It is critical that healthcare organizations have a solid revenue cycle process inclusive of multiple lines of defense. With margins continuing to shrink across the healthcare industry and increased scrutiny around government funding, it is more important than ever for healthcare providers to accurately capture and preserve the revenue they are entitled. Built on Microsoft Power BI, Protiviti’s RiHT Tool helps healthcare organizations to:

Utilize 835 & 837 EDI Remittance data to identify areas of opportunity across your organization.
Mine the vast amount of information that is contained within these files and identify overall revenue cycle improvements related to process breakdowns, payer changes, coding opportunities, underpayments, claim edits, and targeted populations (e.g., COVID-19 and telehealth, etc.).

Protiviti's RiHT Tool Helps Healthcare Organizations to:

Achieve Continuous Monitoring & Compliance Analytics: Implement next generation continuous monitoring audit and compliance analytics
Gain Powerful Insights: Gain insights on process breakdowns, payer changes, claim variance and historical data in a highly interactive dashboard environment
Improve Coding Accuracy: Coding opportunities that can improve coding accuracy and potentially result in additional reimbursement
Track Data Across Multiple Systems: Pull accurate data from multiple, disparate systems for a single, user-friendly reporting dashboard
Maintain Accurate Denial Management & Reporting: Maintain a robust denials management system and validate/verify that current denials reporting is accurate and adequate.

High-Level Process Overview

Convert, load, transform, and validate data
Run analysis (Revenue Cycle Diagnostic) and present results • Charge and payment trending • Technical and Clinical Denials Analysis • Payment Integrity • Charge Capture • Coding • Targeted Population Analysis
Report Revenue Cycle Diagnostic findings / potential gaps
If desired, based on the results of the data analytics, facilitate process understanding interviews and/or conduct targeted claims testing / root cause analysis *
Develop Revenue Integrity roadmap with future state recommendations *

*Subject to additional cost

Timing and pricing can vary depending on number of systems and volume of data

Protiviti's Revenue Integrity Health Trending (RiHT) Tool - 6 Week Implementation

Protiviti

Details

Links