Lots of organizations are working to prevent denials. For example, Rady Children’s Hospital presented on their success in addressing denials through improved communication across registration, coding, and billing departments. They also highlighted some innovative system automation to let the system, rather than a person, take the first step to follow up on denial codes. SCL Health shared work they’ve been doing through a self-service denials management application utilizing Tableau. They preached the gospel of self-service reporting and allowing individual departments access to drill into denial information they needed to prevent and manage those denials.
Emphasis #2: Revenue Integrity
Revenue integrity departments, or teams that ensure charges are complete and accurate, are popping up everywhere. While each organization has a slightly different take on the role of these teams, the benefits are consistent - by auditing encounters for charge accuracy, you may find you've missed charges that you could be capturing more accurately. Based on what we heard, here are a few best practices in the design of a revenue integrity team:
- Revenue integrity teams should sit outside the billing or coding teams, but be composed of people who know those worlds
- Knowing and managing charge capture methodologies
- Maintaining the CDM
- Auditing encounters for missing charges
- Epic has developed the Revenue Guardian for HB. While it’s definitely a useful tool, there was a common need across organizations for a similar tool on the PB side.
At the end, we hosted a happy hour. Our team had a great time talking to some very intelligent revenue cycle minds and unwinding after a productive and informative week.
Stay tuned for more details on how we approach denial management and revenue integrity in our next post! Can't wait? Email me at email@example.com