NAHRI's Core Functions of Revenue Integrity, Second Edition

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NAHRI's Core Functions of Revenue Integrity, Second Edition

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NAHRI’s Core Functions of Revenue Integrity, Second Edition

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Available September 2021

NAHRI’s Core Functions of Revenue Integrity, Second Edition

Available September 2021

NAHRI's Core Functions of Revenue Integrity examines how each piece of revenue integrity comes together on a macro and a micro level by looking through the lens of 10 core functions. It provides actionable advice and guidance for revenue integrity professionals, whether they are new hires or experienced veterans.

This book provides a well-rounded perspective on revenue integrity, covering everything from payment systems and reimbursement methodologies to denial appeals and charge capture review. It is authored by six current and past members of NAHRI’s Advisory Board whose collective knowledge and experience will help revenue integrity professionals ensure their programs are running effectively and capturing revenue opportunities.

Benefits of this guide include:

  • A broad perspective of revenue integrity across 10 core functions, ranging from introductory to advanced topics
  • Trusted guidance by expert contributors from across the country
  • The ins and outs of revenue integrity in one comprehensive resource


Page count: 150
Dimensions: 8.5x11
ISBN: 978-1-64535-140-5

Table of Contents

Chapter 1: Introduction
Chapter 2: Understanding How Revenue Integrity Fits Into the Revenue Cycle
Chapter 3: Revenue Integrity and Denial Management
Chapter 4: Code Management and Code Edits
Chapter 5: Charge Capture
Chapter 6: Eligibility Requirements
Chapter 7: Coverage Regulations and Policies
Chapter 8: Keeping Pace With Regulatory Changes
Chapter 9: Healthcare Finance
Chapter 10: Healthcare Payment Systems
Chapter 11: Coding for Revenue Integrity

About the Authors

Sarah L. Goodman, MBA, CHCAF, COC, CCP, FCS, CHRI
Sarah L. Goodman, MBA, CHCAF, COC, CCP, FCS, CHRI, is president/CEO and principal consultant for SLG, Inc., in Raleigh, North Carolina. She is a nationally known speaker and author on the chargemaster, outpatient facility coding, and billing compliance, and has more than 30 years’ experience in the healthcare industry. Goodman has been actively involved and held leadership roles in a number of professional organizations on the local, state, and national levels—including NAHRI, where she serves as an advisory board member.

Terri Rinker, MHA, MT(ASCP)
Terri Rinker, MHA, MT(ASCP) is the executive director of revenue cycle performance with Community Health Network in Indianapolis, Indiana. Although she started her healthcare career on the clinical side, including working as a hospital laboratory manager, the last 15 years of her career have focused on the revenue cycle, where she currently leads the quality assurance advisor team for revenue cycle, both the clinical and administrative denial teams, as well as utilization review.

She has been a member of The Provider Round Table since its inception in 2003 and is currently the chairperson. She also serves on NAHRI’s Professional Advocacy committee. She has a Masters of Health Administration and a Bachelor of Science in Medical Technology from Indiana University. 

Valerie Rinkle, MPA, CHRI
Valerie Rinkle, MPA, CHRI, is president of Valorize Consulting, LLC, and has 40 years’ experience in healthcare policy, finance, strategy, and revenue management operations. Her expertise spans all CMS reimbursement methodologies and the operational capabilities necessary for healthcare providers to effectively achieve accurate and defensible payment. She has extensive hospital chargemaster, revenue cycle and provider-based department experience.

She also has significant experience in compliance due diligence in support of M&A as well as defense strategies surrounding both governmental and commercial payer audits. She has served as an expert witness in arbitration and litigation. She also provides coding and reimbursement strategy advice to device and pharmaceutical manufacturers.

Rinkle is the author of several books and numerous articles and a frequent public speaker with HCPro and an annual presenter at the Medicare and Medicaid Institute on Payment Policy by the American Health Lawyers Association.

Anna Santoro, MBA, CCS, CCS-P, RCC, CHRI
Anna Santoro, MBA, CCS, CCS-P, RCC, CHRI, is a revenue integrity director at Hartford Healthcare in Newington, Connecticut. She has 20 years of experience with chargemaster, claim edits, denials, and coding.

Donna Schneider, RN, MBA, CPHQ, CPC-P, CHC, CPCO, CHPC
Donna Schneider, RN, MBA, CPHQ, CPC-P, CHC, CPCO, CHPC, is the system revenue compliance officer at Yale New Haven Health in Connecticut. Schneider is a Registered Nurse with a Bachelor of Science degree in Nursing and a Master of Business Administration, both from the University of Connecticut. She has more than 30 years of healthcare experience in clinical intensive care, managed care contracting, network management, quality, compliance, privacy, and quality analytics. Donna has worked for managed care organizations, hospitals in both the community and academic settings, and home health care. She is a frequent speaker at her health care organization and local healthcare seminars. She volunteers for several community and professional boards. Donna is an avid marathon runner, including having qualified for and run in the Boston Marathon four times.

Angela Lynne Simmons, CPA
Angela Lynne Simmons, CPA, is the vice president of revenue and reimbursement at Vanderbilt University Medical Center. A Texas CPA, she brings more than 30 years of experience in healthcare operations and finance, and public accounting for healthcare entities. Simmons has expertise in healthcare policy, reimbursement principles from government programs (Medicare and Medicaid), as well as healthcare financial analysis and cost accounting. Much of her focus throughout her career has been on pursing revenue opportunities through improving hospital operations and through Medicare filings and appeals. Prior to relocating to Vanderbilt, she was the director of clinical revenue and reimbursement for U.T. M.D. Anderson Cancer Center, where she was responsible for Medicare and Medicaid reimbursement, cost accounting, revenue and rate-setting, financial analysis, and clinical decision support reporting.

The National Association of Healthcare Revenue Integrity (NAHRI)

NAHRI’s mission is to enhance the revenue integrity profession through standards, advocacy, networking, and the promotion of shared knowledge and resources. This mission statement was developed by our NAHRI Advisory Board, an amazing group of revenue integrity professionals who bring a wide range of expertise and experience to this organization’s leadership.

PEER-BASED RESOURES AND TOOLS

As a NAHRI member, you’ll get unlimited access to our vast members-only resources, tools, and content such as white papers, best practices, and research reports written by the most respected names in the industry.

Resources include:

  • Member-Only Content, explore the hundreds of the latest articles and research by topic, including white papers and best practices, plus an extensive archive on the NAHRI website
  • A library of sample webinars and other content on the latest revenue cycle topics
  • NAHRI quarterly journal, featuring in-depth, members-only content on the latest developments in revenue cycle

LOCAL CHAPTERS

Be on the ground floor in establishing your local chapter! It’s a great way to: 

  • Quickly integrate and network with other revenue cycle professionals 
  • Expand your management, leadership, and public speaking skills by volunteering for the chapter executive board

CONFERENCES AND TRAINING

Members receive significant discounts on all national and local NAHRI events. Learn from the best and brightest, interact and network with industry leaders, or roll your sleeves up and participate in an intensive, in-person, training events.

CAREER RESOURCES AND CREDENTIAL PROGRAM

NAHRI members receive $100 off the Certification in Healthcare Revenue Integrity (CHRI) credential program. This program will provide professionals like you a tangible way to enhance and promote your revenue cycle skills.

I speak for the NAHRI Advisory Board when I say we all have visions of amazing strides we can make together in the industry, now is the time. I look forward to you joining our growing community of revenue integrity professionals.

 

Sincerely,

Jaclyn Fitzgerald, Director, NAHRI
jfitzgerald@hcpro.com