Analytics - Revenue Integrity Analysis


We have a mature system capable of providing an impact on "Day 1"  that will identify issues and put you on a path to greater revenue recovery because we know that every step counts and there is no room for error when securing earned revenues and reimbursements for their services. However, ensuring revenue integrity can be challenging for most healthcare organizations due to numerous industry complexities. Patient clinical and billing information, for example, traditionally are managed in isolation by different departments with very little integration. Thus, it is common for one department’s deficiencies to impact other departments adversely, as well as the overall integrity of a hospital’s revenue cycle.

Deficiencies and avoidable mistakes in key revenue cycle components undermine the effectiveness of a healthcare provider’s revenue

cycle. Organizations can fail to realize as much as 3 to 5 percent in net revenue due to a lack of effective internal controls for mitigating
financial, regulatory and operational risks.  We have encountered some specific clients for which we can demonstrate an even higher gain during the first 90 days of our engagement.    Our website covers many issues in which hospitals and other providers are commonly at risk
for losing revenue. They include patient access, utilization review, charge capture, and billing and payment accuracy. Healthcare providers should consider evaluating their processes in these areas against leading practices and, if warranted, also focus on making improvements.


Patient Access and Utilization Review

Patient satisfaction and optimal reimbursement hinge on the efficiency and effectiveness of the first patient touch points – the patient access areas. A significant percentage of the insurance claim form is generated through information gathered during this stage of the revenue cycle process. It is also where errors occur that often result in avoidable denials. In fact, avoidable denial-related errors made during patient access activities account for up to 60 percent of total denied claims in many hospitals.  Breakdowns in scheduling, insurance verification, pre-authorization, admissions and utilization review processes (the patient access areas) can lead to patient dissatisfaction, billing problems, excessive insurance denials and extensive rework. Revenue cycle improvement initiatives should focus on these key processes, as effectively designed controls for ensuring accuracy of information prior to or during patient care will enhance patient self-pay collectability and will significantly reduce resources required for billing and collection, including claims rework, denials management and bad debt management during

downstream processes.





Prevalent, Inc. a subsidiary of Axcension, Inc.

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