It’s easy to lose sight of “the forest for the trees” with the daily grind of revenue cycle management (RCM). Coding claims, posting payments, and managing denials can feel routine—even monotonous. But without strong revenue integrity practices woven throughout the process, even the most efficient RCM operation can spring leaks.
Revenue integrity is more than fixing broken processes in the revenue cycle—it’s about building a smarter, more collaborative system that prevents issues before they start. At Access Healthcare, we believe a proactive, team-based model not only protects revenue but empowers healthcare organizations to thrive under growing operational and compliance pressures.
What makes revenue integrity different in today’s healthcare?
Many healthcare providers approach revenue integrity as a reactive effort focused only on recovering missed charges or overturning denied claims. While recovery matters, the real opportunity lies in prevention: fixing root causes, aligning departments, and continuously optimizing documentation and reimbursement practices.
That’s why Access Healthcare does more than plug leaks. We help clients build systems that don't leak in the first place—powered by proprietary automation and analytics that drive smarter, faster, and more efficient revenue cycle decisions.
A collaborative model built to prevent revenue loss
At its core, revenue integrity means making sure healthcare organizations capture the revenue they've earned—fully, fairly, and compliantly. It’s not just about preventing revenue loss; it’s about creating a seamless bridge between clinical operations, billing, coding, compliance, and the business office. And as financial pressures continue to mount across healthcare, revenue integrity has moved from a “nice-to-have” to a business-critical strategy.
For healthcare providers, revenue integrity is everyone’s responsibility—but coordination is often the missing link. At Access Healthcare, we’ve seen what happens when teams work in silos: documentation gaps, missed charges, compliance risk, and higher denial rates.
As an end-to-end RCM provider, we don’t just see the forest—we map the trail through it, leveraging technology, analytics, and deep RCM expertise to guide every step.
Front-end services: patient access, eligibility and benefits verification, prior authorization
Clinical documentation improvement (CDI) and coding teams
Health Information Management (HIM) and compliance
Billing, A/R, and denial management
Specialty service lines
This model reduces rework, accelerates reimbursement, and fosters a more resilient, efficient revenue cycle that is able to adapt over time.
Why revenue integrity is growing in importance
Recent industry data paints a clear (but not pretty) picture:
In MDaudit’s 2024 Benchmark, [GG1] external audit volume more than doubled in 2024 compared to 2023 for healthcare organizations, with total at-risk dollars increasing fivefold to $11.2 million.
The Healthcare Financial Management Association (HFMA) reports that the average cost to rework a denied claim is $25. American Health Information Management Association (AHIMA) notes that for hospitals, this cost can escalate to $181 per claim.
According to Advisory Board research, 90 percent of denials are preventable—often due to incomplete records or coding mistakes—and 66 percent are recoverable.
The takeaway? Even small cracks in your revenue integrity strategy can lead to substantial financial leakage.
Building a stronger revenue integrity strategy
Revenue integrity isn't a task you can assign to one team or tackle with a one-time audit. It requires a coordinated, cross-functional approach across the entire organization.
Here’s what a modern revenue integrity strategy should include:
Executive sponsorship: Ensure leadership actively supports revenue integrity initiatives to drive cultural and operational alignment.
Automation and technology: Implement machine learning, robotic process automation (RPA), and smart EHR template monitoring to reduce manual errors and rework.
Proactive system rules and edits: Implement customized, rule-based alerts within practice management or billing systems to flag missing charges, underbilling, or documentation inconsistencies before a claim is submitted. These alerts—based on real-world billing trends—serve as early warning signals to minimize revenue leakage and ensure appropriate reimbursement. In Epic systems, this functionality is referred to as Revenue Guardian edits.
Data-driven insights: Leverage advanced analytics to find root causes of revenue loss and track trends.
Integrated teams: Collaboration across clinical operations, HIM, CDI, billing, coding, and compliance departments is essential.
Expert guidance: Designate internal experts or specialty line leaders to spot issues early and guide teams.
Proactive payer management: Track and analyze payer audits closely and prepare for rule changes in advance.
Continuous education: Encourage job shadowing and regular knowledge-sharing to bridge gaps between teams.
Case in point: A large physician-led clinic uses revenue guardian edits within their Epic system to identify and correct missing charges before billing. These edits serve as a final checkpoint, ensuring that all services rendered are accurately captured. The organization emphasizes a collaborative approach, involving coding, billing, and revenue integrity teams to manage and resolve these edits effectively.
How Access Healthcare enables clients to succeed
At Access Healthcare, we focus on enablement over outsourcing. Yes, we offer medical coding, auditing, payer contract management, denial management, and other RCM services independently—but more importantly, we bring the complete toolbox of talent, technology, and insights to elevate your internal processes and fortify your revenue integrity.
We help healthcare organizations by:
Identifying and resolving recurring documentation and coding gaps through a blend of expert oversight and proprietary automation that streamlines root cause analysis
Simplifying compliance by aligning EHR templates and workflows to reduce variability and improve consistency
Collaborating with clients to optimize their practice management systems by implementing automated rules that flag missed revenue opportunities or coding inconsistencies before claims are submitted—preventing issues that could lead to denials or lost revenue
Equipping revenue cycle teams with training and insights to spot patterns early and prevent downstream issues
Leveraging analytics platforms and customized dashboards to transform raw data into clear, real-time guidance for better decision-making
Case in point: A healthcare system that encompasses more than 40 acute care facilities and numerous outpatient clinics across multiple states faced significant challenges in its CDI and coding processes due to rapid growth. Our collaboration uncovered critical inefficiencies, including inconsistent documentation practices and extended delays in resolving discharges not final billed (DNFB) cases. After an initial engagement supporting 10 facilities, our strategic plan and early results impressed leadership enough to expand the initiative system-wide. We implemented a comprehensive six-part solution—deploying seasoned teams, conducting regular audits and training, and establishing a multi-tier governance framework. The result: accelerated cash flow through a significant reduction in DNFB cases, improved coding accuracy, and enhanced hospital performance metrics, delivering measurable financial gains.
From reaction to resilience
The future of revenue integrity isn’t about fighting fires. It’s about building or retooling a system that prevents the fire from starting in the first place. Access Healthcare takes the long-term view of revenue integrity—by creating operational clarity, departmental collaboration, and smarter prevention at every step of the revenue cycle.
About the Author
Gayathri Natarajan, BPT, CPC, COC
Gayathri Natarajan serves as Vice President of Coding Operations at Access Healthcare. With more than 20 years of hands-on experience, she oversees service delivery for multi-specialty coding projects including Prospective Coding, Physician Coding, Documentation Audits, and Denial Management. Gayathri also leads Coding Compliance initiatives, facilitates coding implementations across diverse specialties, and manages ongoing education and certification programs to ensure excellence in coding standards.
Let’s build something stronger together.
Contact us to explore how our holistic approach to revenue integrity—powered by automation, analytics, and human insight—can support your goals.