June 23, 2020

3 Things You Should Be Doing to Keep Up with the Joneses: Revenue Integrity Edition

Spencer Thielmann

Revenue Integrity teams live in a world between patient care, coding, and billing, as such their role in the revenue cycle has often been hard to define and their skillsets often underutilized. In the upheaval of COVID-19 and reduced visit volumes it is more important than ever that your Revenue Integrity team be focused on delivering the highest value possible to your organization. How to execute effectively when dealing with a remote workforce and shifting regulatory requirements will test any RI department, we have identified a few areas of focus to help guide your teams.

1. Billing for telehealth and video visits – What can you charge for your telehealth and video visits? What codes are appropriate for billing? When does the pandemic response grace period end and what does that change? Just staying aware of CMS and payer requirements has been a significant time investment for revenue integrity leadership across the county. There have been abrupt changes, helpful accommodations, and plenty of confusion in the last three months. The one certainty now is that telehealth is here to stay, so you need to make sure that your organization is charging and billing accurately to create the opportunity to be fully reimbursed. There are some quality resources available, though we have seen clients struggle to interpret published guidance and effectively implement policies and system configuration accordingly. Check points for your team should be:

    • Creation and dissemination of hospital and professional charge protocols regarding when and how your organization will bill for these services
    • Plan for reviewing detailed compliance directives around hospital outpatient department extensions and requirements
    • Understanding and communicating decisions of your non-governmental payers regarding acceptable billing codes and cost share handling

2. Appropriate revenue capture within your service lines– Outside of the specifics of telehealth, the reduction in visit volumes is making each dollar more important than ever. If you do not have a mature RI department you must take steps to get there in a hurry. Your teams should be getting familiar with your high dollar/volume services and identifying missed revenue capture, undercoded charges, mutually exclusive charges, and general inefficiencies. With most organizations seeing a modest reduction in billing edit volumes and remediation work ensure the time of your staff is appropriately utilized and develop policies and activities to accelerate your development along a maturity curve.

3. Maintaining culture and building relationships with clinical and IT counterparts– In order to effectively improve upon existing revenue capture practices, you will need your team working effectively and buy-in from you clinical operations counterparts. Your remote workforce has some hurdles in attaining buy-in that were not there four months ago, but you can create an environment that will allow them to be successful. Work for your culture, encourage in person meetings and video chats. Do not let team members get untethered from coworkers and the organizational mission. Give your team their focus areas and outline how they add value.The CDM and Charge Review Workqueues may be the bread and butter, let people lean into the familiar. Find people that can embrace the challenge of “projects” and tasks with less definition. Leverage any existing forums for communication with the clinical teams and identify impact areas work hard to maintain whatever connections you currently have. For any services with which you currently lack connectivity, start reaching out and building those relationships and clearly state your intentions (people are often more receptive when you are going to help them find money). To get momentum on revenue recognition improvements work on a small scale with specific departments, to maintain momentum, share results with leadership and get a project charter and plan together so that everyone buys-in.

We all know challenges loom for Revenue Integrity and overall Revenue Cycle operations, and that visibility of those challenges are obscured by much uncertainty. That makes it more critical than ever before that we make clarity where we can and create actionable plans that will bring stability to departments and organizations. Those choosing to wait may find themselves further behind than ever. Take charge of your Revenue Integrity destiny in whatever big or small ways you can right now; your organization and your patients will reap the benefits.

We will continue to publish relevant content with the goal of helping you navigate the challenges you face now and the opportunities the future will bring. If you have questions, please contact Spencer Thielmann at The Wilshire Group – s.thielmann@thewilshiregroup.net or visit our Revenue Integrity services page.  Whether or not you are a current client, we have experts available to assist your team with any Revenue Cycle needs and questions you may have.


Spencer Thielmann

Vice President, Operations

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