Building by in for Revenue Integrity by nursing staff

HelmsL

Good afternoon, 

I recently transferred back to Revenue Integrity and have been tasked with implementing a charge capture/revenue integrity program.  I would appreciate any suggestions or tips that anyone is willing to share to assist me in beginning this process.   Where to start, who to include and how to be successful with this challenge. 

Thanks!!

dwilliamsrsi

Are you looking for ways to get the nursing staff involved? or more in general terms of the entire process?  

HelmsL

I could definitely start with that.  This is almost always a difficult area to gain headway. 

Thanks, 

kay.larsen@ah.org

I always enjoy meeting with departments to make sure that we've created charges for the procedures they're doing.  It's always good to remind them of new CPT codes and changes to existing ones.

stmsmith

Hi I also recently got back into Revenue Integrity. I would love to see/hear anything around the Charge Capture/reconciliation process. If anyone would share that would be great.  Staciesmith@jsmc.org

dwilliamsrsi

One strategy that has been successful for me in getting departments involved in the entire process is to help them understand that charge capture, the CDM information and charge reconciliation is vital to support the cost/resources involved in what they do.  If we don't report/charge for the service and we don't insure that the charge when through, then we are undermining ourselves as a hospital.  Nursing will get on board sometimes when they understand that we are in a position with many payers to be reimbursed for their services.  Nurses have typically be educated that there is no reimbursement for what nurses do so "why charge for it if we don't get paid."  There is an opportunity to explain that we do get paid for all services, maybe just not for the individual charge.  I find meeting with departments to be very helpful.  It builds a team spirit, and they become comfortable with the CDM because a lot of them don't really understand how it works and why anyone is interested.  For the charge capture/reconciliation, work with them on a process that works best for them regarding timing, reports, etc.  Suggest that they not select only one person but have a back up because we know things happen.  Emphasize the positives for them and their department.  That will always make things go smoother.  

Jpilato

Please excuse me if this is too elementary. It’s critical to start off on the right foot so I am starting with the basics. The key is building report and mutual respect with clinical departments. One way to get buyin is let the clinical department know you are working as an extension of their department to reduce leakage and improve charge accuracy. Do your homework and gain knowledge on what’s charged, and what’s not. Start by doing a chart to charge audit, review denials, review edits and trend the results. Create a list of discussion points and schedule a meeting with the department manager. During the first couple meetings, explain your purpose and value to the department (usually in terms of revenue optimization and reduce leakage / denials) ask questions about their charge capture process to gain knowledge, pain points and trouble areas.

An Effective approach requires an organized, methodical approach based on data and regulatory guidelines.