Solutions for CRI

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 care 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?

Coding efficiency is not limited to computer-assisted coding (CAC). CAC tools have proven to be effective for many facilities, while others have opted to not undergo the investment given the poor ROI some facilities have reported.

Coding efficiency doesn’t have to be limited to CAC though. There are many other tools that can improve overall coding efficiency in addition to CAC.

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.

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.

 nSight-Driven Workflow for Clinical Revenue Integrity

What does it mean to be nSight-driven in health care? RecordsOne defines nSight-driven as getting usable and meaningful clinical information to users when, where and how they need it.

Why is that important? Consider this: when a patient is admitted, how many different staff need to be aware of that single admission? CDI? Case Management? Quality? Research? Obviously, it can vary a great deal based upon the reason for the admission, as well as many other contributing and historical factors.

Many believe that Natural Language Processing (NLP) is the ‘key’ to uncovering the ‘hidden gems’… not exactly. Clinical revenue integrity takes the right combination of technologies to truly create nSight-driven workflow. NLP is but one component of a sophisticated set of tools that creates an optimal ‘nSight-driven workflow’.

Clinical revenue integrity incorporates the entire healthcare organization and ensures all stakeholders—CDI, case management, HIM, quality, etc—understand their role and technology’s role. NLP technology enables data capture, but stakeholders enable its effectiveness. If clinicians don’t uphold clinical documentation, cases cannot be coded correctly—missed documentation could mean missed revenue.

The Growing Clinician Role in Revenue Integrity As hospitals and health systems face tightening margins, increased regulatory review, and a shift toward value-based payment, many find clinicians playing a greater role in revenue integrity initiatives. With this in mind, this HFMA Executive Roundtable, sponsored by Adreima, focuses on ways healthcare finance executives can work with clinicians to improve revenue integrity and how to best position these initiatives for success.

Clinical Revenue Integrity

“Revenue integrity means right revenue, right delivery, and right protocols to ensure right [accurate] reimbursement and compliance.  Revenue integrity doesn’t begin with a charge.”

– Suzanne Lestina, revenue cycle technical director for the Healthcare Financial Management Association (HFMA).