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Revenue Integrity Services

Beyond providing tools and healthcare regulatory and compliance resources, VitalWare offers professional CDM
and auditing services designed to support organizations in need of coding guidance, process improvement,
education and financial impact analysis.VitalWare’s™ Revenue Integrity Services consulting enhances our healthcare revenue cycle SaaS solutions to ensure our clients’ needs are met with support beyond technology.

These services are designed to assist clients with their effort to achieve the following key objectives:

  • Minimize compliance risk
  • Optimize revenue reimbursement opportunities
  • Reduce risk of improper claims that lead to rejections, underpayment, overpayments, audits, fines, and penalties
  • Identify regulatory changes that impact services and delivery
RIS
RIS cdm

Hospital Inpatient/Outpatient Auditing Services

CDM Management Services

VitalWare’s Revenue Integrity Services (RIS) team provides retrospective inpatient and outpatient hospital coding audits utilizing the VitalAuditor™ software as a service (SaaS) solution.  VitalAuditor combines audit workflow, management, education and reporting capabilities into a single, web-based solution. 

VitalWare’s™ Hospital inpatient/outpatient retrospective auditing services are designed to assist clients with their efforts to achieve the following key objectives:

  • Support the delivery of quality healthcare through the reporting of accurate diagnosis and procedure codes based on medical record documentation
  • Minimize compliance risks by identifying inaccurate coding trends specific to your organization;
  • Identification of revenue optimization through an analysis of provider documentation,  potential clinical documentation improvement (CDI) opportunities and associated code assignment;
  • Reduce the risk of improper code assignment that may lead to claims rejections, underpayments, overpayments, audits, fines, and, potential penalties;
  • Identify regulatory and coding guidance updates that impact ICD-10-CM/PCS and CPT® code assignment; and,
  • Demonstrate a proactive quality assurance program through the use of an outside, independent party with appropriate expertise to obtain an unbiased evaluation of the organizations’ coding.

VitalWare understands the challenges organizations face when deciding how resources are to be allocated – especially in the mid-revenue cycle arena.  In light of these challenges, VitalWare offers Charge Description Master (CDM) management support services with the purchase of VitalCDM™.  This service, in conjunction with use of VitalCDM, assures the 3C’s of CDM management are met:

  • Current – includes accurate and up-to-date services, codes and descriptions
  • Comprehensive – includes all billable services for all departments
  • Compliant – all charges meet Medicare payer guidelines.

VitalWare’s™ CDM consulting augmentation and support is designed to assist clients with their effort to achieve the following key objectives:

  • Minimize compliance risk
  • Optimize revenue reimbursement opportunities
  • Reduce risk of improper claims that lead to rejections, underpayment, overpayments, audits, fines, and penalties
  • Maintain current CPT®/HCPCS codes (new, deleted or revised)
  • Identify regulatory changes that impact services and delivery

Take the next step.

Contact one of our world class Product Specialists to schedule a live demo.