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First, what are the Revenue Integrity processes? The Revenue Integrity process helps prevent revenue leakage and compliance risk. It increases the efficiency of professional and hospital billing and reimbursement and provides more accurate data for service line review and contract negotiation. Timely and accurate billing is the cornerstone to reducing late bills for payers and patients and reducing rebills. 

Below is a brief description of the steps to Identify and Resolve Revenue Leakage.  

Step One - Daily Reconciliation

Charges should accurately represent the care, services, and supplies provided to the patients, and these charges should be entered promptly. 

• Charges are reconciled daily. Run daily Reconciliation reports to identify missing revenue. 
• Daily review charge review workqueues and resolve these edits timely. 
• Have you implemented a daily Revenue Tracker call and reported variances from the baseline? If not, do so 

Step Two – Average Daily Revenue 

You need to know your average daily revenue.

The Average Daily Revenue is based on analyzing several months of data, which provides an average of daily changes by day of the week. 

Step Three - Daily Reconciliation report and Average Daily Revenue 

By comparing the previous day's charges from the Daily Reconciliation report with the  Average Daily Revenue, you will know if your departments accurately capture charges or if the charges appear lower than average. Next, you investigate and resolve the change issue. 

Step Four – Workqueue Review 

Your charge review workqueues contain charges that are exceptions

• High–dollar
• High-quantity 
• Service dates outside of the range of dates the patient was seen
• Service dates outside the dates of the patient's admission
• (MUE) Medically Unlikely Edits

High-dollar and high-quantity workqueue errors are great places to double-check that the charge values are correct.