Revenue Integrity Services

If you have questions about our Revenue Integrity Solutions, please contact Rob Jones at 484-431-4324.

IMA Consulting offers a unique approach to Revenue Integrity Solutions. A team of seasoned professionals in the areas of coding, charge description master (CDM) compliance, charge capture, managed care, finance, and patient accounting, work collaboratively in a service center environment to deliver unparalleled results. This team of experts work through a client’s data from a global perspective to maximize financial opportunity and ensure hospitals collects what they are rightfully due. Additionally, IMA Consulting differentiates itself by providing value-added services based on forensic auditing techniques that identify areas of operational improvement opportunity.

IMA Consulting’s Revenue Integrity “Service Center” is staffed with billers and accounts receivable representatives to perform the necessary corrective billing tasks, monitor payment activities, and perform follow-up to ensure cash collections. This eliminates the typical hand-off issues and does not place any additional burden on our client’s business office. Essentially, IMA Consulting’s Service Center becomes an extension of our client’s revenue cycle operation that serves as a safety net to ensure maximal financial opportunity is identified and collected. These services include, but are not limited to:

CDM Reviews (electronic off-site, department specific, and comprehensive)

• Identify missing or deleted CPT/HCPC’s codes
•  Identify inaccurate CPT/HCPC’s codes, revenue codes, and units or unit multipliers
• Identify services or supplies currently provided, but not on the CDM
• Identify items on the CDM that are not currently billed
• Analyze charge master and revenue and usage data for inconsistent usage patterns
• Assess pricing relative to APC / other fee schedule reimbursement
• Validate items that are currently bundled that should be itemized / unbundled

Interface Analysis of charge interface system (order entry system)

• Verify the Interface System descriptions match the billing descriptions in the CDM
•  Identify items that are in the CDM but not in the Interface (Order Entry) system
• Identify items that are in the Interface (Order Entry) system but not in the CDM

Charge Capture Review

• Identify charges for services performed & supplies provided, but never billed
• Identify charge capture opportunities related to unique payer requirements
• Identify unbilled late charges and pursue collections

Underpayment Review & Collections

• Validate managed care contract compliance
• Identify underpayment opportunity and pursue collections
• Identify zero balances with offsetting debit and credit A/R

Forensic Patient Accounting Audit

•  Identify avoidable denials
• Identify registration errors leading to insurance plan changes or denials
•  Identify improper contractual adjustments and proration errors
• Assess secondary accounts receivable (A/R) write-offs
• Assess lag time between primary and secondary insurance payments
•  Validate payers are compliant with prompt pay laws

Managed Care Contract Reviews

• Review and analysis of pricing methodology and fee schedules
•  Review of contract language
• Assessment of administrative requirements