Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Practice Management News

Revenue Integrity Top Hospital, Health System Exec Priority

A survey revealed that hospital and health systems plan to focus on revenue integrity over the next year to advance healthcare revenue cycle management.

Hospital and health system leaders to prioritize revenue integrity in 2017 as part of their healthcare revenue cycle management strategy

Source: Thinkstock

By Jacqueline LaPointe

- Hospital and health system leaders plan to prioritize revenue integrity in the next year to improve their healthcare revenue cycle management strategies, according to a recent Healthcare Financial Management Association (HFMA) and Navigant survey.

Revenue integrity involves healthcare revenue cycle management processes that ensure revenue is accurate in terms of coding and charge capture. It also encompasses developing reasonable prices for services provided and complies with federal, state, and local regulations.

The healthcare revenue cycle management component topped the list of areas to focus on with 22 percent of the 125 hospital and health system executives.

Prioritizing revenue integrity may be the next step for many hospitals and health systems since few provider organizations have established a revenue integrity approach. Only 44 percent of respondents said that their organization has implemented a revenue integrity program.

Of the hospitals and health systems with a revenue integrity strategy in place, most agreed that the healthcare revenue cycle component has benefited their organizations. About 68 percent reported that a revenue integrity program increased their overall net collection and 61 percent stated that it improved overall gross revenue capture.

Another 61 percent of executives also found their revenue integrity program to decrease compliance risks.

“Revenue integrity should be the glue that binds clinical operations with coding and business office functions,” stated Jake Morris, Navigant’s Managing Director. “It’s clear that providers with established RI programs are benefiting from them, and expanding their scope will help yield long-term financial reporting reliability and operational efficiencies.”

In addition to revenue integrity, hospital and health system executives plan to focus on physician and clinician documentation as well as business intelligence analytics with 18 percent of respondents selecting these options, respectively.

Other top priorities for healthcare revenue cycle management improvement included:

EHR workflow and reporting with 15 percent

• Self-pay management with 13 percent

• Coding with 6 percent

• Labor utilization with 5 percent

• Staff training and incentives with 4 percent

Researchers pointed out that 79 percent of healthcare revenue cycle management priorities involve or are enabled by health IT.

Consequently, hospital and health system leaders anticipate upping revenue cycle technology budgets in the next year to accommodate their priorities. Almost three-quarters of executives said their organization will increase the budget, with most (42 percent) anticipating a boost of up to 5 percent.

Hospitals and health systems spanning the size spectrum anticipated increasing their revenue cycle technology budget. Seventy-seven percent of organizations with fewer than 100 beds plan to up their spending and 78 percent of facilities with 100 to 500 beds will do the same.

Organizations with over 500 beds also expect to increase their revenue cycle technology spending.

While healthcare executives are counting on greater health IT investments in the next year, the survey showed that hospital and health systems are falling behind with tracking their health IT use. Most respondents (41 percent) reported that their organization does not measure the effectiveness of health IT changes.

The hospital and health systems that do measure health IT efficiency stated that they measure it using the following metrics:

• Return on investment with 38 percent of respondents

• Overheard reduction with 35 percent

• Customer/patient satisfaction with 27 percent

• Decrease in number of vendors used with 21 percent

Additionally, the survey explored how hospitals and health systems are managing an increase in patient financial responsibility. Approximately 90 percent of executives stated that patient financial responsibility will impact their revenue.

Most leaders (52 percent) said that the impact of patient financial responsibility would be moderate and another 40 percent said it would be significant.

Executives in rural hospitals and health systems were almost twice as likely to report that patient financial responsibility would significantly affect their revenue versus their urban peers.

To boost patient collections, healthcare organizations implemented consumer-friendly payment options. Around 93 percent of respondents offer an online payment portal and 63 percent have care cost estimation solutions.

However, hospitals and health systems lacked health IT use within the organization to manage patient financial responsibility. Only 14 percent of hospitals and health systems used advanced modeling tools for segmenting and predicting patient propensity to pay.

“It is essential for healthcare leaders to apply a discipline to patient financial communications,” said Sandra Wolfskill, HFMA’s Director of Healthcare Finance Policy and Revenue Cycle MAP. “This should include when and where conversations may be conducted, who should be engaged, and guidance for discussing issues such as financial assistance and prior balances.”

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