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Revenue Integrity: Healthcare’s Growing Need

By AGS Health

May 11, 2023

Revenue integrity ensures that all clinical encounters between providers and patients translate to revenue. To accomplish this, all workflow components and processes, from clinical operations to billing, are analyzed to ensure they are integrated, efficient, and compliant. Revenue integrity is important because it ensures the revenue cycle is optimized and compliant, and that processes are efficient – eliminating revenue leakage.

In a time when hospitals are facing shrinking margins, increased costs, slower reimbursements, and higher denials, containing revenue is essential. As the industry looks to transition from ICD-10 to ICD-11 and the coding complexity increases, there is a growing likelihood that days in A/R will also increase. For healthcare organizations using AI tools such as computer-assisted CDI and computer-assisted coding (CAC), the A/R risk is lower; however, other external forces, such as inflation, will continue to put pressure on profit margins – hindering organizations’ abilities to advance their missions.

Revenue Integrity Programs

Many healthcare organizations are implementing revenue integrity policies and guidelines. In a recent HFMA survey of 125 healthcare finance executives, revenue integrity was named the top priority for 22% of the respondents' organizations, but less than half of those respondents (44%) have created revenue integrity programs.

For those interested in creating a revenue integrity program, identify a leader with extensive knowledge of compliance, operations, and billing departments. This person can spearhead the program. Due to the division of people, processes, and platforms, these three departments are frequently undermined.

For your revenue integrity program to be as effective as possible, there must be fluidity between these departments throughout the entire patient care process. But once a revenue integrity program is implemented, the results are considerable.

A recent HFMA survey found that of all the organizations that participated in the study and implemented revenue integrity programs, 68% saw an overall increase in net collections, 61% overall gross revenue capture, and a 61% reduction in compliance risks.

Key components of revenue integrity programs include:

  • Examine every step of your workflow, from billing to clinical operations, to ensure they are compliant, effective, and fluid throughout the departments.

  • Proactively manage denials as they lead to substantial revenue leakage.
  • Ensure revenue cycle components are integrated and functioning.
  • Use advanced technology such as automation, artificial intelligence (AI), and machine learning to minimize human error.

Revenue integrity can reassure healthcare executives that their revenue cycle is healthy and compliant, and leakage is eliminated. An unhealthy revenue cycle can cost healthcare organizations millions.

The right technology can change everything about revenue cycle management, from predictive analytics that helps solve problems before they occur, to intelligent automation that removes monotonous tasks and errors. With the help of AGS Health’s robust automation revenue cycle management technology, we ensure high revenue integrity outcomes while your staff concentrates on what matters most – providing excellent patient care.

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AGS Health

Author

AGS Health is more than a revenue cycle management company—we’re a strategic partner for growth. Our distinctive methodology blends award-winning services with intelligent automation and high-touch customer support to deliver peak end-to-end revenue cycle performance and an empowering patient financial experience.

We employ a team of 12,000 highly trained and college-educated RCM experts who directly support more than 150 customers spanning a variety of care settings and specialties, including nearly 50% of the 20 most prominent U.S. hospitals and 40% of the nation’s 10 largest health systems. Our thoughtfully crafted RCM solutions deliver measurable revenue growth and retention, enabling customers to achieve the revenue to realize their vision.

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