Healthcare Revenue Integrity Services

HEALTHCARE BPO

On average, healthcare systems lose up to 5% of their net charges due to revenue leakages that put them at financial risk. Thus, improving healthcare revenue integrity to rectify sources of revenue leakage becomes a top priority. It is reported that 64% of healthcare systems lack a standardized revenue integrity program. Revenue integrity becomes critical as value-based reimbursement (VBR) keeps increasing. With VBR, the charges captured today not only drive current revenue but also direct future target prices. Hence, taking a data-driven approach to seize revenue leakages and assure revenue integrity becomes quintessential. As most healthcare businesses lack a skilled workforce, they choose an expert healthcare revenue integrity service provider like Outsource2india (O2I).

O2I assists healthcare providers to create a scalable revenue cycle process to surpass financial goals by focusing on improving coding and compliance practices. We offer efficient healthcare revenue integrity services that help reach the highest value by optimizing the revenue cycle and maximizing net revenue by applying efficient workflows and artificial intelligence.

Our Healthcare Revenue Integrity Services

Our healthcare revenue integrity program begins with an audit that determines the key sources of revenue leakages. Outsourcing healthcare revenue integrity services to O2I provides you with transformational results in terms of improved revenue realizations, coding/charge capture, and profitability. We further minimize non-compliance risks and optimize reimbursements. Our healthcare revenue integrity solutions include -

Structured Revenue Integrity Program

O2I's healthcare revenue integrity services improve coding and charge accuracy as well as clinical documentation. We apply our quality assurance processes & methods to improve compliance and help reduce DNFB. Our analytics experts pinpoint issues and implement sustainable healthcare revenue integrity solutions.
Clinical Documentation Improvement
We, at O2I, concentrate on upgrading clinical documentation quality. We also enable clinics to facilitate an accurate representation of healthcare services offered. This process includes -
- Looking for trends related to specific procedures/diagnosis
- Identifying gaps in clinical documentation for all procedures/diagnosis
- Educating clients about the best practices for documentation and queries
- Facilitating collaboration amongst team members and clinicians/physicians
Charge Capture Audit Services

Our charge capture audit and compliance services provide a comprehensive review of bills to identify missed chargeable opportunities if any. The audit includes a detailed review of all the procedures, claims, documentation, and processes with clinicians to identify over/under billings. Accordingly, we create a strategic performance improvement plan to improve charge capture efficiency by working with clinicians and billers/coders to mitigate risk and minimize possible future missteps.
HIM Coding Review and Staffing

Coding guidelines and reporting requirements change continually. Our skilled coders work at onsite, remote, and offshore locations to help you with system transitions, regulatory reports, ongoing staff requests and to clear coding backlogs. Our coders analyze patient accounts and audit claims to determine the correct usage of CPT and HCPCS codes and DRGs. We also verify whether coded charts are accurate and identify unbilled procedures, compliance issues, and coding errors. Additionally, we work with coders and clinicians to provide coding education and compliance programs that drive improvements.
Payment Variance Analysis

We perform analysis of underpaid/denied claims to manage appeals processes for getting accurate reimbursements. By performing root cause analysis, we address the underlying issues in the mid-revenue cycle.
Clinical Access and Triage Management Services

Queries concerning patient care are addressed by our clinical access and triage management team. We direct patients to clinically appropriate and cost-effective care facilities.
Utilization Management Services

We use prospective reviews to deliver appropriate care for patients. Our hospital utilization management services ensure that patients receive quality care and cost-effective treatment while reducing compliance risks and medical necessities.
Medical Authorization Management Services

We manage medical authorization across the entire care spectrum. We offer precertification and authorization needs for inpatient/outpatient therapeutic/diagnostic services.

Our Healthcare Revenue Integrity Process

Healthcare centers use a healthcare revenue cycle to manage their clinical and administrative data regularly. The healthcare revenue integrity service process executes all policy-making and clinical functions including capturing, steering, and collecting specific service data. It covers everything from patient registration to generating invoices. The detailed healthcare revenue integrity service flow we follow is as below -

01. Patient Pre-registration

Patient data is collected before their first hospital visit. This includes the patient's name, medical history, and payment mode. Pre-enrolment helps the patient as it saves time before they counsel their doctors. The payment procedure is communicated to the patients which helps healthcare providers to diminish the probability of bad debts. Pre-registration streamlines the process and improves the overall patient experience

02. Patient Registration

During the registration, all the patient data gathered during the pre-registration is verified. Errors detected from the form are brought to the patient's attention before they escalate to become a significant problem

03. Charge Entry and Capture

We help record the data from the various services offered by the healthcare providers and then send these charges to the relevant insurance companies. We make sure that hospitals receive full compensation from their payers

04. Utilization Management

Health insurance companies examine the request made for treatments. Our utilization management team checks whether the active healthcare plan offers the required coverage for medical services. Our team also helps hospitals to evaluate the entire treatment

05. Medical Coding

We help interconnect procedures with diagnoses. Our expert coders translate the written descriptions of health services, processes, individual requirements offered at hospitals into alphanumeric/numeric codes. Although these codes are irrelevant to an individual, it is helpful for hospitals to create a roadmap for the processes coming ahead, that is for insurance bills and claims purposes

06. Claim Submission

During claim entry, we submit the medical claims to the insurance companies for successful payments as per the contract. We try our best to avoid any errors/challenges that may cause a delay in processing the payment

