Hardwiring Revenue Integrity in a Hybrid Revenue Cycle Management Environment

The current and future state of healthcare offers immense opportunities and challenges for revenue cycle leaders. Specifically due to qualified labor being uninhibited by the traditional confines of brick-and-mortar offices, now leveraging the substantial virtual work presence health systems are offering. This new reality has given rise to competing wages, employee engagement and retention strategy shifts, promotion of greater collaboration among clinical and operational stakeholders, and embracing of intelligent automation.

While the work model has changed, the revenue integrity framework of proactively, transparently, and collaboratively supporting the efficient delivery of quality healthcare by enhancing the patient experience, providing financial security, and preserving the organization’s reputation and culture, must remain prioritized to achieve institutional goals

Revenue integrity, at its core, is the deliberate and focused mindset to be fiscally compliant and responsible across the enterprise for optimal performance improvement. Realizing a highly functioning revenue integrity conviction begins with a structure of integrative-team accountability, results-oriented root-cause analysis, impacting operational efficiencies and eliminating waste, and perpetual performance monitoring and improvement. Integrated teams should be comprised of clinical, operational, and revenue cycle specialists who utilize each other’s strengths to identify specific processes that are inefficient. This dynamic group must have access to the right technologies and tools to not only be flexible and thrive in a remote environment but incentivized to use process re-engineering techniques, such as Six Sigma Methodologies of Lean or DMAIC, to highlight how their contributions influence the outcomes and overall goal.

A common roadmap for revenue integrity success includes a deeper understanding and application of the Six Sigma DMAIC (Define, Measure, Analyze, Improve, and Control) framework. This framework hardwires a series of questions that individuals ask themselves at each point to make certain an improvement project is relevant and aligned with KPI’s (Key Performance Indicators). Within the Define phase, the team asks what is important and determining the scope of project/process to target, establishing roles, and setting deliverables, with the best utilization tool being a workflow diagram or Gantt chart. The Measuring phase asks How our current process is performing, reviews the validity of key metrics, and conducts benchmark testing, with the best utilization tools, including benchmarking and data collection plan(s). The Analyzing phase ask Why and What is wrong within the process, identifying and prioritizing key causes of defects, displaying gaps between current performance and goal performance, and potential obstacles, with the best utilization tools being a Fishbone diagram, Pareto chart, and hypothesis testing. The Improving phase ask What needs to be done to achieve the goal more efficiently. From breaking down work structure to developing and testing possible solutions, a failure modes and effects analysis (FEMA) is an ideal tool to employ for the best one to be selected and implemented. Lastly, the Control phase asks how we guarantee and sustain desired performance by documenting standardization, communication by-in/confirmation, and monitoring plan, ideally utilizing control charts or plans as tools to accomplish a seamless project wrap-up.

While every issue encountered will not warrant a DMAIC style project approach, ensuring team members mentally and consistently process these framework questions towards organization issues will aid in driving a higher degree of accountability, cohesive collaboration, cost-containment, and revenue growth-preservation, and scalability.