Protect revenue and increase appeal success with data mining and workflow management

• Protect revenue by assessing and reducing risk
  

  To reduce audit risk exposure, proactively identify risk and take corrective action through targeted improvement of billing requirements, coding, documentation, and physician practices

• Maximize limited resources
  

  Quickly zero in on highest-impact issues and proactively reduce the number of claims likely to result in take-backs

• Improve audit management across all payers
  

  Manage the workflow of a complex audit, organize the incoming and outgoing documents and paperwork, and identify claims about to hit deadlines

• Standardize the compliance plan across the integrated delivery system
  

  Using a centralized compliance platform, place all facilities and departments on the same plan

Compliance and Revenue Integrity (CRI) provides daily insight into compliance risk and coding outliers. Leveraging Medicare and Medicaid audit rules as well as MEDPAR and PEPPER benchmarks, CRI enables healthcare providers to data mine and proactively manage compliance risk and protect revenue through an industry-leading analytics platform. CRI also provides a robust workflow solution to effectively manage the multiple deadlines, documents, and hand-offs of the complex appeal process.

CRI can be used to:

• Develop a comprehensive audit plan to satisfy Affordable Care Act compliance requirements
• Drive corporate integrity agreement initiatives
• Aggregate compliance data after accountable care organization restructuring
• Report critical issues to the board
• Identify and assess new OIG targets

The CRI solution provides a dedicated account management team as well as access to a subject-matter expert with experience as a chief compliance officer who will ensure best practices are “hardwired” into the daily processes of each hospital’s compliance department.