Doctor Using Digital Tablet

Revenue Integrity

Meet the Next Step in RCM Evolution
Healthcare Business Assurance
Financial Performance AR
Validations
Edit Flow EBA Normal Case Flow
Edit Rule
Edit Rule
Diagram View
Edit Diagnosis for 1 - Medical Necessity
Medical Necessity Configuration
Charge Authorizations Date Analysis
Charge Usage Almost Exceeded
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Inaccurate Patient Information
Inaccurate and incomplete patient registration data and documentation is one of the main causes of revenue leakage.
Insufficient Documentation
Documentation is inadequate to support accurate coding and ‘lower’ codes are used instead, directly impacting revenue.
Materials Charging
Chargeable supplies and devices used during encounters are not billed.
Lack of Integration
Inadequate data flow between disparate systems and locations makes drawing business conclusions difficult and subject to human error.
Non-coverage
Lack of insurance verification, or human error during verification, leads to denials.
Fees, Reimbursement and Contracts
Underpayments go unnoticed because commercial agreements, contracts and fees are not loaded into systems.
Like many healthcare organizations, your RCM technology has grown organically over time to accommodate the best solutions for patient health management and individual claims cycle challenges. Information is now siloed in different platforms and locations, creating gaps in operations and efficiency. These gaps produce situations that cause denials, slow down reimbursement and leak revenue.
Our system drills down to identify the exact cause of revenue leakage and fills operational gaps to ensure revenue integrity.
 

Your Challenge

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Revenue integrity is a top priority for many hospital and health system CFOs.

Only 44% say their organizations have established programs.

Those that employ revenue integrity report eye-opening results:

68%

increase in net collection

61%

overall gross revenue capture

61%

reduction in compliance risk

*Source: 2017 HFMA/Navigant Consulting Survey

Our Solution Main Features

Billing Accuracy
Our platform confirms required claim and billing information and alerts when it detects errors or omissions in real-time. If the patient is in the facility, staff can confirm information directly.
Maximized Reimbursement
Continuous auditing and reporting ensure payments meet contractual amounts and comprehensive documentation supports accurate coding. Alerts can be configured to trigger for virtually any situation that has the potential to cause revenue leakage such as missing charges, expired or missing authorizations, and secondary claim processes.
Predictive Analytics
Our platform covers your entire enterprise. Not only will it provide reporting and analysis of past and current events, but it also anticipates future trends and outcomes with technology that interacts will all of your systems. 
 
 
 

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