The Revenue Integrity Manager’s Guidebook

Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS

Have you ever been to a store where a product’s price tag didn’t match the price on the receipt? Or have you ever been over- or under-charged for time and materials?

We expect revenue integrity in other industries, and with new value-based care models, increased patient payment responsibilities, and more intense government regulations, healthcare organizations are also turning to dedicated revenue integrity departments to safeguard their financial health.

Whether you have an established revenue integrity department or are looking to form one, The Revenue Integrity Manager’s Guidebook is your all-encompassing reference guide to revenue integrity leadership. This book provides expert tips on developing and staffing a department as well as guidance on how to identify, monitor, and improve revenue accuracy.

The Revenue Integrity Manager’s Guidebook provides a comprehensive view of the link between revenue integrity and the revenue cycle and explores how their components interact with each other. The book also highlights ways to improve the symbiotic relationship between the two departments. These revenue-saving secrets and strategies are invaluable for any healthcare organization.

Readers will get a complete walkthrough of revenue integrity essentials, such as:

• Best practices on mastering the three keys to achieving revenue integrity: clinical documentation integrity, accurate and appropriate charge capture, and data integrity 
• How to gain buy-in from leadership by demonstrating the value revenue integrity adds to the organization
• A comprehensive overview of revenue integrity department structure and staffing
• Ways to future-proof your revenue integrity department to adapt to new service lines and provider types

About the Author

Rose T. Dunn, MBA, RHIA, CPA, FACHE, FHFMA, CHPS, is a past president of the American Health Information Management Association (AHIMA) and recipient of its 1997 Distinguished Member and 2008 Legacy awards. In 2011, she served as the interim CEO of AHIMA and received a Distinguished Service Award from its board of directors. Dunn is the chief operating officer of First Class Solutions, Inc., a health information management (HIM) consulting firm based in St. Louis.

Dunn began her career as director of medical records at Barnes Hospital, which at that time was a 1,200-bed teaching hospital in St. Louis; it is now the flagship hospital of the BJC HealthCare system. Early in her career at Barnes, she became vice president and was responsible for more than 1,600 employees and new business development. Dunn later joined Metropolitan Life Insurance Company, where she served as assistant vice president in MetLife’s HMO subsidiary. She also served as chief financial officer of a dual hospital system in Illinois and was heavily involved in its successful bond application.

Her consulting firm, First Class Solutions, focuses on HIM-related services, including coding support, coding audits, and operations improvement. Dunn assists clients with their operational, revenue cycle, compliance, and strategic planning needs. She and her team have supported more than 50 hospitals and physician practices with ICD-10 preparation and education.

Published: April 2018

Page count: 140
Dimensions: 8.5x11, perfect bound
ISBN: 978-1-68308-149-4

Table of Contents

Chapter 1: What Is Revenue Integrity?

The revenue integrity goal
Revenue integrity versus revenue cycle
Clinical documentation integrity
Charge capture challenges
Data integrity
Summary

Chapter 2: Revenue Cycle and Revenue Integrity

Revenue cycle departments involved in ensuring revenue integrity
Compliance
Summary

Chapter 3: Using Information Governance and Performance Improvement to Manage Revenue Integrity

Opportunities to improve performance
Summary

Chapter 4: Reimbursement Methodologies

Prospective methods
Retrospective payment methods
Summary

Chapter 5: Building the Case for a Revenue Integrity Department

Developing your business case proposal
Summary

Chapter 6: Staffing the Revenue Integrity Department

What’s needed to work in a revenue integrity role
Types of positions
Amount of staff required
Summary

Chapter 7: Bringing Value to Your Organization

The relationship between charge entry and charge description master
Hard coding versus soft coding
Conducting revenue integrity reviews
Claims
Infusions: A nemesis of revenue integrity
Denials
Human versus system errors
Types of reviews
After the audit
Summary

Chapter 8: Closing Thoughts