Translating Revenue Integrity Principles to a Small Organization

Revenue Integrity Insider, March 7, 2018

At many smaller organizations, such as clinics and physician practices, the providers are also the coders.

This article was originally published by Revenue Integrity Insider March 7, 2018.

Revenue integrity at a smaller organization looks much different than revenue integrity at a multi-hospital system. Fewer resources mean it’s an all-hands-on-deck operation with everyone taking on multiple roles.

“I’m in a rather unique position,” says Sondra Hess, CCS, CRC, documentation specialist at the Levy-Kime Clinic, Los Angeles Jewish Home in Reseda, California.

Hess’ facility is small but diverse—the Los Angeles Jewish Home operates 14 lines of business ranging from residential care to hospice, short-term and long-term rehab, assisted living, skilled nursing, and participates in CMS’ Program of All-Inclusive Care for the Elderly.

The average age of the clinic’s patients is 93, Hess says, and most have long-term chronic conditions.

With so many high-risk patients, it’s imperative that financial and administrative functions are handled as efficiently and correctly as possible.

Related: National Association of Healthcare Revenue Integrity (NAHRI)

To meet her organization’s needs, Hess wears many hats—a concept familiar to most smaller organizations. She’s the coder, CDI specialist, and medical records auditor. She works closely with the providers and clinic staff and the facility’s biller. Other revenue cycle and financial staff at Hess’ facility are always willing to share their expertise and assistance.

Revenue integrity at larger organizations is sometimes more contained, but at a smaller organization everyone will likely be called on to bring their expertise to the table and share some part of the work.

When Hess stepped into the role two years ago, she knew there was a significant amount of work ahead of her. Much of her previous experience was at large health systems such as Kaiser Permanente in Oakland, California, and the University of California San Diego Medical Center. The Los Angeles Jewish Home offered a fresh set of challenges—and rewards.

One of the biggest challenges at a smaller organization is, of course, resources. Hess is a department of one—that made it difficult to find the right focus and prioritize tasks at first. At many smaller organizations such as clinics and physician practices, the providers are also the coders. When Hess first joined the Los Angeles Jewish Home, she took on coding responsibilities from the providers. However, that arrangement, in which Hess reviewed charts and coded them, quickly became too time-consuming.

She shifted gears to a more purely auditing function, conducting prospective, concurrent, and retrospective audits, and was able to review a more significant percentage of charts. Initially, she reviewed 100% of clinic providers’ charge slips and provider notes. That gave her the opportunity to see the big picture and analyze common issues with documentation and coding.

Revenue Integrity Insider

Revenue Integrity Insider is a newsletter published by the National Association of Healthcare Revenue Integrity (NAHRI).

Facebook icon
LinkedIn icon
Twitter icon