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Revenue Integrity / Underpayment 2019
High Value Reported in High-Performing Market
Author
Boyd Stewart
Author
Alex McIntosh
Healthcare organizations lose money when underpayments, transfer DRGs, and denials cause insurance payments and other types of income to be left on the table. Revenue integrity firms aim to solve this problem by helping organizations retroactively recoup revenue and proactively prevent future loss. In a big win for healthcare organizations, these firms are very high performing overall—of the services segments KLAS measures, revenue integrity is rated third overall and first for value and customer loyalty. Rather than splitting hairs on the performance of a high-performing pool of options, this report focuses on firms’ individual services offerings to help organizations find the best fit (or fits, as many organizations leverage multiple firms).
What Revenue Integrity/Underpayment Services Are (and What They Aren't)
In the revenue integrity market, there are three ways that services firms can help your organization catch
more revenue “fish”:
This report focuses on the last type of offering. Exact definitions of revenue integrity/underpayment services vary throughout the market. This report works from a broad definition, summed up as the processes deployed to ensure that organizations are reimbursed accurately for services they have provided. This may include some or all of the capabilities validated in the following chart.
BESLER Fights for Clients
Clients of BESLER report their firm advocates for them, fighting to get them the revenue they are owed. Respondents express surprise at how much money BESLER found in a short time period as a result of these efforts. The firm also goes beyond just finding revenue, teaching clients how to correct holes they find or reverse negative trends they see in the organization’s revenue cycle.
Revecore Praised for Skilled Team, Close Communication
Revecore’s main differentiator is their consultants, whom clients praise for providing effective communication and for being highly skilled, especially with data mining. The high quality of the consultants leads to close client relationships. Clients also report Revecore constantly recommends ways to avoid upstream mistakes that result in unpaid/underpaid claims.
Revint's Broad Offering Delivers Quick ROI
Revint has acquired multiple other firms in the revenue integrity space, generating a comprehensive offering of revenue-recovery tools. Multiple respondents highlight the firm’s DRG-validation service as a core strength of the offering. Revint clients report that despite a high cost, the ROI is strong, and it is also realized very quickly (in part because of fast implementations). The firm also receives praise for consistently underpromising and overdelivering.
TransUnion Healthcare Provides Tailored Approach
97% of TransUnion’s 30 interviewed clients would contract with the firm again. TransUnion enables multiple approaches to revenue integrity, meeting clients where they are but also driving value independently without the need for client direction. Unlike other firms in this report, TransUnion offers both revenue integrity services and the STINGRAY software, which clients can use in conjunction with the services or on its own (only the former were interviewed for this report). The technology performs a retroactive review of past accounts, helping clients identify lost opportunities on Medicare bad debt and leading to higher collections and increased revenue.
Triage Partners, Puts Clients First
Triage Consulting Group stands out with near-perfect satisfaction from all interviewed clients. Clients view Triage as a partner who is not just out to make money. Nearly all feel that Triage exceeds expectations, helping them collect much more than was expected at the start of the engagement. Clients commonly describe the firm as “fantastic,” “competent,” “responsive,” and “proactive,” and they note that the firm's resources are highly trained. Respondents appreciate the actionable data they receive about identified trends and how to fix them. While several clients view Triage as expensive, all feel the value is well worth the cost.
Writer
Amanda Wind Smith
Designer
Madison Moniz
This material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2024 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.