Compliance

Take action on risk and coding outliers before audits ever happen.

Compliance protects revenue by pinpointing areas of risk such as billing processes, coding, and physician practices, and by managing the audit process should one occur. By using the same data mining methodologies that health plans use to conduct audits, we enable healthcare providers to proactively identify and address any potential vulnerability.

  • Gain better understanding of coding trends—readiness is key in preventing audit-related revenue loss

  • Assess and reduce risk with benchmark data—know exactly where you stand

  • Increase audit appeal success by managing the tasks, handoffs and deadlines of the audit process, saving time and money in the process

  • Prevent issues that could trigger an audit in the first place

  • Identify key areas at risk for take-backs

  • Aggregation

    Collect data from claims, remittances and MedPAR benchmarks onto a single cloud-based dashboard.

  • Interpretation

    Analyze over/underpayments and compare documentation and coding performance against national and peer benchmarks.

  • Transformation

    Establish processes that protect and recover revenue in the face of an audit or before an audit ever occurs.

View cost and utilization data at a glance

View cost and utilization data at a glance

Identify and take action on compliance risk areas before audits occur

Identify and take action on compliance risk areas before audits occur

Key Performance Indicators

  • Revenue at risk
  • Audit appeal success rate
  • Net financial impact from audits

What It Offers

  • Helpful dashboards at the enterprise, regional and facility levels
  • Proactive compliance rules engine
  • Real-time compliance audit management workflow
  • Access on the iPad
  • Integration with EHR technology and reporting as validated by Executive Health Resources, Inc. (EHR)

Complementary Solutions

  • ICD-10

    In preparation for the formidable ICD-10 codes conversion, providers can preview financial and operational impacts, implement physician and coder education where it’s needed most and track patterns through the transition to limit errors and extra costs.

  • Revenue Cycle

    Used by healthcare providers across the country, Revenue Cycle optimizes cashflow and improves collections by bringing complex patient accounting data into a unified view. This solution exposes the black holes, bottlenecks and outliers that result in lost revenue for health care organizations.

Questions? Talk to one of our experts. Contact us