Protecting and Enhancing Revenue for Hospitals

Revenue Integrity

According to a recent HIMSS Media research study, only one-third of the nation’s hospital and acute-care facility leaders believe diagnosis-related group (DRG) optimization is a solved problem.

This is an issue because undercoding claims can result in lost revenue while overcoding could create compliance problems.

BESLER has developed a suite of services to address common mid-revenue cycle concerns. Whether you have an existing revenue integrity team that wants to recover more revenue – or no revenue integrity team at all – BESLER’s Revenue Integrity Services can help your hospital capture more revenue and stay compliant.

No costly software implementations. No learning curves. No hassles. Only results.

Inpatient DRG Validation & Outpatient Correct Coding and Charge Capture  

BESLER has demonstrated improvements in coding accuracy ranging from 25-60% translating to tens of thousands of dollars hospitals have recovered.

  • BESLER’s Inpatient DRG Validation and Outpatient Correct Coding and Charge Capture services utilize the power of our Revenue Integrity technology platform to rapidly determine ICD-10 CM/PCS and CPT coding accuracy and appropriateness of code selection. This happens in days, not months!
  • Our coding analysts then examine suspect claims to identify coding error trends, overpayment risk, underpayment cost, and to correct coding issues.
  • Our coders also evaluate the quality of physician clinical documentation for completeness, accuracy, and compliance.
  • Once verified, suggested rebills and compliance issues are reported through BESLER’s online provider review dashboard and are available for client review on the same day they are identified.

Compliance Validation

Proactively addressing coding compliance issues assures hospitals of full compliance and lowers the risk of regulatory intervention.

  • BESLER’s Revenue Integrity Compliance service can rapidly identify potential compliance issues on medical claims for hospitals specifically interested in validating the compliance of their claims.
  • Verified compliance issues are reported through our provider review dashboard and are available for client review on the same day they are identified.
  • Monthly/concurrent education is delivered to help each facility prevent repeatable errors.

Auditing

BESLER auditing and coding compliance identifies areas for coding accuracy and clinical documentation improvement that will help ensure successful reimbursement and decrease in payor denials.

  • BESLER’s Revenue Integrity Audit service provides a retrospective audit of technical coding encounters and can focus on specific service lines or procedures of interest.
  • BESLER reviews the coding and clinical documentation for compliance with applicable Centers for Medicaid and Medicare Services (CMS) regulations and guidance with consideration of client’s specific coding policies.
  • The audit includes a report of the findings as well as a follow-up meeting to reconcile any questions related to the audit findings.