Earlier this year, we outlined strategy for successfully identifying and introducing revenue guardian checks to your organization’s revenue integrity processes. However, what happens after you implement these checks and what should you be doing for ongoing maintenance?
We’re going to outline the three steps to successfully maintain your revenue guardian inventory below, but it’s important to first understand why.
The purpose of revenue guardian checks is to catch possible missing charges on the back-end of the revenue cycle. When set up correctly, it can be a huge boost to your bottom line. If you take it a step further and determine the root cause of the issues and fix them upstream, you wouldn’t need to have a revenue guardian check in the first place.
For that reason, consider revenue guardian checks similar to a band-aid. Once the wound is healed, you no longer need the band-aid. But if you rip the band-aid off too soon, you have to clean up the wound again before replacing the band-aid. It’s a fine line with the wound just as it is with revenue guardian, but we’re here to help.
Here are the three key steps to maintaining revenue guardian checks at your organization.
- Determine historical missing revenue/reimbursement – Prior to the implementation or as soon as possible after implementation of your revenue guardian check, you need to calculate your historical missing revenue numbers. This provides a baseline for what you can expect to capture the next year in previously lost revenue, and it also assists you in step 3 below.
- Perform a root-cause analysis – That seems simple enough, but in the constantly evolving state of healthcare organizations, there often isn’t the appropriate amount of emphasis placed on determining what caused the issue in the first place and what could be done to fix it. For example, if you determine IUDs are reimbursable, but your L&D staff hasn’t been diligent in documenting the use of IUDs, that would be a good candidate for a revenue guardian check. But now you need to figure out why they aren’t being diligent and what would make it easier to document. Sometimes, it’s as simple as additional training and sometimes it may be something much larger, but by doing this, you give yourself a fighting chance of eliminating the volume for a revenue guardian check in the future.
- Review and analyze every year – Your revenue integrity team should always be on the lookout for new opportunities where a revenue guardian check could reduce revenue leakage, but they should also be on the lookout for opportunities to reduce revenue guardian inventory or repurpose existing inventory. To do this, run a query of all accounts in the past year (or since implementing the revenue guardian check) that have been flagged for a revenue guardian check and group by revenue guardian check. This should give you a starting point for how much revenue your organization has realized through the revenue guardian check. If the volume is low, or even none at all, your organization should consider either removing the check entirely or marking it as only reportable to reduce the workload on staff.
While this isn't everything, this is enough to get started with your revenue guardian maintenance, and if you are interested in supplementing your efforts in this area, please reach out to us.