07. Denial Management

We analyze the payment received from the insurance provider/payer and check whether it is approved or not. Are there any discrepancies that are causing payment delays? If we find any errors, the claim amount is re-directed to the clearinghouse for further assessment and claim clearance

08. Insurance Follow-up

Regular follow-ups of insurance are very important for receiving the exact claim. Possible issues like claim denials, underpayments, or non-payments of claims may pop up if there are irregular follow-ups. We adjust the rates for future plaintiff negotiations if you are not satisfied with the reimbursements

09. Patient Billing and Collections

Here, in the last step of our healthcare revenue integrity service, we thoroughly calculate all patient balances and obligations and accurately prepare the statement. We carefully track outstanding accounts and follow-up with the patient's payment balances

Our Healthcare Revenue Integrity Services Tools

O2I is a leading healthcare revenue integrity company. We assure faster deliverables by using top-class and updated healthcare revenue integrity tools and technologies. A few of them are Medisoft, Nextgen, Epic, Brightree, Athena, Pulse, Proclaim, and Carecloud.

Industries We Cover

Clinics/care centers

Diagnostic labs

Hospitals

Insurance & billing companies

Revenue cycle management companies

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Why Outsource Healthcare Revenue Integrity Services to Outsource2india?

Discover hidden sources of revenue leakages and receive accurate reimbursements through healthcare revenue integrity solutions from Outsource2india. Outsource healthcare revenue integrity services to Outsource2india for the following reasons -

Strategic Pricing

We provide affordable pricing options suitable to your budget. Outsourcing healthcare revenue integrity services to us can prove to be cost-effective for you.
High Data Security

Outsource2india is an ISO 27001:2013 ISMS-certified organization confirming that all your patient-related data is completely safe and secure.
HIPAA Compliant

We ensure that the data and medical records of patients are stored safely and are not divulged to any third party.
Certifications

O2I is a compliant healthcare revenue integrity service providing company. We comply with all federal and state regulations and guidelines related to healthcare data security and protection. Our data centers, facilities, processes, and products are analyzed and tested annually by independent third-party assessments. Below is the list of certifications that we currently maintain.
- HITRUST CSF Certified- ISO, NIST, PCI DSS, HIPAA, and COBIT compliant
- SSAE18 SOC 1 (Type 2)
- PCI DSS
- ISO 27001:2013
- ISO 9001:2015 quality management system
These certifications validate our commitment to fulfilling organizational quality, data privacy, and security. We transform your business with the implementation of a strong internal revenue control framework.
Dedicated Project Manager

We assign a dedicated project manager who will be the single point of contact for all your requirements. The project manager keeps you updated at each stage of the project and will answer and resolve any issues that you may have.
Experienced Medical Coders

We at O2I have the best team comprising the most talented and certified medical coders. They have been specially trained to work on the latest tools and technologies.
24/7 Customer Support

We provide round-the-clock support; the project managers being available 24/7 to resolve any issues and answer any queries you may have.
Short Turnaround

We have numerous delivery centers spread across the globe in different time zones that enable us to deliver quality healthcare revenue integrity services with a quick turnaround time.
Easily scalability

Our experienced team has all the required skills, resources, talent, and bandwidth to cater to the revenue integrity requirements.
Additional Benefits
- 240+ successful healthcare revenue integrity programs deployed
- 24+ global delivery centers throughout India and abroad
- Support of 278,000+ physicians
- 90+ medical specialties coverage
- Create a personalized and positive patient experience
- Enable analytical visibility across and within your healthcare settings
- Profound experience with all billing platforms and payers
- Guaranteed world-class healthcare revenue integrity service
- Comprehensive healthcare revenue integrity solution enabled by a fully integrated E2E proprietary technology platform
- Enabling growth in all capabilities with our strong financial standing

Client Success Stories

O2I Delivered Charge and Patient Demographics Entry for Georgian Client

O2I Performed Patient Demographics Entry for a Georgian Client

Our medical billing professionals processed about 1200 claims a month for 4 different medical practices.

O2I Provided Charge and Demographic Entry by Using Kareo Software to a US-based Client

O2I Processed More Than 17000 Claims a Month by Using Kareo Software For a US-based Client

We performed charge and demographic entry for a Houston-based client and processed over 17000 claims a month using the Kareo software.

Testimonials

I want to thank you for the professional way in which you are managing the project and meeting our deadlines.

CEO, Medical Company, UK More Testimonials »

Outsource Healthcare Revenue Integrity Services to Outsource2india

Healthcare systems depend a lot on healthcare revenue integrity management technologies to remain financially sustainable. With competing funding priorities, you require a competent healthcare revenue integrity service provider like O2I. We are a leading independent healthcare revenue integrity service providing company. We transform the entire patient experience, deliver proven ROI for the revenue cycle, and improve the financial performance of healthcare providers.

Our healthcare revenue integrity services are ICD-10 compliant and licensed to satisfy all clinical coding standards accurately. Outsourcing healthcare revenue integrity services enables you to reduce compliance risks and optimize your ROI. Our team of experienced personnel assists in improving your finances by streamlining claim submissions. We ensure the highest level of data integrity. O2I's state-of-the-art technology evaluates, tests, and designs new RCM technologies to resolve major challenges for healthcare systems and hospitals.

Get in touch with us if you are looking for an efficient, trustworthy, and highly skilled provider of healthcare revenue integrity services.