Revenue Integrity

Revenue Integrity

Identify a Road Map to Improved Performance & Increased Margins

BKD’s experienced approach to revenue cycle performance improvement includes integrity functions that can help organizations improve net revenue and prevent leakage by documenting, coding, billing, and capturing charges for the services they provide. Not only can we assess for opportunities, but our team has the depth, knowledge, and expertise to transition assessment opportunities all the way through to implementation.

Charge Description Master (CDM)

At the heart of the healthcare revenue cycle lies the chargemaster, the primary mechanism providers use to charge for the procedures, services, supplies, and drugs provided to patients. Maintaining an accurate hospital or medical chargemaster is essential to revenue integrity, as the chargemaster isn’t just an electronic file—it’s a key driver of financial performance.

BKD’s experienced professionals can help your organization assess the effectiveness of the chargemaster with services ranging from a line-item compliance desk review to a strategic assessment of hospital chargemaster opportunities as your organization transitions to a new era of healthcare delivery and reimbursement.

Price Transparency

With increased regulatory requirements for hospital pricing and a focus on improving the overall price transparency of hospital charges and out-of-pocket costs for patients, healthcare providers will be pushed by CMS, private insurance companies, employers, and consumers to provide better information regarding the cost and value of services. Our experienced professionals can help organizations develop short- and long-term strategies that can position them for success.

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Charge Capture

Providing care to patients is the reason healthcare organizations exist—but staying in business necessitates being paid for the care and services provided. Hospitals and providers that fail to accurately document and capture information on the care provided to patients can cost their organizations millions in lost revenue.

BKD’s experienced professionals can assist organizations in improving healthcare reimbursement methods through an assessment of key policies, procedures, practices, and processes. Discussions with clinical and financial teams help identify procedure and process failures and associated charge capture opportunities. 

Coding & Billing Compliance

Poor clinical documentation and coding integrity practices can result in claim denials and inaccurate reimbursements. Many hospitals have implemented clinical documentation improvement programs to mitigate claim denials for medical necessity, coding, and clinical documentation. Clinical documentation and coding integrity is a large component of the middle revenue cycle, where clinical and financial processes interact.
BKD’s medical coding and billing compliance team includes documentation and coding professionals certified through the American Health Information Management Association and AAPC. Our team specializes in:

  • MS-DRG Diagnosis-related group and clinical validation
  • Documentation specificity
  • Evaluation and management
  • Risk adjustment
  • Hierarchical condition categories
  • Severity of illness/risk of mortality
  • Ambulatory Payment Classifications 
  • Clinical and provider education

Our healthcare performance advisors provide best practice recommendations that can assist up-to-date processes and best practices to assist your organization in preventing denials. BKD’s revenue integrity and compliance team provides up-to-date processes and best practices to help hospitals meet the ever-changing regulatory landscape from fee-for-service to value-based models.

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Locations

We have 40 offices in 18 states, with BKD Trusted Advisors™ who offer solutions for clients across the country.

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