Ensuring Revenue Integrity Across the Charge Continuum
With all the change that’s occurring at your hospital on a regular basis – keeping current with CMS requirements, implementing system upgrades, expanding service offerings – invariably there will be disconnects in the data flow between the various hospital departments, the chargemaster and claims processing. These gaps can be quite disruptive, often leading to underpayments and can mask compliance risks and exposure.
It’s crucial that every hospital be confident in its ability to capture all services and associated costs to maximize revenue opportunities. With Craneware’s Revenue Integrity Package, you can utilize Craneware’s technical expertise to accurately pinpoint data gaps, wherever they occur across the charge capture continuum. This intensive audit and comprehensive review of the charge capture process will identify errors and correct them at the source.
- Perform a comprehensive CDM review to assure all billable services are correctly captured, including validating CPT, HCPCS and revenue codes and add new charges into the CDM and clinical order entry systems
- Conduct a full scale technical assessment for correct charge data flow from the point of service through claim production
- Audit charts to test claim logic for soft and hard coded services to increase revenue opportunities and minimize risk
- Trace errors to the root cause of lost revenue and recommend corrections to help prevent recurrence
- Validate charge code accuracy in the order entry feeder system and confirm correct feeder system mapping to the chargemaster
- Perform a strategic pricing analysis and create a defensible, uniform pricing model to improve net revenue and assure a competitive stance in the market
- Thoroughly audit a representative sample of outpatient claims against medical record documentation to identify critical issues wherever they may occur
- Alleviate internal pressures for PAS-to-finance data accuracy during and after system migration projects and provide revenue stability throughout to assist hospitals during transitions
Partnering to Achieve Revenue Integrity
Partner with Craneware to conduct a technical assessment of your organization’s charging system. Our experience and proven track record helps you identify and understand if the data is flowing correctly throughout the charge continuum and how to correctly address disruptive issues and improve practices. This will allow you to remain focused on supporting your community with quality healthcare – especially in increasingly competitive times.
As the leader in automated revenue integrity solutions for over 15 years, hospitals of all sizes and types rely on Craneware to help address their toughest challenges. Our team of experienced professionals is committed to applying Craneware’s proven industry best practices to help your hospital optimize reimbursements and reduce compliance risk.