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Revenue Integrity: Understanding How to Reduce Costs and Retain Revenue in Healthcare

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Revenue Integrity: Before the pandemic, many hospitals and clinics were already having trouble making ends meet. However, the American healthcare system is currently on the verge of collapse. The American Hospital Association estimates that hospitals are losing $50 million per month owing to COVID-19 and the cancellation of elective treatments.

Patients with serious illnesses, and not just those with COVID, have avoided going to their primary care physicians out of fear of exposure. Another issue that continues to compromise healthcare revenue integrity is incorrect patient identification, duplicate medical data, and medical identity theft.

While there are clear financial benefits to adopting Value-Based Reimbursement (VBR) models, doing so is made more difficult by other factors, such as the constant evolution of healthcare compliance rules. Because of siloed workflows, an explosion in data, and incompatible technology, achieving the teamwork necessary for VBR to succeed is challenging. Smart revenue cycle management, however, maybe the answer to establishing both fiscal security and revenue reliability.

Here are five ways in which hospital revenue cycle management can help you save money:

1. Cut down overhead expenses

In hospitals, it is not always easy to limit spending on things that aren’t directly related to patient care. A healthcare facility’s operating costs can quickly add up, especially when accounting for billing and other administrative expenses. There is room for savings by cutting back on overhead expenses. It is in the best interest of a healthcare executive to keep an eye on overhead. A sizable chunk of most organizations’ overhead goes on sales and marketing.

2. Improve patient satisfaction

In order to boost hospital profits, it is crucial to ensure that patients are happy with every element of their care. Better hospital profits are often characterized by more satisfied patients. A recent study found that in the United States, hospitals that delivered an excellent patient experience had net margins that were 50% larger than those that only met expectations.

When a patient has a negative experience at the office, they may hold a constricted view of the healthcare provider in general. In some cases, this might lead to increased costs for the facility as a result of increased time spent on customer service.

There are numerous other upsides to keeping patients happy. It is way more probable that a patient will continue seeing their doctor and following their treatment plan if they are happy with the care they are receiving. Health outcomes may improve as a result of these factors.

3. Evaluating Key Performance Indicators (KPIs)

Managers need fast access to various types of data and key performance indicators (KPIs) to track things like staff hours, overtime, patient counts, and the ratio of full-time workers to occupied beds in order to reduce labor costs and amplify productivity. It is beneficial for healthcare executives to thoroughly examine financial data.

In order to assess the company’s present performance, they need to collect and verify information from the financial systems. Revenue-related key performance indicators should be identified. Checking key performance indicators for signs of success or failure is also recommended. It is in the absolute best interest of the provider to keep track of key performance indicators and assess if new metrics should be added or old ones dropped.

Key performance indicators (KPIs) should be monitored closely by providers in order to spot problems with readmission during the transition care process. Providers can then evaluate the results and make adjustments as needed.

4. Minimize redundant testing and other services

It has been told that up to $5 billion is wasted annually in the United States due to unnecessary testing, as cited by the American Journal of Clinical Pathology. About 4% of annual healthcare costs are attributed to laboratory and pathology testing.

One contributor to growing health care costs is laboratory testing. The need to stabilize and reduce healthcare costs, including those associated with in-house laboratory services, is growing as a prerequisite to putting the United States’ healthcare system on a more long-term and sustainable footing.

Providers should exercise caution when initially ordering laboratory tests to avoid wasting resources. Computerized physician order input systems that incorporate system-defined guidelines for utilization control make it easier for doctors to place test orders.

5. Adopt technological advancement

Correct application of technology has the potential to be one of the most helpful instruments for a hospital in maximizing revenue cycle efficiency. When it comes to lowering readmission rates, many hospitals are turning to telemedicine as a significant component of their readmission reduction strategies. Many healthcare providers have discovered that they can reduce needless readmissions by working to better coordinate the treatment they give to a wider variety of patients. This reduces the expenses often incurred due to patients’ frequent readmissions.

In some instances, the use of clinical decision support technologies has also helped to lower associated expenses. This equipment is useful for keeping tabs on how the lab is being used. They can help doctors cut back on unneeded testing without sacrificing the quality of care.

After two years of using a laboratory expert system to reduce test volume by around 11 percent, a department of the Veterans Health Administration saved an average of more than $150,000.

Hospitals can save money with the help of clinical decision support systems if doctors use them effectively during the prescription placement phase of patient care. These programs aid doctors in avoiding typical blunders that lead to expensive prescription habits.


The National Association for Healthcare Revenue Integrity (NAHRI) defines revenue integrity as “the proactive management of a healthcare organization’s financial resources with the objective of minimizing financial loss due to improper accounting, billing, or other financial reporting procedures.”

In healthcare, financial losses are often caused by noncompliance with regulations. In the U.S. healthcare system, for instance, HIPAA infractions are on the rise. However, this problem can be helped by using HIPAA compliance software. Providers in the healthcare industry can streamline their compliance efforts and better manage their staff’s training with the use of this kind of software. Protecting patients’ personal information in accordance with HIPAA regulations helps businesses avoid financial losses and maintain efficient revenue cycles.

Also Read:When Should I Be Concerned About Heart Arrhythmia?

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