Revenue Integrity - Medical Claim Audit

Denials and underpayments are two critical areas where revenue is lost for many hospitals. For many smaller hospitals, the cost of technology and staffing required to consistently monitor revenue integrity outweighs the potential revenue gains.

Additionally, complex contract language can often result in payer system load and interpretation errors, as well as difficulty for hospital staff to quickly identify errors in the payments received. Our experience, process and technology allow us to audit these complex contracts to ensure you are paid based on the agreed terms of the contracts.

During the audit all findings relating to your portfolio of payers’ practical business conduct and any identified internal issues at the hospital level are reported to you. In addition, we review certain aspects of your processes such as late charges and “lost” or missing codes and charges.

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