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Revenue integrity crisis management: Be ready

Kelly M. Willenberg ( is President and CEO of Kelly Willenberg & Associates in Greenville, SC.

Maintaining revenue integrity is a daunting task if you have a clinical trials program. In order for a site to develop a risk-based revenue compliance plan, you need to appreciate the risk areas that surround billing compliance. In ranking these risks, you must know the universe of research. Evaluating revenue optimization includes a careful review of the entire billing compliance process. Understanding the types of trials taking place while vetting their effect on your program will help you move toward a positive audit plan and review the revenue integrity as you progress. With the slowdown of some studies due to COVID-19, revenue has become increasingly more important to research programs around the country. A word of advice: Do not be intimidated by having to become more stringent in the trials you open. By having a more stringent feasibility study, you can be more successful in realizing revenue. Analyze whether you have a centralized or decentralized practice—having the information can help you be successful at auditing trials. From not knowing what studies are occurring to having no way to review claims prior to their release, missteps can occur. Managing this process can be tricky even in the best circumstances. Arm yourself with knowledge of the risk so you can set yourself up for success as you begin to build a course of action in revenue review and optimization in clinical trials.

Prior to the crisis, there was really no way of knowing how much your program was spending on research without a solid revenue integrity process. Understanding the following risks and how to combat them will help you identify gaps surrounding revenue integrity now and in the future.

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