Revenue Integrity Support Services

Revenue integrity asks a different question than billing: not “did the claim get paid?” but “did everything that should have been billed get billed, at the right rates, with nothing lost between systems?” Leaks hide in the seams — interface gaps between EHR and billing system, fee schedules years out of date, charge capture habits that vary by provider.

Our revenue integrity support builds recurring controls: schedule-to-charge reconciliation, charge capture audits by service line, fee schedule review against current benchmarks, and system interface checks — each producing findings with owners and deadlines rather than reports that get filed.

Problems This Service Addresses

• Charges lost in interface gaps between clinical and billing systems
• Fee schedules unchanged for years, billing below market or below contract
• Charge capture varying wildly between providers doing identical work
• No recurring control that would catch a new leak when it opens

What’s Included

• Charge capture audits by provider and service line
• Schedule-to-charge and system interface reconciliation
• Fee schedule review and update recommendations
• Missed-revenue quantification with root-cause findings
• Recurring integrity control calendar with owner assignments

Who This Service Is For

• Groups that have grown past the point where one person can see everything
• Practices after a system conversion, when interface leaks are most common
• Owners who want financial controls, not just billing production

Risks and Operational Considerations

Fee schedule strategy interacts with payer contracts and market position — we provide analysis; pricing decisions rest with practice leadership.

Integrity findings sometimes implicate workflow owners; the program works best with leadership sponsorship and a no-blame framing.