Director of revenue integrity discusses short- and long-term goals

Prioritization and time management are crucial when it comes to leading a revenue integrity department. Kimberly Yelton, RHIA, CCS, CDIP, AHIMA-approved ICD-10-CM/PCS trainer, and director of revenue integrity at WakeMed Health & Hospitals in Raleigh, North Carolina, told NAHRI about her experience with this when planning and following through with department initiatives.

When WakeMed first launched its revenue integrity department, it was met by a positive response from staff members, says Yelton. To ensure the department’s time was well focused, requests for revenue integrity department tasks were prioritized to ensure they should be routed to the staff. WakeMed also took a close look at what positions would be needed in the department and what traits candidates should possess for each role.

 
Short-term goals
When it comes to short-term goals, Yelton’s top three priorities are hiring, automating processes, and streamlining information. Looking for new hires can be challenging, so she recommends ensuring that a person’s skills align with the job requirements. “You’re only as good as the folks around you,” she adds.

For new hires, Yelton has been successful at placing internal candidates but also extends to external candidates. Hiring is critical to ensuring a successful department. Staff must have great communication skills and be able to effectively work with physicians, clinical staff, executive leadership, departments, and peers. “We're going to make sure each department is aware of their charges/charge reconciliation and ensure we have a person to communicate with,” says Yelton. “And not only do we have a main contact but a second and third person to contact as well.”

The second priority is automating time-consuming processes, including accurately assigning ownership to work queues in Epic. Yelton focuses on how work rules can automate revenue integrity processes so accounts require less manual work. Revenue integrity and information services departments must have a strong relationship for automated processes to run effectively.

Lastly, the department is working on streamlining information upward so issues do not get bottlenecked on the backend. Yelton recommends using root-cause analysis to identify the issue and resolution and work toward preventing additional occurrences. For example, if charges are posting late, the revenue integrity department must communicate with other departments to determine the root cause and avoid late charges in the future.

“No one comes in wanting to do the wrong thing—everybody thinks that they’re doing the right thing the first time,” she says. “But if we identify issues, and we don’t go back to the departments or to staff and educate them and let them know what the mishaps were, then we’re never going to fix the problem. We’re going to continuously be cleaning it up.” Don’t forget to give positive feedback to departments that are doing a fantastic job, Yelton adds. 
 

Long-term goals
Looking ahead, Yelton’s long-term goals include ensuring that the department is always following industry standards, maintaining open communication with staff and leadership members, and using best-practice methods.

A key element of following industry standards is ensuring the chargemaster is up to date. To do this, Yelton and staff audit the chargemaster to eliminate any errors such as invalid codes. Additionally, the department seeks out external resources to improve practices. They work with a consulting company and use nThrive for additional support in pulling chargemaster reports.

Maintaining open communication is heavily reliant on having a good relationship between departments. This is eased due to the fact that many members of the revenue integrity department came from revenue cycle or other departments at WakeMed, Yelton says.

“You have to have that strong foundation and that working relationship with them. Joining forces with our administrators has been very beneficial,” Yelton says.

Open communication is also part of ensuring a department is up to date with best practice methods. Yelton meets weekly with IT support to discuss any issues related to revenue integrity, nThrive, Epic claim/charge edits, work queues, and automation of processes. Revenue cycle, patient access, and other key departments also attend this meeting. A detailed spreadsheet is kept for tracking ongoing and resolved issues.

“The spreadsheet includes date of issue, ownership of the issue, IT owner, issue description, who is impacted, status, notes, and outcome,” she says. “This allows us to track past and future efforts and gives us the tools for continuing to streamline processes.”

Yelton also recommends taking advantage of external auditing to maintain best-practice standards. Choose a company that is reputable and you feel comfortable with, she says.

The biggest improvement has been shortening the turn-around time from when a claim gets caught to when it is fixed in a work queue. Today, the department has a three-day turn-around time.

“If an account is not resolved within a three-day time frame and falls within revenue integrity, then the account is escalated to me, so I can follow up and see what steps need to be taken,” Yelton says.  “Since implementing an escalation process and having continued communication, accounts are being reconciled a lot quicker.”  

Note: This case study is from the National Association of Healthcare and Revenue Integrity. For more revenue integrity updates, subscribe to our newsletter, Revenue Integrity Insider.