Revenue leakage identified and recovered across the entire cycle.

We audit your revenue cycle for systemic leakage that day-to-day billing operations don't catch — charge capture gaps, CDM pricing errors, payer underpayments against contracted rates, and denial patterns that keep recurring without resolution. We identify where revenue is being lost, quantify the exposure, and recover what's recoverable.

Billing processes claims. Denial management reworks the ones that come back denied. Neither is designed to answer: why are charges being missed before they reach billing? Why does the same payer consistently underpay the same service? Why do the same denial root causes keep recurring quarter after quarter? That's the layer we provide.

That depends on whether your current partner is catching systemic leakage or just processing claims. If charges are being missed, payer underpayments are accumulating undetected, or the same denial patterns keep recurring without resolution, there's a revenue integrity gap — regardless of who's running your billing. This can run alongside an existing RCM engagement.

HFMA research indicates hospitals lose 3 to 5% of net revenue annually to leakage — from missed charges, undercoding, unresolved denials, and payer underpayments. For context, the average hospital operating margin is approximately 5.2%. Organizations without formal revenue integrity oversight typically lose 3 to 8% of net collectible revenue.

BH organizations run multiple levels of care with different billing structures (session-based vs. per-diem), different payer rules per program, and carve-out contracts with separate rate schedules. Charge capture gaps between clinical delivery and billing are structurally common — a PHP day that falls below the minimum hour threshold isn't billable at all, and if nobody catches it, the revenue just disappears. At scale across multiple programs and locations, these gaps compound significantly.

Both options are available. A one-time assessment identifies where leakage exists and quantifies the exposure. Ongoing oversight ensures those gaps stay closed and new ones are caught as payer rules, contracts, and program structures change. Most organizations that start with an assessment move to ongoing oversight once they see what the first review uncovers.

No. We work across multiple EHRs, practice management systems, and billing platforms. Revenue integrity is an audit and oversight function — it works with the data your existing systems produce.

With an initial assessment — we review charge capture patterns, CDM accuracy, payer reimbursement against contracted rates, and denial root-cause data. The assessment identifies where leakage exists, quantifies the exposure, and recommends whether ongoing oversight is warranted. There's no commitment beyond the initial assessment unless the findings justify it.