Paid and Protected - Enhancing Revenue Integrity with Healthcare Technology
Regulations are complex and evolving. Coding requirements change often. You’re up against these challenges while working your way through day-to-day tasks.
It’s a lot. So, it’s no wonder some things slip through the gaps and compromise your revenue integrity.
That’s why enhancing your revenue integrity is essential in healthcare. The goal is to ensure billing accuracy and maintain compliance.
Get it right, and you maximize your profit. Let it fall to the wayside, and your earnings take a hit. Then, there’s the potential for audits that could destabilize your practice.
In this guide, we’ll give an overview of revenue integrity and the role of healthcare technology in achieving it.
Then, we’ll review the benefits of adopting healthcare technology and how to implement it. We’ll finish with a few quick tips you can use to get started.
Every dollar counts. You know this better than anyone. But with the right tools and revenue integrity as your north star, you can achieve your practice’s financial goals.
What Is Revenue Integrity?
Revenue integrity in healthcare ensures that every service you provide is paid for. It’s about accurate documentation, proper coding, and consistent billing practices. Together, these lead to proper reimbursement.
Prioritizing revenue integrity helps practices like yours optimize revenue cycle management (RCM). This can reduce the risk of audits and boost cash flow. It can also help you maintain compliance.
Let’s dive a little deeper. Here are some of the challenges faced by billing departments and a look at how revenue integrity fits into the broader picture.
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Challenge 1: Revenue Leakage Due to Undercoding
Undercoding means services are billed at a lower level than the actual service provided.
What causes it? There’s no one answer. Maybe the clinical documentation isn’t complete. Or perhaps the billing staff simply made an error.
Mistakes happen from time to time. However, when revenue leakage becomes a pattern, the impact on revenue can be disastrous.
Proper documentation and accurate coding prevent revenue leakage. In turn, this contributes to revenue integrity.
Challenge 2: Compliance with Billing Regulations
Healthcare billing is complex. You have to tick boxes for many different governing bodies. This includes Medicare, Medicaid, and private payers.
You need to keep up with their rules and requirements. Otherwise, you might experience an uptick in denied claims and, in some cases, legal action.
Weaving compliance and integrity into the very fabric of your billing processes can help you avoid these outcomes.
Challenge 3: Inconsistent RCM
RCM is an end-to-end process that starts with patient intake and finishes with payment. There are many interdependencies, and a mistake at one stage in the cycle has a ripple effect.
If you are inconsistent with your RCM, you will likely get paid late. Your claim denials might rise, and you might find it hard—if not impossible—to keep track of your revenue.
Standardizing your RCM practices can help you achieve revenue integrity and the benefits that come with it.
The Role of Technology in Revenue Integrity
Technology aims to make life easier. It solves a problem. And in healthcare billing, it’s a powerful tool that protects revenue integrity.
What kinds of technologies? Here are some recent advancements you should know about:
- Electronic health record (EHR): These software systems unify clinical documentation. They act as a single source of truth. All information is linked automatically to accurate billing codes. This cuts the risk of mistakes and undercoding—all without extra manual effort.
- Automated Coding Software: These tools examine clinical documentation and suggest which codes to use, making compliance a little bit easier.
- Revenue Cycle Management (RCM) Platforms: These comprehensive software solutions track and manage every stage of the patient’s journey. They lock in consistent processes that are compliant and uphold integrity.
- Claims Management Systems: These tools submit claims automatically. Before doing so, they flag potential issues. That way, your team can make changes before the claims are sent off and inevitably denied. This is a big time-saver.
How do these technologies address common pain points?
They reduce manual errors with automation. This plugs up any gaps that are causing revenue leakage.
They also improve compliance and efficiency—two outcomes that don’t usually come hand-in-hand.
Technology also improves visibility. You gain access to real-time data. You can maintain your practice’s financial health and make evidence-based decisions.
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Benefits of Using Healthcare Technology
Technological advancements have a way of making things easier. From horse carts to motor vehicles, dial-up internet to 5G, innovations transform how we approach work and life.
