The healthcare sector has been moving at an unprecedented pace over the last couple of years. In the meantime, revenue integrity is becoming a very popular concept among healthcare providers and institutions from all over the globe. This is an excellent enhancement in the healthcare sector and certainly a force for good in the long term.  

The importance of revenue integrity became even more evident during the pandemic season when there was a steep rise in patient volume. As a result, healthcare revenue integrity solutions have also been on the rise in the past few years. But is it worth using a healthcare revenue integrity solution in today’s age? Let’s dive into this ordeal’s details to better understand.

Let’s start with understanding healthcare revenue integrity first

Healthcare revenue integrity is much more than a mere concept or practice. This includes many aspects, such as constant monitoring, auditing, and training employees to ensure effective care and billing. The healthcare revenue integrity process also includes enhancing clinical documentation, reviewing codes, and educating healthcare providers.   

Effective healthcare revenue integrity is one of the best ways to enhance healthcare compliance, efficiency, and payment management. Besides that, it also helps healthcare providers get a better understanding of patients and their outcomes. The primary reason behind this is that healthcare revenue integrity always ensures accurate documentation for all relevant stakeholders.   

Important key performance indicators (KPIs) for healthcare revenue integrity

Effective healthcare revenue integrity can yield numerous benefits for healthcare providers and institutions, especially in terms of better healthcare revenue cycle management. Therefore, it is imperative to remain mindful of some of the most important KPIs associated with healthcare revenue integrity. Some of the most important of these KPIs include:

• Days not final billed (DNFB). Days not final billed, commonly known as DNFB, is an important performance indicator for measuring the healthcare revenue integrity of a healthcare institution. DNFB refers to the period of time needed to get a bill out of the door. Therefore, it is always important to monitor this metric to ensure healthcare providers meet all their filing requirements in a timely manner. It is also worth noting that better charge capture and coding automatically shorten the DNFB of the healthcare institution.  
• Coding productivity and accuracy. The next important KPI for healthcare revenue integrity is determining the productivity and accuracy of coding. This means evaluating the correctness of different codes based on services rendered and claims assigned to the same. Furthermore, coding productivity refers to the percentage of claims coders can get done in a given period of time. This productivity can vary based on multiple different factors, such as the department for which they are coding.
• Initial denials . The final important KPI for effective healthcare revenue integrity is evaluating initial denials. These are the cases where an insurance provider might deny a request from the patient for paying for their healthcare needs. This is an important metric for healthcare revenue integrity since it directly impacts the overall revenue-generating potential of a healthcare provider or institution. 

Benefits of using a healthcare revenue integrity solution 

Now that you have an understanding of healthcare revenue integrity and the important KPIs associated with it, the complexity of this ordeal becomes evident. But there is no reason to sweat over this since modern healthcare revenue integrity solutions can make this an easy ordeal. So here are a few prominent reasons why you should consider using a healthcare revenue integrity solution.

• Resource optimisation. Resources are scarce for every organisation and even more so for healthcare providers and institutions. Therefore, it is always important to ensure the effective use of resources for these organizations. Thankfully, this becomes much easier when you use healthcare revenue integrity solutions for the purpose. These healthcare revenue integrity solutions can help you route patients to the most cost-effective and clinically suited medical care setting. This means you can get an overview of the best-suited staff members, protocols, and tools. This overview will allow you to assign the right patient to the right setting to ensure the best use of resources.
• Mitigating risk. The quality of coding and auditing those codes is one of the most important aspects of ensuring effective healthcare revenue integrity. But unfortunately, there is only so much one can do when relying on manual processes to evaluate all code quality. This is where a healthcare revenue integrity solution can be a really helpful tool to evaluate the quality of coding. These healthcare revenue integrity solutions come with advanced features and abilities to help you evaluate all your codes in no time. If the solution comes across something wrong or out of context, it will immediately highlight that. As a result, you can quickly make all the necessary changes and mitigate the risk of things going wrong with your healthcare revenue integrity.
• Seamless access to valuable insights. Data plays a very important role when it comes to establishing effective healthcare revenue integrity in any healthcare organisation. However, manually recording all data can be more challenging than many might imagine. Besides that, relying on manual processes also leaves room for human errors which can lead to more complications. But fortunately, this will not be a concern when you are using a healthcare revenue integrity solution. These solutions are designed to record all relevant data you can access at any given time. Hence it becomes much easier to evaluate these datasets for determining trends and flaws. You can then take necessary measures to address and persist issues and facilitate better healthcare revenue integrity.

Final thoughts 

There is no denying that the quality of healthcare most people enjoy today results from practical healthcare revenue integrity. The importance of this ordeal will only increase with time with a growing population and better healthcare becoming more accessible.

Therefore, it only makes sense that healthcare providers make all necessary efforts to master this front at the earliest. One of the best ways to make this a reality is by using a healthcare revenue integrity solution and easily realizing your goals.

Adam Mulligan, a psychology graduate from the University of Hertfordshire, has a keen interest in the fields of mental health, wellness, and lifestyle.