Revenue Integrity Services

Healthcare systems and hospitals lose as much as 4-5% of their revenue due to revenue leakage. As a hospital executive, you should be worried about the outcomes your revenue processes deliver. Shift your focus to maximizing net revenue, improved coding, and compliance and create a scalable error-free revenue cycle process that helps you exceed your financial goals.

Structured Revenue Integrity Program 

• We apply our services expertise and technology to improve coding accuracy, improve clinical documentation, reduce DNFB, improve charge accuracy, and apply our quality assurance processes & methods to improve compliance,

• Our analytics expertise enables us to pinpoint issues and implement sustainable solutions.

Optimize authorizations

• We provide technology-enabled precertification and authorization services for inpatient/outpatient services.

Clinical Documentation Improvement

We focus on improving the quality of clinical documentation and enable clinicians to represent the healthcare services they provide accurately. Our CDI services include:

• Trends of specific diagnosis and procedures

• Gaps in clinical documentation for each diagnosis/procedure

• Sensitize clinicians to issues in clinical documentation

• Creating an ongoing dialogue between clinicians and team members

·Charge Capture Audit Services

Our charge capture audit services include a review of bills to identify any missed chargeable opportunities. The audit consists of a comprehensive review of the procedure, documentation, and process with clinicians to identify over/under billing. We create a strategy to sustainably improve charge capture efficiency by working with billers, coders, and clinicians.

HIM Coding Review and Coding Staffing

• Coding Staffing. Coding guidelines and reporting requirements change constantly. We can deploy skilled coders at onsite, remote, and offshore locations to help you with coding backlog clearance, system transitions, regulatory reporting, and ongoing staffing needs.

• Coding Reviews. We analyze and audit claims for correct usage of CPT and HCPCS codes and DRGs.

• Coding Education. We verify the accuracy of coded charts and identify compliance issues, unbilled procedures, and erroneous coding issues through our coding audit and education services. Further, we work with coders and clinicians to create and deliver focused coding education and compliance programs.

Payment Variance Analysis

We perform analysis of denied claims and underpaid claims to manage appeals processes to get reimbursed correctly. Further, we perform root cause analysis to address the underlying issues in the front office and mid-revenue cycle.