In this 7-part series, we will explore the tactics you can employ to build and optimize a revenue integrity team designed to create measurable value for your organization. If you missed part 1, you can find it here.
At Hayes, we define revenue integrity as getting paid for everything you do – and keeping it. It’s a holistic approach that breaks down silos within the organization and leverages the combined expertise of both revenue cycle and billing compliance professionals to manage financial risks and create a stronger, more resilient organization. As you would expect, communication is one of the most critical components to be successful.
Here is a sample communication model that starts with your billing compliance department, extends to leadership team, revenue integrity, coders, and providers. It is designed to make sure that when compliance or billing risk is found, the information travels around the organization to ensure there is a plan in place to correct it and avoid future risk.
The communication may happen in a variety of ways:
- Phone or live conversation
- Virtual or online meetings
- Group or individual presentation
- Or even within your software systems such as the coder rebuttal features of MDaudit.
To help ensure your message is absorbed, focus on the top 3-4 issues that will make the biggest impact. Use fresh data whenever possible and if possible, incorporate visuals that will help reinforce what you are saying. For example, if you are discussing potential undercoding with a provider, show a graph of how they compare to their peers. Pull up a recent case that they may still remember going through. Explain what needs to be done to correct the action and then reevaluate them 30 days later to see if they have changed their behavior. Or when discussing audit team results with your leadership team, use a dashboard that allows you to highlight the key items such as the financial impact of the findings and then discuss what you found and the corrective action steps you have taken, or the steps you recommend be taken. On both examples, assigning responsibility must be supported with collaboration and assistance
Ultimately it is critical that communications move outside the billing compliance or revenue cycle silos. By breaking down those walls, the organization begins to prevent future risk instead of merely fixing the problems as they are found.
Next up in the series we will discuss the importance of benchmarks to identify both risks and opportunities.
Interested in learning more about creating a value generating revenue integrity team right now? Click to watch our on-demand webinar!
