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How to successfully implement a holistic revenue integrity program | Healthcare Finance News

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How to successfully implement a holistic revenue integrityprogramJune 19, 2012 | Chris Anderson, Senior Editor

LAS VEGAS According to a recent industry survey by business intelligenceand revenue cycle software provider Craneware, more than 60 percent ofhospital executives believe effective revenue integrity programs are essentialto the financial health of their organizations.

But understanding this need and finding a way to effectively launch a viablerevenue integrity program that incorporates the entire enterprise can be adaunting task. Hospital executives and administrators attending HFMA's ANIconference looking for insight on how to accomplish this kind of sweepingorganizational change can gain insight on one such successful implementationduring the University Medical Center Uses Revenue Integrity Culture toImprove Revenue and Payer Mix session at 10 a.m. on Monday, June 25th.

According to session presenter Micky Allen, director of revenue integrity atUniversity Medical Center Health System (UMC) in Lubbock, Texas, aneffective revenue integrity program requires support from the hospitaladministration, accountability from staff across the enterprise, all mixed with ahealthy dose of technology.

Accountability is key, Allen said. It is all about making your people and allthe clinical staff understand how important revenue capture and chargecapture is. When we started the department here (in 2009), we started witheducation because it is important to get everyone to understand all that goeson behind the scenes and how each department can contribute.

In order to accomplish this holistic revenue integrity approach, organizationsmust be deliberate in how they plan for and implement their own programs.

Excellence doesnt happen by accident. It is by design, said Michael Najera,professional services manger with Craneware and a co-presenter of thesession. As much as we have undertaken over two decades a performanceimprovement focus on the clinical side, we need to bring that culture into ourfinancial and operations side. And that exactly is the very core of revenueintegrity.

Further, hospitals that want to succeed in creating a meaningful revenueintegrity program need to be able to measure performance in order to identifyareas for improvement. Organizations just starting out should use existingindustry standard measures of performance to create an initial idea of howthey stack up, which can help them identify the areas where performance ispoor and target those right away.

And while technology solutions can play a meaningful part in helping capturecharges as well as data that can help a hospital measure its performanceinternally, both Allen and Najera warn it is not the be-all, end-all on the road torevenue integrity success.

The first thing people shouldnt expect is for the solution to affect changeautomatically, Najera said. It takes a change in culture and a change in process

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Related Topics: business intelligence Las Vegas Lubbock MichaelNajera Micky Allen Revenue Cycle Management Texas UniversityMedical Center Health System University Medical Center Uses RevenueIntegrity Culture

and that takes individuals and relationship management. The solution wont dothat.

Allen can attest that much of the hard work he did early on was to gain the trustof staff in various departments at UMC, in order for them to openly shareinformation that would help make the revenue integrity program successful.

At first, people are leery and they thought I was doing a lean Six Sigmaapproach and was there to cut heads, Allen said. But you really need to explainthat you are there to help improve the bottom line and even to invest in new FTEsor tools for their department if it will help them improve. It does take time. Butonce 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 asolid technology solution can really shine.

What technology does is allow us to capture the thousands of transactionsthat 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 thetechnology that we have in place to bring efficiency and ease of use to point usto where the problems are.

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