Hospitals & Health Systems

Revenue Cycle Management for Hospitals & Health Systems

Enterprise-grade RCM that scales with your health system. From CDI and charge capture to complex claim adjudication and revenue integrity — we protect every dollar across every department.

$500M+ Revenue Recovered
50% Cost Reduction
98% Net Collection Rate
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Enterprise Challenges

Hospital Revenue Cycles Are Under Siege

Razor-thin margins, rising labor costs, payer complexity, and regulatory pressure create a perfect storm that demands more than incremental improvement — it requires revenue cycle transformation.

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DRG & APC Complexity

Inpatient DRG assignment and outpatient APC grouping require deep clinical documentation. Missed CCs/MCCs and inaccurate severity-of-illness coding leave millions on the table annually.

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Workforce Shortages

Certified coders and experienced billing professionals are increasingly difficult to recruit and retain. Understaffed revenue cycle departments lead to backlogs, delayed claims, and missed filing deadlines.

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Regulatory Compliance

CMS rule changes, No Surprises Act requirements, price transparency mandates, and RAC audits demand constant vigilance. Non-compliance risks penalties and reputational damage.

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System Integration Gaps

Disparate EHR, HIS, and billing systems across departments and acquired facilities create data silos that fragment the revenue cycle and hide revenue leakage points.

Clinical Documentation Integrity

CDI Programs That Capture True Acuity

Accurate reimbursement starts with accurate documentation. Our CDI specialists work concurrently with clinical staff to ensure medical records reflect the full complexity and severity of each patient encounter.

By querying physicians in real time — not retrospectively — we capture CCs and MCCs that drive appropriate DRG assignment, improving case mix index and ensuring compliance with coding guidelines.

  • Concurrent review — CDI specialists review charts during the patient stay, not after discharge
  • Physician query optimization — compliant, specific queries that improve response rates and documentation quality
  • CMI improvement — average 0.15-0.25 CMI increase within the first 6 months
  • Mortality/quality alignment — ensure documentation supports accurate quality metrics and risk adjustment
Hospital facility for health system RCM services
Charge Capture

Stop Revenue Leakage at the Source

Hospitals lose an estimated 1-3% of net revenue to missed charges. Our charge capture auditing identifies unbilled procedures, supplies, and services by comparing clinical documentation against the charge master and departmental workflows.

We deploy charge capture analysts across high-revenue departments — surgery, radiology, emergency, and lab — to close gaps before they become write-offs.

  • Charge master optimization — annual reviews to align pricing with market rates and payer contracts
  • Late charge identification — automated monitoring catches charges entered after billing cutoffs
  • Departmental audits — targeted reviews of OR, cath lab, infusion, and ED charge workflows
  • Supply chain integration — capture implants, high-cost drugs, and supplies tied to specific procedures
Revenue Integrity

End-to-End Revenue Integrity Programs

Revenue integrity extends beyond coding accuracy. It encompasses charge capture, contract compliance, underpayment recovery, and denial prevention — creating a continuous feedback loop that strengthens your entire revenue cycle.

Our revenue integrity team conducts proactive audits, monitors payer behavior patterns, and coordinates with your compliance department to ensure every dollar earned is collected.

  • Contract modeling — simulate reimbursement impact of proposed payer contract terms before signing
  • Underpayment identification — automated comparison of payments against contracted rates with variance alerts
  • RAC/audit defense — pre-billing audits and documentation standards that withstand recovery auditor scrutiny
  • Compliance safeguards — HIPAA, ISO 27001, and HITRUST CSF protocols protect data and ensure regulatory alignment
120+ Hospitals Served
0.20 Avg CMI Improvement
$4.2M Avg Annual Recovery per Hospital
99.1% Coding Accuracy Rate
FAQ

Frequently Asked Questions

We have deep integration experience with Epic, Oracle Health (Cerner), MEDITECH, and other major HIS platforms. Our technical team works with your IT department to establish secure interfaces for charge data, coding workflows, and reporting — typically within 6-8 weeks for enterprise deployments.
Yes. We handle UB-04 facility billing and CMS-1500 professional fee billing across all departments. Our teams understand the distinct coding requirements, modifier rules, and payer expectations for each billing type and ensure proper coordination between them.
Our ED billing team specializes in high-acuity, high-volume environments. We assign accurate E/M levels using compliant documentation-based criteria, manage trauma activation charges, handle facility fees, and ensure proper coding of critical care time, procedures, and observation hours.
We maintain HIPAA compliance with a comprehensive security program, ISO 27001 certification, and HITRUST CSF validation. We support BAA agreements, undergo annual third-party penetration testing, and provide detailed compliance documentation for your risk management and legal teams.
We have extensive experience integrating acquired facilities into unified revenue cycle operations. This includes payer re-credentialing, charge master harmonization, system migration, staff training, and reporting consolidation — typically completed within 90 days of acquisition close.
Most hospitals see a 3-5x ROI on CDI investment within the first year. This comes from improved CMI driving higher DRG reimbursement, better quality scores impacting value-based payments, and reduced RAC audit vulnerability. We provide monthly ROI tracking so you can measure impact in real time.