| Course | HI555 Revenue Cycle Management |
|---|---|
| Unit | Unit 9 |
| Paper type | Revenue integrity plan |
| Length | About 1,040 words, 6 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MS in Health Informatics |
| Updated | October 2026 |
Free sample paper for HI555 Unit 9
Owned Where the Problem Starts: A Unit 9 Revenue Integrity Plan With Six Controls Run by Departments the Author Does Not Supervise
[Student Name]
Purdue University Global
HI555: Revenue Cycle Management
Unit 9 Revenue Integrity Plan
[Instructor Name]
[Date]
Bellcourt Health, its departments, measures and every cost are composite; the sources cited are real.
The Constraint
The revenue cycle director at Bellcourt Health supervises patient access and patient financial services. The problems the earlier denial analysis traced to their origins mostly begin elsewhere: in surgical scheduling, emergency nursing, health information, case management and the chargemaster. A plan that assigns controls to departments the director does not run can only work through agreement, shared measures and sponsorship from executives who do run them. This plan is built around that fact.
How Controls Were Chosen and Ordered
Each control prevents a failure identified in the earlier units, and the controls are ordered by the net cost of the failure they address, from the denial analysis's net cost table. Every entry has the same five parts: the failure prevented, the step where it begins, the owner, a measure the owner can influence, and how often the measure is reviewed.
The Control Register
1. Physician query turnaround. Failure prevented: medical necessity and documentation denials on inpatient claims coded before the query was answered. Origin: open queries at the time of coding. Owner: health information director, with the medical staff office. Measure: median days from query to answer, target two, and the share of records final-coded with an open query, target under 2 percent. Review: monthly.
2. Emergency admission notification. Failure prevented: inpatient stays never reported to the payer within its notice window. Origin: the case management worklist, which lists only accounts already flagged as plan members. Owner: case management director. Measure: share of inpatient admissions whose payer is told within one business day, target 98 percent. Review: weekly.
3. Re-verification of moved surgical cases. Failure prevented: authorization denials on cases moved to a new date, hospital or procedure. Origin: the scheduling handoff mapped in Unit 3. Owner: patient access manager. Measure: share of moved cases re-verified before surgery, target 95 percent. Review: weekly.
4. Emergency charge reconciliation. Failure prevented: missed infusion, point-of-care and splint charges. Origin: discharge-screen charging and missing infusion stop times. Owner: emergency nurse managers at both hospitals. Measure: share of visits with charge counts reconciled against documented services before the claim drops, target 100 percent at the north hospital, and infusions without a stop time, target under 3 percent. Review: monthly.
5. Chargemaster change control. Failure prevented: charges built with wrong codes or prices after code updates. Origin: chargemaster edits made without a second review. Owner: revenue integrity analyst. Measure: share of chargemaster changes reviewed by a second person before going live, target 100 percent. Review: quarterly, and after every annual code update.
6. Scrubber rule maintenance. Failure prevented: claims rejected for edits the scrubber should have caught. Origin: payer rule changes not loaded into the scrubber. Owner: patient financial services manager. Measure: days from a payer bulletin to the scrubber rule going live, target ten business days. Review: monthly.
Only one of the six owners, the patient financial services manager, reports to the director who wrote the plan.
Responsibilities
For each control, one role decides, one carries out the work, and others are consulted or informed.
1. Query turnaround: health information director and chief medical officer decide together; documentation specialists and physicians do the work; coding is consulted.
2. Notification: case management director decides; case managers do the work; patient access is consulted on eligibility responses; the committee is informed.
3. Moved cases: patient access manager decides; authorization specialists do the work; surgical scheduling is consulted on the trigger.
4. Charge reconciliation: emergency nurse managers decide; charge nurses do the work; the revenue integrity analyst is consulted.
5. Chargemaster: revenue integrity analyst decides; a second analyst reviews; finance is informed of price changes.
6. Scrubber: patient financial services manager decides; billing analysts load rules; payer contracting is consulted.
Governance
A revenue integrity committee meets monthly. Members are the six owners, the revenue cycle director as chair, a compliance officer and a finance representative. Its one standing agenda item is the register: each owner reports the measure for the month, with account examples for any miss. Compliance guidance for hospitals encourages exactly this kind of regular, documented review of billing risk areas by the people responsible for them (Office of Inspector General [OIG], 2005), and the more recent general guidance stresses that compliance oversight should reach across departments (OIG, 2023).
Sponsorship
The plan has two executive sponsors, the chief financial officer and the chief operating officer. Four of the six owners report through operations, through nursing, case management, health information and surgical services, so a finance sponsor alone could not hold them to their measures. Each sponsor receives the register quarterly and attends one committee meeting a quarter.
Escalation
Escalation is mechanical, not a matter of judgment. A measure missed in two consecutive months goes to the owner's vice president with the account examples attached and a request for a written response within thirty days. A third consecutive miss goes to the sponsors. Making the rule automatic protects the chair from having to decide, month by month, whether to escalate a colleague's department.
Recurrence Check
When a denial reason that a control was designed to prevent rises again, for two months running, above its level when the control began, the control is reopened at the next meeting. The owner and the analyst read twenty recent denials to find whether the control has drifted, whether the failure has found a new route, or whether the control was never the right one. Administrative rework of denied claims is expensive (Tseng et al., 2018), so a control that has stopped working should be found by the denial data before it is found by the write-off report.
