Our Services

Revenue Integrity Services

In the complex healthcare landscape, maintaining revenue integrity is essential for hospitals and healthcare systems. Revenue leakage, which can result from coding errors, documentation issues, and operational inefficiencies, poses a significant threat, accounting for a substantial loss of 4-5% of total revenue in healthcare. This financial drain has far-reaching consequences.

At Global Healthcare, we recognize the paramount importance of Revenue integrity. With our deep-rooted commitment to excellence in healthcare, we are dedicated to ensuring that your organization maximizes its revenue potential while maintaining the highest standards of compliance and quality care. Our structured revenue integrity program includes regular audits.

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Common Sources of Revenue Leakage

Revenue

Unbilled Procedures : In healthcare, revenue leakage often stems from services provided to patients but not properly documented or coded for billing, resulting in direct revenue loss.

Coding Errors : Errors in translating healthcare services and procedures into billing codes can lead to underbilling or overbilling, impacting revenue accuracy and compliance.

UB-04 Form Challenges : The complex UB-04 claim form, with 81 fields, poses challenges in accurate completion. Any form of error can result in revenue leakage.

Charge Description Master Issues : Problems in maintaining CDM files, such as incorrect pricing or missing services.

Staff Training and Clinical Documentation : Inadequate personnel training and incomplete or inaccurate clinical documentation.

Our Services

Revenue Integrity Services & Solutions

Auditing & Identification
Revenue Integrity
Provider Outreach
Audit Services
Payment Analysis
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    Auditing and Identification

    Auditing and identifying primary income leakage sources are the initial steps in developing a robust revenue integrity program. Our team of experts at Global Healthcare Services specializes in this critical task. We conduct comprehensive assessments of your healthcare facility's revenue cycle to pinpoint areas of concern.

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    Structured Revenue Integrity Program

    Our Structured Revenue Integrity Program is designed to enhance your revenue cycle's overall efficiency and accuracy. We employ a multi-faceted approach to address various aspects of revenue management, including coding precision, clinical documentation improvement, charge accuracy, and compliance enhancement.

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    Provider Outreach

    Our provider outreach services are facilitated by cutting-edge technological means. We offer precertification and authorization services for both inpatient and outpatient care. By leveraging advanced technology, we streamline the pre-approval process, ensuring that the necessary authorizations are obtained efficiently, reducing claim denials and revenue delays.

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    Charge Capture Audit Services

    As part of our charge capture audit services, we thoroughly examine your billing processes to uncover unrecognized opportunities to add new charges. This involves engaging clinicians in a comprehensive assessment of procedures, documentation, and the billing process itself. By working closely with billers, coders, and clinicians.

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    Payment Variance Analysis

    Our payment variance analysis services focus on analyzing claims that have been denied or underpaid. We also conduct root cause analysis to identify and address challenges in the front and middle of the revenue cycle. By thoroughly investigating payment discrepancies and addressing their underlying causes, we maximize your facility's revenue recovery efforts.

Benefits of Partnering with our Services

Global Healthcare Services

Maximizing Net Revenue : Our Revenue Integrity Services are meticulously designed to identify and rectify sources of revenue leakage, ultimately boosting your healthcare system's net revenue.

Ensuring Compliance and Error Reduction : Maintaining compliance with healthcare regulations is paramount to avoid costly penalties and legal entanglements.

Long-Term Financial Success : Establishing a scalable and error-free revenue cycle process is fundamental to achieving long-term financial success.

Minimizing Downstream Problems : Revenue leakage and compliance issues can cascade into downstream problems, including delayed payments.

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