Effective revenue cycle management is essential for healthcare organizations to prevent revenue loss and ensure financial stability. This leading health system is focused on enhancing revenue integrity in its mid-revenue cycle processes by leveraging data insights and tools for continuous improvement. Using the Vitalware® Revenue Integrity suite, the organization streamlined its operations, reduced manual work, and improved revenue capture.
Revenue cycle performance plays a critical role in the financial health of healthcare systems and hospitals.1 However, many organizations unknowingly leave a portion of their net revenue unaccounted for due to evolving billing practices, new technology implementations, staff training gaps, and outdated charging methodologies. This health system sought to improve its financial performance by enhancing revenue integrity processes.
The health system struggled with revenue integrity within its mid-revenue cycle processes, resulting in revenue leakage and financial losses. Despite recognizing the issue, the organization lacked the necessary data insights and tools to drive improvement. The existing revenue tool within its EHR was limited in functionality, and expanding its capabilities would have required substantial resources. The health system needed a comprehensive and efficient solution to optimize revenue capture while ensuring compliance.
To address these challenges, the health system elected to implement the Vitalware® Revenue Integrity suite, a web-based solution that focuses on mid-revenue cycle—regulatory compliance, coding, chargemaster management, and charge capture—to support the overall goal of improving reimbursement and compliance. The health system's centralized revenue management team quickly onboarded the suite, utilizing VitalIntegrity concierge services to efficiently vet improvement opportunities, establish a stable operational state, and accelerate implementation and process improvements.
The health system implemented VitalCDM®, which handles its entire charge description master (CDM), consolidating sources into a single system that the team views and manages. The revenue cycle team utilized VitalCDM to review the Healthcare Common Procedure Coding System for all supplies, efficiently completing the review of more than 20K line items to improve accuracy, customize rules, and reduce false positives. New rules are added regularly, and the rules engine is continuously updated, ensuring the health system uses the most recent rules and meets regulatory requirements.
The revenue cycle team uses VitalIntegrity™ and its comprehensive rules to perform daily reviews of itemized charges. Teams can identify potential revenue leakage from undercharging, overcharging, late or missing coding, and mismatched charges and supplies. They can then drill into the root cause of the issues to provide education and implement process, workflow, and documentation changes that prevent the recurrence of the problems. For example, the revenue cycle team identified and resolved recurrent issues related to documentation and coding for peripherally inserted central venous catheters, sedation for procedures, and bedside bronchoscopies.
Revenue cycle leaders utilize system reports to demonstrate the impact of their work on revenue recognition and to identify and quantify annual improvement opportunities.
Implementing the Vitalware Revenue Integrity suite has significantly improved operational efficiency and revenue capture while reducing the need for manual interventions. Results include:
"Implementing the Vitalware® Revenue Integrity suite helped us transform our revenue cycle, providing the visibility and automation necessary to prevent revenue loss and ensure long-term financial stability."
- Revenue Management Executive
The health system will continue to utilize Vitalware Revenue Integrity suite to enhance charge-capture processes, increase earned revenue, reduce accounts receivable days and rebills, and identify and address compliance issues—supporting long-term financial sustainability.
