Grassi Healthcare | Revenue Integrity
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Revenue Integrity

Grassi Healthcare Advisors, LLC (GHA) supports organizations in achieving and maintaining high level revenue integrity performance.  Medical providers and healthcare organizations that achieve high levels of revenue integrity enjoy appropriate reimbursement for the services and care they deliver, as well as a decreased likelihood that they will lose revenue because of payer audits and take-backs.  Revenue integrity activities also support the organization’s compliance plan.  During merger and acquisition transactions, revenue integrity reviews provide useful information to prospective purchaser on the target’s approach to revenue cycle upon which the purchase price may be based.
 
Our approach to revenue integrity engagements follows our consulting formula of data analysis, innovation, and transformation. 
 
Step 1: collecting billing submission data for high-risk codes when comparing the client’s revenue to similar organizations; accuracy of coding and the quality of the supporting clinical documentation is also evaluated; review of medical necessity and meeting other requirements

Step 2: mapping of current revenue cycle processes and comparing to industry best practices, and then recommending new best practice process innovations to improve revenue cycle performance and compliance

Step 3: transforming the organization in order to ensure continued success.  This is accomplished by identifying current organization incentives that don't match desired goals, and replacing them with incentives that focus on revenue integrity—accurate coding with supporting documentation for care and services provided appropriately
 
Grassi Healthcare Advisors, LLC provides revenue integrity consulting services for providers across the healthcare continuum—hospitals, medical practices, nursing homes, home care agencies, hospice programs, etc.  Our team members also have subspecialty expertise in areas of behavioral health, developmental disabilities, substance abuse, etc.  Each of these engagements are customized to the applicable reimbursement scheme, as demonstrated below:
 
 

Scope: Medical Services, Behavioral Health and Substance Use Disorder Services, including Telehealth

 
  • Technical Qualifiers: Proper service, provider and setting; Insurance validated; Incident-to issues
  • Clinical Qualifiers: Medical necessity
  • Coding and Documentation: CPT coding is supported by clinical documentation
  • Billing Review: Billing submitted within allowable time; CPT code in chart matches bill and matches payment
 
 

Scope: Skilled Nursing Facility

 
  • Technical Qualifiers: Proper service and setting; Covered days verified; Three-day hospital stay or waiver; MD Certification
  • Clinical Qualifiers: Skilled level of care; progress to goals is demonstrated
  • Coding and Documentation: MDS coding is supported by clinical documentation
  • Billing Review: Billing submitted within allowable time; RUG score on MDS matches bill and matches payment
 
 

Scope: Home Health Agency

 
  • Technical Qualifiers: Proper service and setting; homebound status; MD certification and Face to Face Cert
  • Clinical Qualifiers: Skilled level of care; progress to goals is demonstrated
  • Coding and Documentation: OASIS coding is supported by clinical documentation
  • Billing Review: Billing submitted within allowable time; HHRG score on OASIS matches bill and matches payment
 

What is the value proposition of a revenue integrity review?

Conducting a revenue integrity review and process improvement project offers three key value propositions:
  • Identification of missed revenue opportunities because of inaccurate or understated billing
  • Identification and prevention of potential future pay-back of revenue for inaccurately over-billed services
  • Identification and recovery of uncollected receivables