Opinion piece authored by Penn Medicine, Navigant featured in HFMA
The ongoing shift to value-based care, coupled with reduced payments, has increased hospital and health system focus on effective and accurate pricing, charging, and coding. As a result, revenue integrity departments have expanded, often including all efforts to collect information across the continuum of care and ensure claim payments are received expeditiously and in agreement with complex payer contracts.
As Penn Medicine prepared for its electronic health record (EHR) conversions in October 2016 and March 2017, senior leaders believed the conversions could be catalysts to develop a formal revenue integrity department. Penn engaged Navigant to provide revenue cycle support for its hospitals that were converting to a new billing platform in two waves. Collaborating with the consultants and the billing system’s implementation teams, Penn set out to mitigate revenue and cash disruption during each go-live, particularly in the areas of charge capture, pre-bill management (i.e., coding and claim error resolution), and claims integrity.
The conversion achieved 102.7 percent of gross target revenue within 30 days of each conversion go-live. More important, Penn developed a revenue integrity department unique to the health system, based on how it pivoted to support their conversion.