Slide 1. Slide 2. Slide 3. Revenue Integrity For Physician Billing. Revenue Integrity. Complexity of Coding and Billing

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1 Slide 1 Revenue Integrity For Physician Billing Teresa Treon, RHIT, CPC, CPMA, AAPC Fellow & Sherry Wright-Fontenot, CPC, CPCO, CPMA, CEDC, AAPC Fellow Slide 2 Revenue Integrity Merriam Webster defines Revenue Integrity as firm adherence to a code of especially moral or artistic values; incorruptibility; completeness. For those of us working in the provider based arena we define Revenue Integrity as wanting to completely capture all possible opportunity for reimbursement and remain complaint with the rules and regulations. This is the approach the guides physician organizations toward achieving operational efficiency, being completely compliant with regulatory guidelines, while achieving total reimbursement Slide 3 Complexity of Coding and Billing With the every changing coding and billing regulations and changing cost in our physician organizations we find that it leads to missed revenue and increased regulatory scrutiny. Revenue Integrity programs are being developed in many physician organizations to help capture the missed revenue opportunities while remaining compliant with the regulatory guidelines.

2 Slide 4 What Is Revenue Integrity? It is a governance type structure with cross functional work streams that aid in effectively identify, improving, and sustaining charge capture to prevent leakage. Slide 5 Benefits of Developing Revenue Integrity Programs Standardization, it can be specialty focused, you become proactive instead of reactive, aids in bridging silos and develops a focus on charges and reconciliation Slide 6 Revenue Integrity Analyst or Specialist A Revenue Integrity Analyst or Specialist works as a liaison between the revenue cycle, finance and operations and IT. The analyst or specialist will work closely with physicians, directors and managers to help define lost revenue opportunities and assist with helping to capture that lost revenue.

3 Slide 7 What is the Role of a Revenue Integrity Analyst? Research and communicate all regulatory requirements that impact charging and reimbursement. Provide education on annual CPT coding updates and drive the necessary CDM (charge description master) revisions. Trend denials, RVU s and revenue for each specialty and then provide the education to operational leaders and providers in monthly meetings. Train Clinical departments of how to review charge reconciliation reports. Slide 8 More On The Role of Revenue Integrity Analyst Conduct regularly chart reviews for all providers and provide the feedback on the findings. On boarding of all new providers, (physician, nurse practitioners, physician assistants, etc.). Support operational leaders on all efforts and initiatives related to charge capture, documentation and reimbursement items. Slide 9 Working with Hospital Departments Revenue Integrity Analyst work closely with some hospital departments that are working to improve the hospital revenue as well. Many times the Revenue Integrity Analyst and CDI specialist have some common goals one is to improve provider documentation.

4 Slide 10 RIA Programs- Partnering for a better outcome Revenue Integrity Analyst s should educate that coder s apply codes at the highest specificity possible with the current documentation. Revenue Integrity Analyst s find missed query opportunities when documentation is unclear, lacks specificity or inconsistent. Revenue Integrity Analyst s identify query opportunities that CDI may have missed due to staffing, volume or CDI staff training/experience. They are a true partner- able to provide that training, educational resources or guidance as needed. Slide 11 RIA Programs- Partnering for a better outcome CDI and RIA working together can improve facility documentation and CMI as well as professional services documentation. WIN-WIN Communication of findings is vital. Learning what to communicate and who needs to know- is part of creating this role. Understand your goals- example Great Patient Care, includes Proper Documentation of All Services Provided and Appropriate Reimbursement of those Services at the Correct Rate. Physician and Staff Satisfaction can improve by the education and support they feel from the RIA s in this program. They have a source of credible information and this is vital to improving their documentation and satisfaction. Slide 12 RIA working with Central Billing Office RIA s meet with the CBO to discuss payer denials and provide feedback to help improve the denial rate. Education to the CBO staff on provide billing updates that have been educated to providers so everyone is on the same page.

5 Slide 13 RIA- Liaison By reviewing your revenue from the beginning of the encounter thru the payment of the service, you are able to see many trends and issues that will need to be prioritized. The RIA is a liaison- that continues to look at the cycle and evaluate trends. The RIA as a person cannot get caught up in the day to day work flows or they will may not be able to abstract the trends. Slide 14 Questions? Slide 15 Contact Information: Teresa Treon, RHIT, CPC, CPMA, AAPC Fellow terthomas@saintlukeskc.org (Office) Sherry Wright-Fontenot, CPC, CPCO, CPMA, CEDC, AAPC Fellow swright-fontenot@saintlukeskc.org (Office)