What is revenue integrity in healthcare?

According to a recent survey conducted by the national healthcare industry, around 60% of the hospitals and their executives were of the opinion that revenue integrity in the healthcare sector was beneficial for their financial stability.

A lot of hospitals, both in the private and public healthcare sectors have already started working to develop revenue integrity in healthcare. This will directly enable them to have better visibility as businesses. The process will also further help these hospitals in communication, showing leadership qualities, and having an unstoppable workflow.

What does it mean by revenue integrity in healthcare?

Generally, the term revenue integrity can mean different things when used in places other than healthcare. In the case of healthcare, however, revenue integrity means to make sure there are ethical and morally checked business policies that are being implemented and practiced by the hospitals.

So, for instance, your hospital or clinic has been in compliance with managing good coding and billing practices then you will be at a lesser risk of being externally audited. This means that you will save a lot of time and money for your hospital in case of a possible payment denial.

Another target that revenue integrity in healthcare will ideally take care of is cases pertaining to underpayments of medical bills or overpayments being charged by the hospitals for the patients’ healthcare facilities.

One case that made rounds was in November, 2019 when it was found that acute care hospitals were overpaid. The amount that they were overpaid for was not less. It was almost $54.4 million that they were overpaid for with 18,647 claims.

To keep things in check and balance, there are laws and policies that exist. One such policy is the Post-Acute Care Transfer (PACT) that was created in 1998. The main idea behind PACT was to help prevent such overpayments made by a hospital for a patient’s healthcare facilities.

Another survey that was conducted showed the following results concerning revenue integrity in healthcare: 

• 68% increase in the overall net collection
• 61% growth in the overall revenue
• 61% decrease in the compliance of risk

One other way to help you understand revenue integrity in healthcare is by looking at it through a driver’s lens. Yes, you read that correctly. Revenue integrity is the driving force of your entire healthcare sector if driven carefully.

How can revenue integrity in healthcare be achieved?

Now that you know what revenue integrity is it is important that you also know the means to achieve it when it comes to the healthcare sector.

Revenue integrity in healthcare can be achieved by making sure that you keep a balance in how you run the overall administration of your hospital. It is your responsibility to comply with the laws.

Here are the two most important ways of achieving the balance:

• By decreasing the risk of audits
• By reduction in payment denials

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