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Revenue integrity tops list of concerns for hospital executives

New survey reveals biggest challenges

ATLANTA – Results of a national healthcare industry survey revealed that 60 percent of hospital executives believe revenue integrity is essential to their organization’s financial health.

Conducted by solutions firm Craneware in November 2011, the first Annual Executive Industry Survey found that operational efficiency, compliance and legitimate reimbursement (the holy trinity of revenue integrity) rank highest on the list of concerns currently plaguing hospital financial managers.

“I think there is just a lot of anxiety around making sure that you are adequately collecting and charging for the services that are performed and doing it in a way that is supported through the documentation that is collected,” said Todd Craghead, vice president of revenue cycle at Intermountain Healthcare based in Salt Lake City.

“The use of integrity, in my mind, means, obviously, doing it right and getting it right. It can be extremely challenging given all the complicating factors” such as federal regulations and rules contained within commercial contracts, added Craghead.

Other survey results include:

• Nine out of 10 respondents feel that the current business environment is much more challenging now than in the past few years.

• More than three-quarters of respondents consider improving operational efficiencies across all hospital departments as the strongest area of opportunity in the current economic climate.

• After improved operational efficiency, respondents ranked charge capture and coding improvements as well as denials prevention and management as the next biggest opportunities to improve hospital fiscal performance.

• 54 percent of hospital executives added additional staff to address revenue integrity issues, while 25 percent went so far as to establish an entire revenue integrity department.

“When I think about over half of the executives reporting that they have added staff to support this area, it’s no surprise,” said Craghead. “I think that’s been a necessary thing given the complex nature of some of the CMS rules and the complicating factors that are embedded in some of the commercial contracts.”

Craneware believes the survey supports the view that there is a growing trend of healthcare organizations shifting from a traditional revenue cycle to a collaborative revenue integrity approach.

“The combination of economic and healthcare reform pressures call for healthcare organizations to increasingly focus on financial performance and compliance,” said Craneware CEO Keith Neilson. “As our first annual industry survey revealed, many executives believe that traditional revenue cycle management strategies are no longer adequate methods for achieving financial success.”

Many hospitals are developing revenue integrity teams to gain greater visibility into their business processes and to develop the workflows, communication, accountability and leadership needed to enhance compliance and ensure optimal reimbursement, and Craneware expects this trend to continue.

“In today’s healthcare environment, optimal financial performance requires more than cost reduction strategies, internal audits and denial management,” said Kelley Blair, Craneware’s senior vice president, professional services. “As a holistic concept, revenue integrity is characterized by consistency of actions, values, methods, measures, principles, expectations and outcomes. Applied to the healthcare industry, revenue integrity is the achievement of operational efficiency, compliance, and optimal earned reimbursement.”
 

 

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