This is the fourth and final post in our series of blogs discussing how a revenue integrity program can help clinical, compliance and revenue cycle teams join forces to address the increasing challenges of compliance. In our first post, we discussed how a revenue integrity program can be a unifying force in the organization. In the second, we explored the impact to physician practices as regulatory demands have grown. In the third post, we showed how the increasing rules and regulatory burden have strained the relationships of the three key stakeholder groups.
In this final installment, we lay out a plan that shows how to break down silos and bring the three groups together under the umbrella of a strong revenue integrity program. Following these steps will not only enhance morale, but will dramatically improve the financial health of your organization.
Improve communication
The unification process starts with enhancing the communication among the three groups. This should take the form of an official forum that proactively addresses new rules and regulations as they arise. This forum should facilitate continuous discussion and feedback on how both government and private payers are changing their behavior to adapt to these new requirements.
For example, if there is a new rule or regulation regarding pay-for-performance, similar to the one Medicare initiated in January of 2018, effectively communicating that change among clinicians, compliance, and revenue cycle teams can help the three groups work together more effectively. They can determine how the change will impact each group as well as the organization as a whole. This allows them to work together within the revenue integrity program to adjust appropriately.
Uniting clinicians, compliance and revenue cycle teams under a revenue integrity program can ensure that the organization achieves the common goal of maximizing profitability, maintaining compliance and providing quality care for patients. Ultimately, that is the goal of every healthcare organization.
Leverage appropriate tools
Revenue integrity as a function is critical, but in order for a revenue integrity program to be successful, you need to leverage tools and technology to monitor and analyze the activity surrounding it. This means deploying up-to-date tools for compliance, denials management and other issues to monitor revenue stream activity, from the initial patient encounter through payer behavior.
These tools should include the EHR systems clinicians use every day as part of their ongoing workflow. A key component of a revenue integrity program involves finding every opportunity to help clinicians achieve maximum productivity when using these systems. This can be accomplished by simplifying the requirements and “clicks” required when entering documentation for the services they’re delivering.
When discussing the technology tools that are available to your teams, it’s important to stress using the tools – not letting the tools use you. Tools are developed to assist your teams for specific tasks. For example, a screwdriver is designed for a screw, but in a pinch it can also be used for other things such as opening a can of nuts or punching a hole in the wall.
The tools you use should not dictate how you use them, but should simply assist you in accomplishing necessary tasks. You wouldn’t buy a screwdriver and expect to be told there’s only one way to use it. The same is true of your EHR and other systems. These systems have no limitations, and should be leveraged to the fullest extent possible to acquire and share data that can used to form a common bond among clinicians, compliance and revenue cycle teams.
Maximize revenue opportunities
It’s critical to support clinicians to ensure you can collect – and retain – the maximum amount of revenue to which your organization is entitled. This requires having the three groups collaborate in order to properly interpret payer rules and regulations, optimize revenue recognition and collection, and maintain strict compliance. Instead of spreading fear among the three groups that might lead to a reduction in the revenue stream, healthcare leaders should encourage these groups to work together to take advantage of every revenue generation opportunity within the allowed parameters.
The easiest way to make this happen is to establish an information flow that helps everyone involved understand payer rules and regulations, while providing continuous feedback that encourages the entire team to adjust appropriately to ensure a robust revenue stream. So, instead of acting as a “boogeyman” toward clinicians and revenue cycle teams, the auditing team should become the “accountant” for the other two groups and partner with them. When a new rule or regulation is implemented, the compliance team can educate clinicians and revenue cycle team members on the changes to help them avoid a negative financial impact. They can do this by sitting down and explaining the regulation clearly and the pitfalls that exist within it.
Provide support
An important part of a revenue integrity program is providing the right level of support for the three groups. For example, with ICD10, you can distribute a customized dictionary of the most often-used diagnostic codes to simplify clinicians’ workflow. This helps the clinicians adapt their workflow to ensure the delivery of outstanding care in the most efficient way possible. This simple action results in improved clinical documentation, increased revenue, enhanced patient satisfaction and improved productivity, enabling clinicians to see more patients on a daily basis.
Another important aspect of a revenue integrity program is making appropriate operational changes when new rules and regulations are imposed – instead of forcing clinicians to change the way they practice medicine. For example, suppose Medicare implements a new rule that requires monitoring and reporting on patients from ages 25-35 for a specific condition. To accommodate that requirement, you should tailor your EHR to enable this reporting, without dramatically changing the clinicians’ workflow.
Uniting clinicians, compliance and revenue cycle teams under a revenue integrity program can ensure that the organization achieves the common goal of maximizing profitability, maintaining compliance and providing quality care for patients. Ultimately, that is the goal of every healthcare organization.
