Focusing on Net Revenue Integrity will Help You Get Closer to Your Financial Goals

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When was the last time your Net Revenue was evaluated for potential missed opportunities? 

​According to a May 4, 2020 article in the Washington Post...

“…multiple health systems are reporting revenue loss of 50 percent or more.”  

​In our recent engagements across the nation, we have seen Chargemasters full of errors and mistakes costing organizations millions in lost revenue.  It has been our experience that it is one of the most overlooked areas for improving revenues. Whether it be below market pricing, CPT and Revenue code error, or old and outdated payor contracts, the issue is the same... mismanagement of the Net Revenue.
Unlike expensive big consulting firms, we offer an Operational Revenue Integrity Assessment that is:
  • Easy to undertake
  • timely  
  • affordable 
We can help you “get out of the starting gate” with a big win towards returning to your financial health.  ​The Assessment focuses on specific areas of the revenue integrity cycle where there are revenue improvement opportunities including:
  • Net Revenue Integrity (accuracy)
  • Chargemaster Review
  • Market Pricing
  • Payment Analysis Review

Remove Chargemaster Errors to Improve and Capture Revenue

​Our customized approach is efficient yet comprehensive due to the sophisticated software we use to upload data from the Chargemaster and CMS.  This unique approach provides enhanced results in the fraction of the time of a desk review and manual audit of the charge cycle.  The Chargemaster Review analyzes both the information received from Charge Capture and the information submitted for billing in order to produce a comprehensive picture of the current charging practice.

​Net Revenue Integrity and Chargemaster Review
  • Reviews Chargemaster for optimal charge codes
  • Identifies revenue leakage
  • Coding usage for accuracy and consistency
  • Procedure code volume for appropriateness and consistency
  • Order Entry linkage to Chargemaster

Maximize Your Pricing Strategy to Market Competitors

Throughout our in-depth analysis, you will have the opportunity to review the impact of various pricing scenarios to your bottom line. Our pricing software is customized for each engagement by developing a net revenue model based on the current reimbursement structure of your hospital, which allows for evaluation of net revenue changes associated with price movements down to the line item level.

Market Pricing and Payment Analysis Review
  • Comparison of pricing to market competitors
  • Identification of service pricing that fall below payor contract rates
  • Payment trends over time and by payor to identify large variables across multiple periods
  • Claim level charge analysis, payments, zero payments, claim payment by period and payor
  • Denial activity analysis as to why claims are not full reimbursed with focus on:
    • Authorization
    • CDM/Charge capture, Diagnosis/Documentation
    • Claim Follow-up and resubmission payment rates
    • Insurance verification/registration
    • Non-coverage/Medical necessity

​You Can Start Improving Your Revenue Opportunities Today!

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​The entire evaluation process is undertaken offsite with relevant information provided (uploaded) by the client coupled with CMS data.  The data is then reviewed by propriety software that compares information to a Master Chargemaster, CMS market data, and charge payment models. The entire process takes about 60 days and results in an executive report that outlines the net revenue opportunities with examples of the findings for each area.  A typical Assessment runs around $50,000 per hospital.  We also offer a service to assist you in fixing the problems the Assessment has uncovered.  
​​To speak to Frank Lordeman, Senior Partner, about the
​Revenue Integrity Assessment, click here.