Panelists during a recent National Association of Healthcare Revenue Integrity webinar shared how they are forming strategic partnerships in their health systems to streamline the revenue cycle.
In a recent webinar hosted by the National Association of Healthcare Revenue Integrity (NAHRI), a panel of revenue cycle leaders gathered to discuss the results of NAHRI's recently released 2025 State of the Revenue Integrity Report and associated survey.
The discussion featured important insights on denials management, communicating the value of revenue integrity, and AI in the revenue integrity space, among other topics. Panelists were Jennifer Gardiner, senior director of revenue integrity at the University of Maryland Medical System; Kay Larsen, revenue integrity senior charge assurance associate at Adventist Health Glendale; and Evan Martin, vice president of revenue cycle management at ZoomCare.
Where revenue integrity teams can offer additional assistance
While denials management doesn't typically fall directly under the umbrella of revenue integrity departments, it is certainly an area where they can help. Nearly 60% of survey respondents claimed denials management was a secondary function for their teams.
However, as claim denial rates increase and denials become more complex, revenue integrity departments could help to "pull a lot of the pieces together," Gardiner says.
Revenue integrity teams could also add value in supply management, according to Martin. Providers will too often begin using a new supply, believing it to be reimbursable when that is not the case. By involving revenue integrity early, health systems can ensure that they achieve more value from supplies used in surgeries and other clinical procedures.
Similarly, health systems will often launch a new service line without input from revenue integrity departments, according to Larsen, who relayed an anecdote about a request for support two weeks after the launch of a new line of service. Engaging with revenue integrity departments before new services go live can help health systems to maximize revenue streams from those services.
Communication is key
As Larsen's anecdote indicates, revenue integrity departments can sometimes be overlooked. They need to conduct outreach to draw attention to the value they add.
"We can be proactive and working with departments," Larsen says.
She says she downloads charges for different departments every day, looking for patterns that reveal opportunities to improve, and will call the department to see if the revenue integrity team can help make adjustments.
Although she technically works remotely, she'll occasionally travel to the hospital to work elbow-to-elbow with providers and administrators. During these times, she is often able to help departments optimize their EHR functionality to reduce administrative burden in billing processes.
Similarly, the revenue integrity team at University of Maryland Medical Center conducts what Gardiner calls "revenue integrity roadshows," which are essentially opportunities to meet with practice leaders and show how the team can help.
On the flip side, it is important that revenue integrity teams avoid taking on responsibilities that belong to someone else. It is common for a revenue integrity team to do a task outside of its purview once or twice, and then it becomes a pattern, according to Gardiner.
AI and revenue integrity
Only around half of health systems are using AI in their revenue integrity departments, according to survey results. However, there was a lot of enthusiasm among panel participants for its potential.
AI platforms can be trained in charge capture and charge edits to replicate what human medical coders do in certain instances, according to Martin. This would help to mitigate staffing challenges and free up time for revenue integrity team members to work on tasks that require more complex knowledge.
Additionally, as more health systems adopt AI-powered digital scribe systems, there is potential to reduce the burden of documentation on providers.
However, "revenue integrity needs to be part of that conversation," according to Martin. Revenue integrity involvement ensures that the scribe captures information and uses verbiage that aligns with what is being charged for.
Luke Gale is the revenue cycle editor for HealthLeaders.
KEY TAKEAWAYS
Early engagement with revenue integrity departments can help health systems to ensure that all charges are being captured when launching new lines of service of using new supplies in clinical procedures.
Conducting internal outreach can help revenue integrity teams to communicate where they add value.
While only half of revenue integrity departments are currently using AI, there is potential for AI platforms to mitigate workforce staffing challenges.