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 and manual 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. Our approach targets the highest-yield areas while enabling process improvements that reduce long-term leakage.
Our team is experienced across hospital systems, ambulatory networks, and payer operations. We understand DRG mechanics, payer contract nuances, and the operational constraints of billing teams.
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 findings into sustained revenue improvements.