Q&A: Developing a revenue integrity business plan

June 11, 2018
Medicare Web

Q. How can organizations develop a business case or plan for revenue integrity departments?

A. A business case proposal or business plan is a written document outlining goals, objectives that will contribute to achieving those goals, and plans to reach the objectives. Essentially, a business plan is a roadmap. It is very specific and details the resource requirements, benefits, and time required to meet each objective. It may predict outcomes and may span a time frame of longer than one year. The purpose of a business plan or business case proposal is to make a well-written and comprehensive case to secure the funding of the program. Development of a business plan does not happen overnight, as it requires significant time to research and draft. A strong business plan will not only pitch your goals to upper management, but also serve as a foundation to which you can refer when building your department. The business plan should include:

  • A clear statement of your project’s mission and vision
  • A blueprint you can use to focus your energy and keep your project on track
  • Benchmarks you can use to track your performance and make midcourse corrections
  • An objective analysis of your industry, including opportunities and threats
  • A portrait of your potential targets and their current impact on the organization
  • A rundown of major hurdles and your strategies for facing them
  • An honest assessment of your plan’s strengths and weaknesses
  • A roadmap and timetable for achieving your goals and objectives
  • A description of what will be achieved
  • An analysis of your revenues and costs
  • An action plan that anticipates potential detours or hurdles you may encounter

A business plan aimed at creating a revenue integrity department should focus on inventorying an organization’s shortfalls, setting priorities, and dedicating staff and resources to address the issues. To enhance readability of the plan, use text and graphs whenever possible.


For more information, see The Revenue Integrity Manager's Guidebook.

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