Q&A: The role of registration in revenue integrity

Q. What impact does the registration or access department have on overall revenue integrity?

A. The access (or, as it is sometimes called, registration) department plays a major role in ensuring revenue integrity. Known as the “front end of the revenue cycle,” its staff is responsible for not only being exceptionally personable with the patients, but also ensuring the accuracy of all the registration data collected.

If there is a mistake in the patient demographics, several potential issues could occur. For example, with an incorrect address, a claim could be sent to the wrong place and the patient might not be able to pay in a timely manner or at all. In addition, if the address does not match the one the payer has on file, it could result in a rejected claim.

If the medical record number is incorrect, the patient’s clinical history and results could end up in multiple places in the organization’s paper or electronic record system. While this may not impact revenue integrity, it does impact data integrity and has both Health Insurance Portability and Accountability Act (HIPAA) and Office of Inspector General (OIG) implications.

If the patient’s status is incorrect, then elements of the encounter pricing may be incorrect (e.g., for observation, pricing would be by hour, and for inpatient, pricing would be by day). When the case goes to coding, it might be assigned to the wrong coder (e.g., inpatient cases are assigned to coder A and outpatient cases to coder B, but an outpatient case with incorrect patient status accidentally gets sent to coder A). Incorrect patient status can also lead to denials, thus causing an interruption in payment.

Finally, if the wrong health plan is selected, deductibles and contractual adjustments may be incorrectly applied. Alternatively, the claim could be denied or rejected by the payer because the coverage for the insured will not match its files.

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

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