Improving revenue integrity is hospital executives’ top priority, yet many organizations never dig deep enough to correct sources of revenue leakage. Considering 1 to 3 percent of net charges are lost to leakage, it can cost your organizations millions—unless you have a strong revenue integrity program.
Revenue integrity is especially critical as value-based reimbursement (VBR) increases. With VBR, the charges captured today not only drive current revenue but also dictate target prices for future reimbursement. In both reimbursement models, ignoring small leaks can cost millions now and jeopardize your organization’s performance tomorrow.
R1’s Revenue Integrity Solutions help you attack revenue leakage to achieve the greatest value – by optimizing your revenue cycle holistically, from end to end.
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 reimbursement; 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.
Download the Latest Report On The State Of The Revenue Integrity Industry.
Does your hospital have a dedicated revenue integrity staff or does it employ a committee approach? Do you have a budget for revenue integrity education? How does your hospital maintain its chargemaster or address price transparency? Given the wide variation in the way revenue integrity is addressed in the healthcare industry the National Association of Healthcare Revenue Integrity (NAHRI) recently published a survey on the various trends and strategies hospitals across the country are adopting to optimize revenue and ensure compliance.
Chief Financial Officer (former)
Ascension, Gulf Coast Ministry
Chief Financial Officer