Revenue Integrity

Start the fee-for-value conversation. See how clinical operations affect revenue.

Healthcare reimbursement is changing. By 2020, fee-for-value reimbursement is projected to represent 83% of your revenue—up from 43% today and 14% in 2010. Clinical operations will become vital to your bottom line. It is at the mid-cycle—the point between patient access and the business office—where improvement initiatives will have the greatest impact. Revenue Integrity gives you complete visibility into documentation and coding performance—and that of your peers. So you can quickly spot opportunities to improve revenue capture, minimize audit risk, and measure and monitor the impact of ICD-10 on your revenue.

For the CFO

  • Quickly spot revenue opportunities in just a few clicks

  • Identify improvement initiatives and their revenue impact

  • Start the fee-for-value conversation with clinical leadership

For the CMO

  • Understand your new role in financial operations

  • Identify where clinical operations affect revenue

  • Appeal to physicians’ analytical and compassionate motivations to effect change

  • Aggregation

    Marrying your clinical and financial data prepares you for the fee-for-value future.

  • Interpretation

    Quickly identify where coding and documentation initiatives will boost your bottom line.

  • Transformation

    Minimize denials, reduce the impact of ICD-10, and mitigate audit risk today and for reimbursement changes yet to come.

Link clinical and financial metrics into one comprehensive, interactive dashboard

Link clinical and financial metrics into one comprehensive, interactive dashboard

Customize dashboards specific to key clinical staff to prioritize efforts

Customize dashboards specific to key clinical staff to prioritize efforts

Benchmark coding and documentation performance down to the secondary diagnosis code level

Benchmark coding and documentation performance down to the secondary diagnosis code level

Key Performance Indicators

  • Documentation and Coding metrics: case mix index, CC/MCC capture rates, and unspecified code usage
  • Quality metrics: readmission rates, HACs, ALOS, and mortality rates
  • Efficiency metrics: days to code, days to bill, DNFC, and DNFB days and dollars
  • Compliance statistics: audit request volume, audit risk, appeal success rate, and net dollar outcome
  • Revenue metrics: AR days and denial rates

What It Offers

  • Daily snapshot of clinical and financial data
  • Executive dashboards with intuitive red and green color-coding
  • Benchmark comparisons by facility, department, physician, and more
  • Customized, role-based views for directors and managers
  • Granular data identifying documentation specificity

Evolving at the Speed of Healthcare

  • Improve Revenue Capture

    When your coding and documentation indicate the level of complications associated with patient interactions, you will be paid accordingly.

  • Monitor Your ICD-10 Impact

    Identify coding and documentation specificity improvements and reveal missing documentation concepts to ensure success with ICD-10.

  • Reduce Audit Risk

    Protect revenue and proactively manage compliance by monitoring audit risk, appeal success rates, audit volumes, and more.

Complementary Solutions & Services

  • Patient Access

    Patient Access provides critical real-time analytics information during the patient registration and payment clearance processes. With intuitive dashboards and simple step-by-step checklists, front office staff are able to accurately estimate patient cost, improving pre-service collections and reducing back end denials.

  • Business Office

    To ensure your financial viability, you need insight into the revenue cycle so you can boost cash collections, reduce bad debt, stop denials, enhance productivity, and guide business strategy. Business Office provides the analytics you need to identify revenue bottlenecks and manage reimbursement trends so you can focus your resources on what matters most: providing quality patient care.

  • Population Health for Providers

    The powerful Population Health analytics tool provides unmatched insight into understanding high-risk patient populations. By aggregating data on costs, quality and efficiency measures across multiple sources, it proactively identifies gaps in care and segments at-risk populations, cutting clinical costs and ensuring viability in a fee-for-quality system.

  • Performance Management

    Performance Management combines robust analytics with action planning, resource assignment, progress tracking and performance monitoring—all in one closed-loop performance improvement system—to ensure the organization is on the same page at the same time, working toward the right goals and achieving the best possible results.

Questions? Talk to one of our experts. Contact us