Revenue Integrity Audits

Revenue Integrity Audits analyze the flow of charges and the completeness of documentation in the medical records to ensure coding accuracy and to validate the charges from the point of order through to final third-party adjudication. Today these audits are essential for ensuring that your organization is compensated appropriately for the valuable services that it renders.  When conducted by consultants who specialize in revenue integrity audits, the effort often resolves problems that have been hidden for extended periods of time and identifies additional revenue gain that might have otherwise gone uncaptured.

Quality’s Revenue Integrity Audits

Quality Healthcare Partners (Quality) will provide experienced consultants that possess in-depth knowledge of clinical documentation and coding, including both ICD-10 and CPT codes and the Healthcare Common Procedure Coding System (HCPCS) and their modifiers.  Quality consultants will review client claims and medical records for opportunities to identify missed charges, instances of over-billing and coding errors that can adversely impact revenue and create significant compliance issues, including penalties for charge overages.

Quality’s approach to Revenue Integrity Audits includes:

  • Validating written orders for level of care and all treatments rendered
  • Ensuring necessary modifiers are appended and that the exact number of units are billed
  • Comparing charges by patient accounts
  • Verifying charges against updated fee schedules
  • Identifying undercharges, duplicate postings, and overcharges
  • Verifying the charges emanating from various department billers and coders

This service offering can be expanded to include collateral operational areas such as might be involved in the processing of end-to-end financial transactions.  This can add to your organization’s capability to improve revenue performance and the patient’s billing experience.

Quality’s Credentials and Client Experiences

Quality’s revenue integrity auditors are certified medical auditors with years of experience providing a wide range of auditing services for acute care hospitals, rehabilitation hospitals, clinics, and physician practices. They also possess operational experienced in revenue cycle management, patient access, charge capture, charge master integration, medical chart auditing, and reimbursement optimization.

Project examples include:

  • Developed a revenue integrity program for a prominent rehabilitation hospital in the western United States. The structure for the program was based on a series of in-depth audits.
  • Performed baseline charge audits for numerous departments of an acute care hospital system to identify revenue optimization and reimbursement opportunities
  • Implementing EPIC, Oracle Health/Cerner, Harris Affinity hospital and professional billing systems

Benefits to Your Organization

Adjustments applied for revenue integrity must no longer be applied on an occasional basis in today’s ever-changing world of healthcare regulations and reimbursements.  It is crucial that corrective adjustments be applied systematically and regularly.  A comprehensive revenue integrity program offers substantial dividends and is key to the financial success of every healthcare organization.

By performing regular revenue integrity audits, organizations can expect:

  • A higher clean claim rate
  • Proactive identification of opportunities for enhancing revenues
  • Accelerated resolution of claim issues
  • Improved financial results