Integrated Revenue Integrity System

What is Clinical Revenue Integrity?

As health care moves from fee-for-service to value-based payment, organizations must have the ability to connect cost with clinical outcomes. Clinical revenue integrity (CRI) is essential for each individual patient and across entire patient populations. It prevents the recurrence of issues that create risk for revenue, for patients and for the healthcare provider organization.

 

CRI incorporates the entire healthcare organization and ensures all stakeholders—CDI, case management, HIM, quality, etc—understand their role and technology’s role. When CRI programs are appropriately designed and implemented, organizations can expect a higher clean claim rate, proactive identification and resolution of patient care issues, and improved quality reporting results. CRI begins with complete and accurate clinical documentation, and RecordsOne can help in many ways other tools simply can’t.

Integrated Clinical Revenue Integrity Tools

Clinical Documentation Improvement (CDI) has established itself as one of the foremost opportunities for hospitals to improve their clinical and financial performance, while elevating the facility’s quality scores.

CDI efficiency in many ways is limited to the quality and utility of the tools that the documentation specialist have at their disposal.

The integration of the facility’s Quality team is integral to the Clinical Documentation Improvement (CDI) process. To the degree that Quality and CDI can be integrated, in large measure, plays into how successful each of these programs will be.

And as the shift to value-based reimbursement continues, this need only becomes more pressing. Are you ready?

Population Health means many things to many organizations. At RecordsOne, we develop tools for monitoring patients that qualify for the Bundle Payments for Care Improvement (BPCI) as well as identify patients with HCC opportunities within your Medicare Advantage / Accountable Care Organization population.

Population Health monitoring does not have to be retrospective, in fact it is arguably more effective when it’s concurrent.

If performing a greater number of reviews concurrently, in both CDI and Quality, make good sense, then perhaps concurrently evaluating the performance of the CDI, Quality and Coding departments also is worth pursuing – both DRG and HCC.

We couldn’t agree more, and we built the tools you need to do just that. Audit – it’s not just retro’ anymore.

What we mean by integrated –

RecordsOne is a Platform, and not a series of separate stand-alone software products. What’s the difference you ask? Imagine if every time you wanted to get a new app on your smartphone, you actually had to purchase a new smartphone and somehow get the two separate devices to communicate? Ridiculous, right?

Yet that’s what health care organizations do all the time. A coding product from one vendor. A CDI product from another. An Audit product from somewhere else. And then try to get IT to somehow make it all work together. How’s that working out?

Integrated – “to put together parts or elements and combine them into a whole

Integrated means:

  • Modules versus Products – the RecordsOne Platform [the whole] has tightly integrated modules, not separate products
  • Transparency – Diagnoses, queries, notes… interdepartmental communication is easier with RecordsOne
  • Reconciliation – CDI with Coding, CDI/Coding with Audit, concurrently or retrospectively
  • Extensibility – you can start with one module and easily expand the use as your needs change
  • Future proof – as we build new modules to address the changes in the market, you are already there with us

Integrated also means, in many ways, cost-effective. The time, effort and money saved by not having to integrate disparate applications – applications that were never really designed to be integrated with one another – provides tremendous long-term savings. And of course, not having to pay for servers, back-ups, redundancy and IT support generate substantial savings as well.

Ready for a demo? Contact us now.