Comprehensive Outpatient Revenue Integrity Services
Comprehensive coding, documentation improvement, charging, unbilled account management and denial management services, packaged to provide a complete end-to-end solution for outpatient revenue cycle improvement.
Comprehensive analysis & audit
Unbilled account management
Access to professional coders to code outpatient accounts
Ensure quality and completeness of coding
Integrate “charging” and/or validation of charging in the coding process
Analyze coding data and identify areas to improve
Collaborate with providers to resolve/improve documentation (deficiencies, insufficiencies, medical necessity, quality indicators, etc.)
Implement a thorough analysis and management of unbilled accounts/accounts receivables
Address denials timely and completely; analyze, report and educate to reduce/prevent denials
Maintain an up-to-date CDM (CPT/HCPCS, charges, etc.)
Identify and correct workflow and process issues throughout the outpatient revenue cycle
5 Tips to Build an Outpatient Revenue Integrity Program
According to MedPAC’s 2018 Report to the Congress, outpatient payments rose by almost $3 billion, partly due to an increase in physician services billed as hospital outpatient services.
With the surge in outpatient payments, hospital revenue integrity teams face a deluge of denials, edits and coding and documentation issues, each with unique requirements.
To help identify, track, manage and improve coding errors and documentation gaps, Pena4 offers CORIS—comprehensive outpatient revenue integrity services. The mission of CORIS is to help clients ensure comprehensive documentation, accurate coding and optimal reimbursement for complete outpatient revenue capture.
Gross Outpatient Revenue Increase