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Frequently Asked Questions

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.

How to develop a revenue integrity ( ri ) program?

The process of developing an RI program may start with hiring a department head who can build out an RI department. The National Association of Healthcare Revenue Integrity (NAHRI) offers tools and resources, including a job description for systems to use when hiring a revenue integrity leader.

What are the tools used for revenue integrity?

The processes and tools used to support revenue integrity include workflow optimization, compliance, clinical documentation improvement, data analytics and business intelligence.

Why do you need a revenue integrity director?

Furthermore, a revenue integrity department or director can help lead enterprise-wide efforts to coordinate elements of claims processing and charge capture, acting as the connective tissue between clinical operations and billing by optimizing the workflows between these often-divided areas. The knowledge needed to accomplish this includes:

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