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Revenue Integrity Audits

Revenue Integrity Audits analyze the flow of charges from the point of order through to final third-party adjudication. These audits are an essential tool for visualizing the big picture with regard to charge processing and often identify additional opportunities which may otherwise go unnoticed. Even with a clean and compliant CDM, there are many other areas up and downstream that can have deficiencies leading to revenue loss, compliance risks, or both.

An IRI consultant will review a selection of encounters provided by your facility. This review may be performed on-site, or remotely. You choose the number of encounters you would like reviewed and the scope of clinical service areas (e.g., 20 cardiac catheterization encounters, 50 encounters from various clinical areas, etc.). The following elements are examined for each encounter:

Physician orders
Medical record documentation
Itemized patient charges
UB04/HCFA claim form(s)
Third-party remittance advice

Each encounter is examined to determine whether:

All services have valid physician orders (including proper dates/times/signatures, if applicable)
All services which are charged for are supported by documentation
All services which are documented have been charged for
Charges have been reported correctly on claim forms in accordance with CMS and other requirements
Services have been properly reimbursed by third-party insurer(s)

A written report and detailed line-by-line results are provided which identify any deficiencies in orders, documentation, charge capture, or reimbursement. Revenue Integrity Audits may be provided as a stand-alone service, or as an added component of a Charge Master Review. Please contact us for more information.

TESTIMONIALS

“As a Critical Access Hospital undergoing conversion to Epic, we needed assistance in moving to the new platform. We engaged IRI for their Charge Master Services and were delighted with all aspects of their work. They are abundantly professional and quickly built confidence in their expertise with all of the teams involved in this project. The requests that we had of them ranged from Provider Based billing, to Operating room, to Pharmacy among others. We had a tight timeframe and they fit us in with supreme customer service and responsiveness. We will definitely use them again for future projects, as well as some ongoing services. So grateful to have found this wonderful group of Charge Master experts.”

"The Concord Hospital Revenue Integrity department engaged IRI to perform comprehensive CDM Reviews for all our facilities and service lines. We chose IRI, because unlike other firms, they commit to analyzing every single charge line. They delivered on that promise. The reports and files they returned were comprehensive, easy to understand, and thoroughly explained potential issues and opportunities. We also use the IRI Retainer Service to assist us in understanding complicated charging and billing rules as they come up. Jon and Julie are extremely knowledgeable and helpful. I highly recommend their services."

"We are incredibly satisfied with the exceptional Revenue Cycle services provided by Integrated Revenue Integrity (IRI). Julie Hall and her team demonstrated unmatched expertise, professionalism, and a commitment to exceeding our expectations. Their proactive approach, clear communication, and dedication to customer satisfaction made a significant positive impact on our project. IRI truly stands out in the industry, and we highly recommend them for top-notch service."

I would highly recommend IRI in an interim management capacity; they filled a critical staffing gap and performed much needed analysis on claims and denials. They took time to understand the objectives that were important to our revenue cycle and worked to target those areas of concern. When changes were recommended, they included well researched payer policy, supporting documentation, and alignment with industry best practice. Julie integrated seamlessly into the department, effectively worked with operational stakeholders in our organization, and assisted with knowledge transfer for the incoming manager to ensure a smooth transition. Julie’s leadership and expertise were valuable; we will utilize IRI should another need arise for interim management.

Integrated Revenue Integrity (IRI) provides an integrated suite of solutions to ensure that your facility is maximizing reimbursement in compliance with regulatory guidance.

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