Health information management professionals are fulfilling roles in numerous healthcare settings.
“Revenue integrity” is a relatively new buzz-phrase, but it certainly is a concept that should have been in practice since pay-for-service healthcare began. In essence, if it had been religiously practiced, the “fraud” would not be in the healthcare lexicon. At least that is the position I am taking in the new Revenue Integrity book I am preparing for the National Association of Healthcare Revenue Integrity (NAHRI), which will cover the topics in this article and more.
Achieving revenue integrity is an important goal for all revenue cycle leaders. By striving for it, we concern ourselves with correcting those practices, systems, and processes that create erroneous charges. Our goal should be to claim only those charges for which we are entitled compensation, and those that are supported by documentation in our records.
Roles in revenue integrity are popular these days. Nearly 9,500 revenue integrity position listings appeared on a popular recruiting website recently. The titles ran the gamut, including auditor, analyst, assistant director, director, educator, liaison, manager, nurse, and specialist. Clearly, the revenue integrity role is broad, and there is a growing need for professionals to fill these roles.
There are many initiatives that health information management (HIM) professionals can participate in to contribute to their organization’s revenue integrity endeavors.
Obviously, the first area is coding. Coding drives much of each claim, and accuracy will properly depict the conditions treated, but not necessarily the services delivered. The specificity of our coding contributes to the reimbursement defined by risk, prospective payment methodologies, and quality indicators.
Another area is the chargemaster. Individuals knowledgeable in chargemaster rules are hard to find. But how often do we see charges doubled on a claim, or a service that should be soft-coded being incompletely or inaccurately hard-coded by the charge description master (CDM)? Joining the chargemaster committee is a first step to contributing HIM knowledge to this process.
There are health information departments where the coding team codes services (including EKGs, radiology exams, and other services) that are routinely coded and charged by the CDM in other organizations. Why? It’s because these organizations trust the coding professionals more than the CDM. There is such a need for guidance in the chargemaster arena, making for a great opportunity for HIM professionals.
Another area where HIM can make a difference is with other charges that are applied through our patient care processes. Analyzing workflows and understanding logistics are often talents HIM professionals possess. Some HIM departments have taken on the duties of charge capture for the ED, OB, OR, and other departments. Doing so allows the patient care team to focus on patient care and allow HIM professionals to assume responsibility for accurate charge entry. Since data integrity contributes to revenue integrity, the organization benefits.
Achieving an environment of revenue integrity requires determination, detective skills, and the passion to ensure that your organization does what is right. HIM professionals can rev up the revenue integrity initiatives to do just that.
EDITOR’S NOTE: Ritesh Ramesh, CEO for MDaudit, appeared on Monitor Monday to report his company’s findings on nationwide audit trends. The rate of payer audits
EDITOR’S NOTE Day 3 of the federal shutdown continues. This article by Rose Dunn is part of a special section today published by RACmonitor and
Please log in to your account to comment on this article.
Expert presenters Kathy Pride, RHIT, CPC, CCS-P, CPMA, and Brandi Russell, RHIA, CCS, COC, CPMA, break down complex fracture care coding rules, walk through correct modifier application (-25, -57, 54, 55), and clarify sequencing for initial and subsequent encounters. Attendees will gain the practical knowledge needed to submit clean claims, ensure compliance, and stay one step ahead of payer audits in 2026.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
