The Role of Revenue Integrity in Reducing Revenue Loss, Payment Denial Risk

Guidehouse On Healthcare Podcast Series

In this episode, Guidehouse revenue cycle experts Andrew Hancock, managing director, and Amanda Vallozzi, associate director, share insights on how the revenue integrity process can help hospitals and health systems reduce the risk of revenue loss and payment denials. 

Hancock and Vallozzi discuss how a revenue integrity program is vital to a provider’s success and how adherence to policies and procedures - especially in the middle of a hospital’s revenue cycle - can make a difference in preventing gross revenue leakage and ensuring accurate reimbursement. The conversation also highlights the key components of a revenue integrity department, including gross revenue capture and net improvement focus areas; important success factors such as organizational commitment and how to best coordinate with operations, finance, and other areas; an appropriate implementation approach, timeline, reporting, and key performance areas; and provider case study examples.

As Hancock suggests, high-performing organizations have implemented revenue integrity functions and departments, allowing them to “maximize the effectiveness and efficiency of the revenue cycle directly” and “coordinate those activities with interdependent areas, such as clinical departments, contracting, and physician offices. We know that some of those outlying areas can have significant impact on the revenue cycle’s ability to collect and optimize cash collections.” 

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