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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.Do you need revenue integrity in a hospital?
Most every hospital CFO recognizes the need for revenue integrity, but many hospitals are still tinkering with how RI fits into their organization.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.What are the KPIs for revenue integrity management?
Revenue integrity and coding managers are responsible for monitoring coding and charging accuracy. In addition to accuracy, claims need to be filed as soon as possible so that payer payments and patient billing can be handled quickly. Two KPIs that revenue integrity managers should monitor, in particular, are the following: