Healthcare Charge Integrity

Charge Integrity for Hospitals

Crowe® Charge Integrity is a programmatic solution designed to help your organization identify and address areas of opportunity related to the operations and charging for both inpatient and outpatient services. The program can provide the framework for hospitals to maximize net revenue, charge accurately, be paid appropriately, and defend the reimbursements already received. Our program includes the following services:

Clinical denials are typically lost in the shuffle of all the denials received at a hospital. Most hospitals do not have dedicated staff to address these denials, which can result in nonclinical billers working accounts and not telling the correct clinical stories. This results in final denials for very high-dollar accounts that should not have ever reached that point. Using our denials reporting package, we are able to drill down to root causes by clinical service line and by physician. This not only helps the organization address the process for resolving the clinical denials being received but also provides tactics for prevention and mitigation.
Leading practices dictate that to effectively and optimally manage an organization’s charge integrity, a designated department and staff are necessary. Crowe Horwath LLP has assisted numerous organizations with the development of departmental infrastructures to optimize net revenue.
Crowe can assist organizations with several offerings related to their charge masters, including periodic compliance reviews to confirm accuracy of the elements of the CDM, charge master maintenance activities on an annual and quarterly basis, and pricing analyses.
Utilization management departments are not always considered a part of a hospital revenue cycle even though the tasks that the clinicians perform directly affect a hospital’s revenues. Our program analyzes the workflows performed in the department and redesigns and implements policies to help improve net revenue and performance in the revenue cycle.
When organizations migrate to a new charge capture system, it is imperative to be proactive to prevent any revenue decline related to charge capture or charge mapping issues following "go-live." Our approach reviews the source systems and the necessary links to the charging system and follows the encounter through the generation of a claim to verify accuracy of the inputs.
Crowe can assist organizations as an outpatient coding resource for either an entire book of business – for example, the emergency department – or as needs arise for a third-party opinion on coding performance.

Each of the offerings from Crowe Charge Integrity includes the ability to:

  • Quickly identify areas of focus using analytics, technology tools, and benchmarks
  • Implement a highly customizable monitoring tool
  • Support your existing revenue cycle and clinical staff by improving processes that increase net revenue
  • Help you reduce clinical denials, improve the net realization rate for existing denials, maximize charge capture, and prioritize initiatives to quickly implement change
  • Identify trends and opportunities that most significantly affect the organization