News: 2018 State of Revenue Integrity Industry Survey shows diversity, growth potential

Revenue integrity (RI) is still the new kid on the block as far as hospital departments and roles are concerned, so it’s not surprising that more than half (62%) of respondents to the 2018 State of Revenue Integrity Industry Survey have held their current role for five years or less. And an array of titles makes up the revenue integrity profession, including RI director, 18%, and 7% each for positions of RI manager, analyst and specialist, according to the National Association of Revenue Integrity (NAHRI) survey report.

“Many organizations—depending on the specialization within the revenue integrity domain—require a coding background to enable the successful interaction with pre-claim edits that include NCCI, LCDs, NCDs, OCE, MUE, and revenue capture opportunities,” says Cassi L. Birnbaum, MS, RHIA, CPHQ, FAHIMA, systemwide director of health information management and revenue integrity at UC San Diego Health.

“Also, this department typically interacts with cases that bump into an edit associated with simple visit coding. A clinical background is best suited for revenue integrity functions which involve clinical appeals and the coding appeals should be routed to a revenue integrity analyst with a clinical background. Defense auditing also should be an integral part of the revenue integrity umbrella,” Birnbaum says.

Like the respondents’ titles and credentials, the primary functions of those with a dedicated revenue integrity department were also varied. Top responses include:

• Chargemaster maintenance: 79%
• Charge capture: 73%
• Education: 62%
• Chart auditing: 60%
• Correcting claim edits: 49%

Additionally, respondents wrote in other functions not listed as options on the survey, including external third-party audits, maintaining department charge sheets, charge monitoring, clinical trials billing, system reporting and data analysis, claim edits and denials management, and designing workflows.

“The NAHRI survey is a crucial step in defining who and what revenue integrity encompasses. It was striking how diverse the respondents were as well as the scope of responsibilities,” says Elizabeth Lamkin, MHA, ACPA, CEO and partner at PACE Healthcare Consulting, LLC, in Bluffton, South Carolina.

Respondents also wrote in the functions they assist with or support that were not listed in the survey. The write-in responses included utilization management, health IT, project management, reporting on billing activity, and pricing.

“As we tackle our new and complex environment of billing and compliance, this group’s role will expand to include the assembly line of clinical departments and medical staff needed to reduce errors on the front end,” says Lamkin. “Revenue integrity professionals will lead the coordination and collaboration whether as a program or a department. As such, NAHRI is crucial in as a platform to define and formalize this vital role.”

Editor’s note: This article is an excerpt from the 2018 State of the Revenue Integrity Industry Survey Report from NAHRI.