share actionable insights with physicians. This allows teams to collaborate with physicians to drive better coding practices, reduce the risk of audit findings, and enhance revenue capture.
Achieving collaboration between billing compliance, HIM/coding, and revenue integrity teams requires commitment and technology-driven solutions. By implementing these best practices, healthcare organizations can ensure smooth operations, reduce compliance risks, and protect their bottom line while improving patient care.
Leveraging platforms like MDaudit’s continuous risk monitoring solution ensures that each department works together more effectively to deliver high-quality, compliant care. Need help implementing best practices for revenue cycle management? Contact us to learn how our platform can drive meaningful outcomes for your organization.
