The Revenue Cycle Claims Review service paired with our #1 in KLAS ranked CDM software and a certified audit team, helps ensure your organization is compliantly capturing every dollar of earned revenue. By combining the latest technology with certified coders, clinicians, and auditors we review random claims for lost charges, reporting errors and units of service that could cost your institution earned dollars.
Why a Claim Review Matters
Keeping your revenue cycle current with ever-evolving coding, billing, and regulatory changes is essential—especially in today’s environment, where hospital staff are stretched thin. Our services help:
- Review claims for under and overcharges
- Focus on pharmacy and multipliers to ensure all earned revenue is captured
- Ensure all HCPCS coding, modifiers, and documentation are accurate, complete, and supportive of the charge
- Identify opportunities for improved charge capture
Our review process includes detailed review of each claim from the orders, through the performance of the service, the documentation, the charges assessed, and coding performed to the claim submission. With so many steps and silos, our claims review is focused on gaps causing revenue disturbance.
When a Claim Review Matters Most
Hospital claims reviews are essential when major changes occur in regulatory and facility management. For example:
- Year-end code changes and CDM Updates
- Mergers and Acquisitions
- EEMR upgrades or new implementations
- A CDM review
- Lack of on-going random claim reviews
Flexible Integration with Any Revenue Software
Whether your organization uses Epic, Meditech, Cerner, CPSI, or another system, you would give our team access to the system. Provide us with a list of claims to review and account numbers and that is all the work required from your standpoint. Our audit team will do the rest and provide claim level findings and recommendations for you to enhance your process.
Scalable Solutions for Any Facility Size
From 100-bed hospitals to 600-bed integrated delivery systems, our experienced team scales to meet your needs. We recommend a 100-claim sample, but the final number is based on your needs and budget. We adapt our approach to fit your organization’s size, structure, and goals. We can perform limited scope reviews such as pharmacy and supply charge capture or full review to include Nursing, Specialty Cost Centers and Observation. You drive the selection, and we perform the work.
