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How to Improve Revenue Cycle Integrity as Denials Trend Upwards

How to Improve Revenue Cycle Integrity as Denials Trend Upwards

What is Revenue Cycle Integrity?

Revenue cycle integrity is a broad term that can mean different things across different industries. In the context of healthcare, it boils down to ensuring that clinical encounters are accurately translated into revenue. To achieve this, people, processes, and platforms all play a role in working towards operational efficiency, compliance, and optimal compensation.

The Challenge

Even before the pandemic struck, many medical organizations struggled with operational losses. Even among groups managing to operate at a profit, the median hospital margin was a modest 3.5% according to a study commissioned by the American Hospital Association. COVID-19 has only exacerbated the problem, with many groups operating at a loss as any procedures and services deemed non-essential were paused and staffing shortages continue to plague the industry.

The pandemic has also brought with it a slew of regulatory challenges. From the onset of COVID-19 through the end of 2020, denials rose 11% nationally. The DOJ continues to crack down on the overreporting of diagnoses, leaving organizations open to costly audits and penalties. In addition to COVID-19 changes, nearly 750 new CPT codes have been added, further complicating an already overwhelming billing and coding field. In short, revenue cycle integrity has never been more important—or more difficult to achieve—than it is now.

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Ensuring Accurate Charge Capture is Key, But Not Easy

Breakdowns and discrepancies in charge capture are a significant contributor to revenue loss. If charges aren’t captured and billed correctly, a medical organization loses money, or exposes itself to potential regulatory consequences. To improve revenue integrity, it’s imperative that groups have a system in place to review charges for coding completeness and accuracy. While historically the charge review process has required extensive and expensive staffing, there are now ways to significantly simplify the process by leveraging artificial intelligence.

Improve Revenue Cycle Integrity with AI

Artificial intelligence can help organizations hit their financial targets through reliable, predictable, and surprise-free revenue generation. Working seamlessly on the front end of your process, the RCxRules Revenue Cycle Engine reviews each and every charge for coding completeness and accuracy immediately after it leaves your EMR, before a claim is created. By cleaning data at the beginning of the process, this AI solution saves countless hours of manual work while ensuring encounters are accurately translated into revenue.

To learn more about improving revenue cycle integrity with AI, set up a 15-minute meeting today.

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