How can social determinants of health affect revenue integrity?

Social determinants of health play a significant role in shaping an individual's access to healthcare services, which in turn can create discrepancies in how care is provided and billed. Factors such as socioeconomic status, education, geography, and access to transportation can influence a person's ability to receive timely and appropriate medical care. When patients encounter barriers due to these social determinants, it can result in variations in the types of services they receive. For example, patients from lower socioeconomic backgrounds may delay or forgo necessary treatments, leading to more acute interventions later on.

This variability can complicate the revenue integrity process as it affects not only the volume and type of services billed but also the coding accuracy. When care is accessed inconsistently among different patient populations, it can lead to challenges in ensuring that billing reflects the actual services provided. Consequently, understanding how social determinants affect patient care is crucial for maintaining revenue integrity, as it helps to ensure that all patients are represented accurately in billing practices, leading to better financial outcomes for healthcare organizations.