Revenue Integrity in 2024: Reducing Leakage Points in a Complicated Cycle

The concept of “revenue integrity” hasn’t really changed over the years, but the roles, responsibilities, and oversight have become far more complex and difficult to gain industry consensus around. What began as several defined systems of controls by which hospitals guarded against revenue loss, revenue integrity has seemingly turned into more narrowly focused controls in many organizations, leaving critical gaps in what once was a more holistic approach to fiscal oversight.In short, revenue integrity simply means ensuring providers are paid appropriately for all services provided and in an efficient and compliant manner to prevent revenue leakage and compliance risk. That’s easier said than done.An increasingly complicated payer-provider landscape and rising staff shortages are magnifying the disconnects between clinical and administrative metrics, technologies, and processes. These challenges are further compounded by technology and digital transformations, system consolidations, and organizational restructuring across many hospitals and health systems – exposing more possibilities for revenue loss than ever before.