Our Revenue Integrity Solutions help optimize the revenue cycle to recover net revenue, mitigate compliance risk, reduce A/R days and improve cash flow.
Considering one to three percent of net charges are lost to leakage, organizations can experience significant financial issues if strong revenue integrity programs are not in place. We can help drive compliance while delivering revenue-generating improvements in the following areas:
Identify opportunities for improved compliance and consistency in billing structure, with management of any corrections or rebills.
Identify incorrect coding and missing charges; review for net revenue potential. Analytical insights drive process change to help eliminate future missteps.
Analyze managed care and government payer contracts. Model scenarios showing revenue impact of changes to insurance contracts, charges, coding and pricing.
Analyze patient accounts and claims to determine proper use of CPT and HCPCS codes and DRGs.
Evaluate transfer-eligible accounts and identify potential missing reimbursements; manage Medicare rebilling.
Identify incorrectly reimbursed or denied accounts and manage appeal process to receive correct payment.
Analyze chargemaster, payer contracts and competitiveness to find areas of pricing opportunity and create pricing scenarios aligned with strategic goals.
Create a strong revenue integrity program that meets critical KPIs.
increase in net revenue
to receive additional cash flow
successful revenue integrity programs