RCM Auditing & Consulting
Comprehensive RCM audits, revenue integrity, repricing and denial analytics — designed to recover revenue, reduce leakage, and strengthen operations.
Revenue Integrity Audits
End-to-end claim validation, coding accuracy, and charge capture reconciliation to identify underpayments and leakage.
Denial Analytics & Playbooks
Data-driven denial root-cause analysis, automated workflows and playbooks to reduce future denials.
Repricing & Recovery
Systematic repricing engagements, DRG corrections, and payer negotiations to recover improperly paid claims.
How we approach RCM audits
Our engagements blend data science, claims expertise and clinical/coding review. We surface the highest-value recovery opportunities first, then combine automated repricing with targeted human review for defensible recoveries.
- Scoping & Data Intake: Receive claim extracts, remits, and system access to define the opportunity.
- Data Analysis & Prioritization: Identify high-value buckets using analytics and sampling.
- Clinical & Coding Review: Nurse/coder reviews for medical necessity and coding accuracy where needed.
- Repricing & Recovery: Execute repricing, prepare defensible documentation, and manage payer recovery workflows.
- Remediation & Controls: Deliver process changes, playbooks and monitoring to prevent recurrence.
Long description to attract clients
In complex healthcare environments revenue leaves the organization for many reasons: missed charges, payer misapplication, coding variance, and inconsistent documentation. RCM auditing is the strategic lever that not only recovers past revenue but also hardens future processes. SamITHealth delivers pragmatic, measurable auditing programs that combine automated analytics and human expertise to produce defensible recoveries and sustainable process improvements.
Our team is experienced across hospital systems, ambulatory networks, and payer operations. We understand DRG mechanics, payer contract nuances, and the operational realities of billing teams. That enables us to quickly identify the highest-return opportunities and execute recovery with minimal disruption. Clients engage us for targeted pilots, full-scale recoveries, or ongoing auditing programs — and expect transparent reporting, conservative revenue estimates, and a clear remediation roadmap.
Start with a pilot: we'll analyze a representative sample of claims, return a findings report with estimated recoveries and a recommended plan to operationalize fixes. With the right controls in place, organizations not only recover funds but also reduce ongoing leakage — turning RCM auditing from a one-time project into a continuous improvement capability.