Revenue Integrity Solutions
We help providers bolster the middle revenue cycle to maximize revenue with an adaptable blend of leading edge technologies and expert people power.
Patients always have questions about their care, and they need a trusted, reliable source to guide them. Our Clinical Access and Triage Management Services enable you to align needs to resources by routing patients to clinically appropriate, cost-effective care settings.
Our hospital Utilization Management Services help to ensure patients receive quality, cost-effective care while helping to reduce compliance risk and medical-necessity denials.
Our Authorization Management Services manage pre-certification and authorization needs for inpatient and outpatient diagnostic and therapeutic services. We also provide comprehensive concurrent or retrospective inpatient authorizations after admission.
Our experienced Clinical Documentation Improvement Services focus on improving the quality of clinical documentation and facilitate an accurate representation of healthcare services. Our process includes four key areas: (1) Identifying trends, growth, and gaps in diagnosis and procedures; (2) Concurrent or retrospective reviews of health records; (3) Providing education and best practices on querying and documentation; and (4) Facilitating collaboration among physicians and other team members.
As reporting requirements and coding changes increase, many providers struggle to hire skilled professionals to focus equally on productivity and performance and to maximize revenue without compromising compliance. Our flexible Physician and Hospital Coding Services provide coding support during system changes, backlogs, and prolonged coder absences. Our team is proficient in multiple billing systems, making it possible to quickly deliver bottom line value while you focus on your core priorities.
Our Coding Quality and Audit Services help organizations mitigate risk by implementing quality review programs that verify accuracy and identify potential coding compliance issues. We then create education and compliance plans to drive continuous quality improvement in your organization.
Our Charge Capture Compliance Audit Services provide a comprehensive post-bill review to identify missed-charge opportunities. We perform a comprehensive claim, documentation, and process review to identify under- and over-billing. We then complete a root-cause analysis and create performance-improvement plans.