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Revenue Integrity Services

It is estimated that revenue leakage accounts for a loss of between 4-5% of total revenue in healthcare systems and hospitals. You, as a hospital administrator, should be concerned about the results of your revenue procedures. Make a switch to prioritizing net revenue maximization, enhanced coding, and compliance in order to build a scalable, error-free revenue cycle process that propels you to financial success.

Your health system might lose millions of dollars if modest income leakage is ignored. It is disappointing that most revenue cycle teams only meet less than once a month to discuss strategies for stopping revenue leakage and ensuring revenue integrity. And it's even more worrisome because as many as 60% of health systems don't have any sort of organized revenue integrity program.

Some sources of revenue leakage are:

  • Coding Issues including unbilled procedures and errors in coding leading to high DNFB Rate (Discharges Not Fully Billed)
  • UB-04 form has 81 fields and even more subcategories that create a high probability of errors in claims submitted
  • Issues in the set up on Charge Description Master (CDM) files
  • Lack of staff training on causes of revenue leakage and clinical documentation
  • Lack of a structured data-driven revenue integrity program
  • Lack of structured payer contracting processes.

Taking a data-driven approach to arresting revenue leakage and assuring revenue integrity is of paramount importance.


Auditing and identifying the primary income leakage sources is the first step in developing a revenue integrity program. If you work with the revenue integrity specialists at RM Healthcare, you can see dramatic improvements in your revenue realizations and bottom line.

Some sources of revenue leakage are:


Structured Revenue Integrity Program

  • Through the use of our Services' knowledge and tools, we enhance coding precision, enhance clinical documentation, decrease non-numerical functional behaviour, boost charge precision, and implement quality assurance processes and ways to increase compliance.
  • By using our analytical skills, we can identify problems and create long-term fixes.


Provider Outreach

Our precertification and authorization Services for inpatient and outpatient care are enabled by cutting-edge technological means.


Clinical Documentation Improvement

We want to assist medical professionals in providing more complete and correct descriptions of the healthcare services they render. The following are some of the CDI services we offer:

  • Alterations in the frequency with which various diagnoses and treatments are performed.
  • Inadequate documentation of each diagnosed condition or medical treatment
  • Educate medical professionals about the importance of accurate recordkeeping in clinical settings.
  • Integrating team members and clinicians into a continuous conversation


Charge Capture Audit Services

As part of our charge capture audit Services, we check your bills for unrecognized chances to add new charges. Over/under billing can be uncovered by having clinicians participate in a thorough assessment of the procedure, documentation, and process. Together with billers, coders, and clinicians, we devise a plan to increase charge capture efficiency over the long term.


HIM Coding Review and Coding Staffing

Coding Staffing : The standards for reporting and coding are always evolving. Whether you need assistance with coding backlog clearance, system transitions, regulatory reporting, or continuing staffing needs, we can put expert coders to work for you locally, virtually, or internationally.

Coding Reviews : We analyze and audit claims for correct usage of CPT and HCPCS codes and DRGs.

Coding Education : Through our coding audit and education Services, we ensure that all chart entries are correctly classified, and we detect instances of noncompliance, unbilled services, and incorrect coding. To add to this, we collaborate with coders and physicians to develop and implement targeted coding education and compliance programs.


Payment Variance Analysis

To manage the appeals process and get properly repaid, we analyze claims that have been denied or underpaid. We also do root cause analysis to get to the bottom of difficulties in the front and middle of the revenue cycle.


RM Healthcare handles more than 250,000 patient support calls each month