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Revenue integrity for a hospital is more than being morally upright. Being fully compliant in coding and billing practices also reduces the risk of costly downstream efforts such as managing external audits and even payment denials.How is revenue integrity used in clinical practice?
The goal is to bridge the gaps that naturally form between clinical operations, coding teams and the business office. Revenue integrity focuses on better coding and charge capture, in particular, to reduce the risk of noncompliance, optimize payment and minimize the expense of fixing problems downstream with claim edits.What does the billing department do for revenue integrity?
The billing department is responsible for ensuring the bill meets the regulations determined by the patient’s insurance. Revenue integrity efforts examine all workflows in charging to determine the greatest efficiency and to identify patterns that need correcting.When did Medicare begin to use revenue integrity?
In 2004, revenue integrity began to evolve as health systems moved toward value-based and risk-adjusted payment models. When Medicare added hierarchical condition categories (HCCs) to assess patient risk as part of the consideration for payment, the need to be precise with coding and charge capture increased.