What is a Certified Revenue Integrity Professional?

A Certified Revenue Integrity Professional is a health care administration professional who has obtained industry standard certification through the American Association of Healthcare Administrative Management (AAHAM).

Who is the AAHAM?

The AAHAM is a professional association that provides advocacy, networking events and training opportunities. As a matter of fact, they are the premier organization that certifies health care administrative professional who specialize in patient account revenue cycle management. Certifications provide an industry approved way to recognize competent health care professionals who have the necessary skills and know-how to excel in patient account and revenue cycle management. It also improves workplace productivity and ethical standards. The AAHAM provides the only certification exam for becoming a Certified Revenue Integrity Professional (CRIP).

CRIP Certification

Health care revenue integrity is quickly becoming one of the most important health care topics. Patient account and revenue integrity management includes topics such as cash management, regulation compliance, claims processing, patient access, account resolution and financial management. The CRIP exam was created to test health care administrators’ knowledge of all aspects of the revenue cycle processes. It is only exclusively available to members of the AAHAM.

The test covers knowledge required for proper billing, documentation and collections. The CRIP exam is divided into four parts: review of charge capture, ancillary service, surgical services and clinical services. The exam has either multiple-choice or true/false questions. A passing score of 70 percent means that the individual has a working knowledge of regulated patient account management.

Who Should Become CRIP Certified?

There are many types of health care professionals who should become CRIP certified. For starters, health care office staff who deal with patient access, accounts and billing should become certified. IT staff, such as those involved with health information systems (HIS) and health information management, should take the exam. Finally, management personnel who deal with compliance, finance, and operations should become CRIP certified.

What Certification Matters

For employees, achieving a recognized professional certification is an excellent way to prove their core competencies and commitment to professional growth. Employees will have a deeper understanding of revenue cycle operations and federal compliance regulations and may be better positioned for potential promotion opportunities. Health care organizations are benefited through knowledgeable staff who can improve their departments’ financial performance. CRIP certified employees decrease liability, turnover and major mistakes. In the end, CRIP certification will increase employee awareness, efficiency and cooperation with other departments.

Revenue Integrity Job Description

Revenue integrity professionals are responsible to analyze and ensure proper health care reimbursements for target accounts. They must continually coordinate between administrative and clinical operations staff to ensure that accounts have the correct coding, billing, payment and charge captures. They assist management with implementing policies that have been updated to ensure regulatory compliance. Typical candidates will have a bachelor’s degree related to health care or information technology. They must have a working knowledge of reimbursement regulations for Medicare, Medicaid and Managed Care. Additionally, they must know how to perform proper revenue and reimbursement capture; be familiar with Physician and Hospital IP/OP coding; and be highly analytical, detailed and independent. Finally, revenue integrity professionals must have strong communication, persuasion and negotiation skills.

To close, a Certified Revenue Integrity Professional is a health care administrative professional who has the right skills and knowledge necessary for proper revenue cycle and patient account management.