Issue link: https://beckershealthcare.uberflip.com/i/144069
38 Executive Briefing: Leading Alignment Through Data Improvement supported by software tools, no one inside the healthcare organization will know about the recurring errors; yet, when external auditors perform their automated and semi-automated reviews, they will spot missing or errorridden charges by comparing common procedure charges across multiple healthcare organizations. This results in compliance issues for healthcare organizations that are often expensive to manage. Sustainability Success now and into the future requires people, processes and technologies that are focused on preventing data errors, reducing revenue leakage and ensuring data and revenue integrity. Revenue leakage is the difference between the amount of revenue that providers are entitled to and the amount of reimbursement they eventually receive. Overall, the inconsistencies, inaccuracies and inefficiencies in outdated business processes are causing revenue leakage. The goals for charge data today are that charges are current, accurate, clean and lean — with nothing more in the chargemaster than absolutely necessary, in order that the organization's charges remain an asset, and do not become a liability. Charges require maintenance to remain current with changing rules and regulations. Maintenance is required. • Every year end with new code changes • Quarterly with OPPS quarterly updates • Any time procedures expire or new procedures are added • When the facility or auditor detects a pattern of incorrect charging Leadership must evaluate the proper balance between centralized and decentralized elements in its systems to achieve optimal accuracy, efficiency, compliance and legitimate reimbursement. Many healthcare organizations are consolidating and standardizing their internal charge audit process across their enterprise. Their revenue integrity strategy encompasses building a centralized internal audit team; educating on best practices; and establishing a proactive approach to managing audits and compliance through a robust internal audit and monitoring program that encompasses hospitals' departments, physicians' practices and clinics. Success now and into the future requires people, processes and technologies that are focused on preventing data errors, reducing revenue leakage and ensuring data and revenue integrity. To ensure that business processes follow the current, industry-defined best practices, it is vital to support people with tools they can efficiently use to prevent data capture errors, and ensure data and revenue integrity. Tools that enable staff and managers to show their results in terms of reduced compliance risks and improved reimbursement, while working more efficiently, empower both an individual's work performance and his or her organization's overall financial performance. Achieving both quality and cost goals in a transparent way is challenging, especially in a time of declining reimbursement, rising competition, non-standardized metrics and growing demand for services. Using automated tools to ensure the accuracy and completeness of EHR data as it translates into charges quickly enables the identification, prioritization and management of issues that directly impact revenue and compliance goals. As a result of a consistent revenue integrity program, the data emerges that is necessary to proactively implement sustainable process improvements in a changing industry. Ensuring data and revenue integrity supported by automation is integral to optimal financial performance in this new era of healthcare. n Craneware is the leader in automated revenue integrity solutions that improve financial performance for healthcare organizations. Craneware's market-driven, SaaS solutions help hospitals and other healthcare providers more effectively price, charge, code and retain earned revenue for patient care services and supplies. This optimizes reimbursement, increases operational efficiency and minimizes compliance risk. By partnering with Craneware, clients achieve the visibility required to identify, address and prevent revenue leakage. To learn more, visit craneware.com and stoptheleakage.com.