According to a recent industry survey by business intelligence and revenue cycle software provider Craneware, more than 60 percent of hospital executives believe effective revenue integrity programs are essential to the financial health of their organizations.
But understanding this need and finding a way to effectively launch a viable revenue integrity program that incorporates the entire enterprise can be a daunting task. Hospital executives and administrators attending HFMA's ANI conference looking for insight on how to accomplish this kind of sweeping organizational change can gain insight on one such successful implementation during the “University Medical Center Uses Revenue Integrity Culture to Improve Revenue and Payer Mix” session at 10 a.m. on Monday, June 25th.
According to session presenter Micky Allen, director of revenue integrity at University Medical Center Health System (UMC) in Lubbock, Texas, an effective revenue integrity program requires support from the hospital administration, accountability from staff across the enterprise, all mixed with a healthy dose of technology.
“Accountability is key,” Allen said. “It is all about making your people and all the clinical staff understand how important revenue capture and charge capture is. When we started the department here (in 2009), we started with education because it is important to get everyone to understand all that goes on behind the scenes and how each department can contribute.”
In order to accomplish this holistic revenue integrity approach, organizations must be deliberate in how they plan for and implement their own programs.
“Excellence doesn’t happen by accident. It is by design,” said Michael Najera, professional services manger with Craneware and a co-presenter of the session. “As much as we have undertaken over two decades a performance improvement focus on the clinical side, we need to bring that culture into our financial and operations side. And that exactly is the very core of revenue integrity.”
Further, hospitals that want to succeed in creating a meaningful revenue integrity program need to be able to measure performance in order to identify areas for improvement. Organizations just starting out should use existing industry standard measures of performance to create an initial idea of how they stack up, which can help them identify the areas where performance is poor and target those right away.
And while technology solutions can play a meaningful part in helping capture charges as well as data that can help a hospital measure its performance internally, both Allen and Najera warn it is not the be-all, end-all on the road to revenue integrity success.
“The first thing people shouldn’t expect is for the solution to affect change automatically,” Najera said. “It takes a change in culture and a change in process and that takes individuals and relationship management. The solution won’t do that.”
Allen can attest that much of the hard work he did early on was to gain the trust of staff in various departments at UMC, in order for them to openly share information that would help make the revenue integrity program successful.
“At first, people are leery and they thought I was doing a lean Six Sigma approach and was there to cut heads,” Allen said. “But you really need to explain that you are there to help improve the bottom line and even to invest in new FTEs or tools for their department if it will help them improve. It does take time. But once you have some who grab on, they can help spread the word.”
Once an organization buys into a holistic revenue integrity program that is when a solid technology solution can really shine.
“What technology does is allow us to … capture the thousands of transactions that occur in an organization daily and point us to the exception,” Najera added. “If we can get consistency in our processes, then we can capitalize on all the technology that we have in place to bring efficiency and ease of use to point us to where the problems are.”