You can experience these same efficiency-boosting benefits by leaning into the future of healthcare technology. Those who embrace it reap the following rewards:
Greater Accuracy
Accuracy is non-negotiable in healthcare billing. Even a small mistake can lead to revenue loss or compliance issues later on.
The right tools can all but eliminate human error. For example, automated coding software can analyze a physician’s notes and suggest the best-fit codes to use. Over- and undercoding code potentially become a thing of the past.
More Efficiency
Wish there were more hours in a day? Technology can make it feel that way. Billing processes that traditionally took hours can be completed in just minutes.
RCM platforms, for example, automate the entire billing process. Workflows unfold faster, which means your team has less on their plate. They can spend their time and energy on complex or patient-facing tasks.
Stronger Compliance
Manual compliance checks are not easy when you’re aiming for a moving target. But healthcare technology keeps pace.
Tools can automatically update and apply the latest regulations to your billing processes. You can proceed full force knowing your practice meets all current standards.
Actionable Insights
If you don’t know the problem, you can’t fix it.
Reporting functions can shine a light on areas of your financial processes that need improving. Using this data, you can implement meaningful change that moves you closer and closer to true revenue integrity.
For example, let’s say you see a high rate of denials for a specific service. You can dig into the numbers to uncover and address the root cause.
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Implementing Technology for Better Revenue Integrity
According to the American Medical Association (AMA):
“A physician private practice with a good handle on its revenue cycle can bring in more dollars and adapt more quickly to external forces such as lower payment rates."
Technology can help you claim control of your revenue cycle. The benefits of this are irrefutable—in theory.
But what about practically? How can you implement technology to improve revenue integrity without disrupting your operations?
5 Steps to Introduce and Integrate New Technologies
A structured plan goes a long way in achieving your goals with healthcare technology.
Here’s a step-by-step process to follow:
- Assess your needs. Your practice and billing needs are unique. So, highlight the specific areas where technology can make an impact. This could be in coding accuracy or claims submission, for example.
- Research and settle on the right tools. Compare features and choose a solution that aligns with your practice’s needs.
- Plan the implementation. Include timelines, milestones, risk mitigation strategies, and clear objectives. Assign roles and outline responsibilities so everyone involved is on the same page.
- Run pilot tests. Before the rollout, conduct a pilot test. See how the new technology performs in a small, controlled environment. You can flag issues and come up with solutions before launch.
- Go live. Monitor the tool’s performance closely in the initial stages. You want to make sure it’s working as expected.
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Prioritize Staff Training and Change Management
Implementing new healthcare technology is only half the battle. The other? Giving your team the hands-on knowledge to use it.
Make sure you schedule several training sessions for all users. These should stress why the technology is being introduced. When team members understand the benefits, they’ll be more inclined to embrace it.
After launch, think about running ongoing training sessions. Technology updates and your staff should know how to use new features.
Finally, acknowledge and accept that you may experience resistance. Change can be disruptive, especially when everyone is familiar and comfortable with the old ways of doing things.
Communicate clearly and often. Address any concerns and involve your team in the process.
How You Can Start Enhancing Revenue Integrity Right Now
Here are four actionable steps you can take now to level up revenue integrity in your practice:
- Know where you stand. Review your current billing and coding processes. Is there somewhere errors frequently occur? What about inconsistencies? This insight will show you where to focus your efforts.
- Compare RCM solutions. You want an RCM tool that meets your needs and has features like coding and claims management. You might like to start your search with KLAS Research.
- Request a demo. Don’t commit without trying first. Most RCM providers are more than happy to give you a hands-on demo. Take full advantage of this. Pay attention to how easy and intuitive the platform is to use. Consider how it might fit into your workflow.
- Plan early for implementation. Once you’ve chosen the right technology, write up a detailed training plan for your staff. Create a timeline for implementation with potential peak times in mind. To reduce risk, you might want to roll out the technology during quieter periods. HealthIT has some information on team training strategies.