Limits of the Promise
No control set can stop every denial, and this one is not offered as if it could. Payer processing errors will continue, and some medical necessity disagreements are genuine clinical disputes. The goal is to reduce preventable denials, measured each quarter against the baseline in the denial analysis.
References
Office of Inspector General. (2005). OIG supplemental compliance program guidance for hospitals (70 Fed. Reg. 4858). U.S. Department of Health and Human Services.
Office of Inspector General. (2023). General compliance program guidance. U.S. Department of Health and Human Services.
Tseng, P., Kaplan, R. S., Richman, B. D., Shah, M. A., & Schulman, K. A. (2018). Administrative costs associated with physician billing and insurance-related activities at an academic health care system. JAMA, 319(7), 691-697. https://doi.org/10.1001/jama.2017.19148
Reading the HI 555 Unit 9 instructions
The ninth unit typically asks for a plan that prevents revenue loss across the cycle, building on the analyses from earlier units. Expect to define controls, assign owners, set measures and describe governance. Many prompts ask for a responsibility chart. Eight pages with a control register is a common scope. Assign each control to the department whose process produces the failure, even when that department sits outside the revenue cycle. Give every control a measure its owner can actually influence and a review interval. Explain how the plan gains authority if its author does not supervise the owners. Include an escalation path and a way to reopen a control when the problem returns. Avoid promising to prevent every denial.
How the HI 555 Unit 9 example is put together
The plan opens with its constraint: the author supervises none of the owners. A short section explains how controls were chosen and ordered by net cost. The control register then lists six controls, each with the failure prevented, its origin, the owner, a measure with a target and a review interval, from physician query turnaround to scrubber rule maintenance. The highlighted sentence notes that only one owner reports to the author. A responsibilities list then names, control by control, the decider, the people doing the work and anyone to be asked first. Governance describes a monthly committee with one standing agenda item, linked to federal hospital compliance guidance. Sponsorship, a two-miss escalation rule and a recurrence check follow, and a final section limits what the plan promises.
Where the points sit in the HI555 Unit 9 rubric
Revenue integrity plans are commonly graded on the soundness of controls, assignment of ownership and measures, governance, use of prior analysis and writing. The heaviest weighting tends to fall on controls and measures, and graders check that each control aims at a real failure and has a measure its owner can move. Ownership earns credit when it follows where problems begin, not the org chart. Governance is rewarded when the plan explains how decisions get made and enforced, including escalation. Use of earlier unit findings to prioritize controls adds points. A responsibility chart, clear register and APA citations complete the rubric. Plans that assign every control to the revenue cycle department, or that rely on goodwill without escalation, tend to lose points.
HI555 Unit 9 help from the desk
A frequent problem in this unit is assigning controls to the department that sees denials instead of the one that causes them. Another is choosing measures the owner cannot influence, which guarantees frustration. Some plans list controls with no review interval or target. Governance is often vague, with a committee but no rule for what happens when a measure is missed. Students sometimes ignore their earlier analyses and start fresh. Promises to eliminate denials undermine credibility. If your organization's problems differ, such as pharmacy charging or physician billing, share your earlier findings and the prompt, and a plan can be drafted around your own controls.
Get an HI555 Unit 9 example written to your instructions
Earlier findings, a case from the course, or failures seen at work with identifiers removed: any of these can seed the control register. Include the unit's instructions and grading rubric alongside it. Within 24-48h the free first sample is back, each control in it owned by the department where its failure begins. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
More HI555 papers and MS in Health Informatics samples
- HI555 Unit 1: Discussion Board Post
- HI555 Unit 2: Account Trace
- HI555 Unit 3: Front-End Process Map
- HI555 Unit 4: Charge Capture Review
- HI555 Unit 5: Denial Analysis
- HI555 Unit 6: Appeal Letter
- HI555 Unit 7: Accounts Receivable Report
- HI555 Unit 8: Seminar Reflection
- HI555 Unit 10: Cycle Improvement Proposal
- HI550 Unit 9: Communication Plan
- HI545 Unit 9: Investigation Memo
- HI540 Unit 9: Change Control Procedure
- HI530 Unit 9: Terminology Governance Plan
HI555 Unit 9 questions, answered
What does revenue integrity usually cover?
Definitions vary by organization, but the function commonly includes chargemaster maintenance, charge capture, pricing review, and the documentation and billing controls that keep charges accurate and supported. Some organizations fold denial prevention in; others keep it separate. The example states its own scope in the first section so the reader knows which controls belong and why others sit elsewhere.
Is a RACI chart required?
Not always, though some responsibility assignment is expected. The example uses a table naming who decides, who is consulted and who is informed for each control, because ownership is the plan's central problem. If your course prefers a different tool, the principle holds: one accountable owner per control, named by role, with a measure that owner can move.
Can the plan claim to prevent all denials?
It should not. Payers change rules, clinical situations vary, and some denials are payer errors that no provider control can stop. The example states that its controls target the largest preventable categories and includes a recurrence check for when they fail. Overpromising undermines the plan's credibility with the executives it asks to sponsor it.
Where can I find a free HI555 Unit 9 sample paper?
You can read the complete Unit 9 plan here, including the six-control register, responsibilities, governance and the escalation rule.
How can a director run controls in departments she does not supervise?
Through shared measures, executive sponsors who do supervise those departments, and an escalation rule that fires automatically when a measure is missed.