Expert Audit & Quality
Assurance
With over 20 million patient encounters reviewed, we utilize inferential and descriptive statistical models to uncover weak spots and redundancy, and to make an opportunity assessment
Concurrent CDI
Real-time record review for prompt detection
Prospective CDI
Review of medical history ahead of appointments
Concurrent CDI
Improve compliance and revenue recognition with clinical documentation support embedded directly in providers’ current workflow for real-time support and rapid revenue recognition.
Improved clinical documentation
Accurate chart notes ensure payments accurately reflect the work done by clinicians prior to charges being sent to the clearinghouse
Simplified process for multiple payment models
We use a single workflow to support value-based care (VBC) and fee-for-service (FFS) requirements to help you achieve your clinical and financial goals
Skip the technical issues
Concurrent review operates within providers’ existing documentation, coding, and billing, technology without requiring a costly integration process or on-going technical maintenance
Reduced denial rates
End-to-end ownership of correct application of payor-specific medical policy improves organizational coding specificity, accuracy, and accounts receivable balances
Accurate risk scores
Embedded risk adjustment reviews for VBC organizations supports provider adoption of adjustment requirements, and ensures FFS claims edits do not override valuable diagnostic information
Scalable support
Eliminate the cost and complexity of staffing, training, and managing coding, billing, and clinical documentation integrity teams, while meeting all regulatory requirements at scale
Option to deploy staff augmentation services
Dedicated R5RCM team members can act as fully-integrated members of an organization’s coding, billing or revenue cycle teams
Prospective CDI
Gain comprehensive understanding of historical documentation and coding patterns, actionable recommendations for improvement, and custom curation of workflows to optimize data capture.
Provides an actionable level of detail
Pre-visit chart reviews to assess a patients’ medical history and identify any known or suspected conditions before the appointment while reducing administrative burden
Available at the point of care
Trained clinical coders and clinicians ensure providers can access the necessary risk adjustment and quality information within the clinical point-of-care workflow
No integration required
Compatible with all EHR and EPM systems
Understand financial performance
Establish a baseline for risk-pool and provider performance based on your EHR data, not payor reports or claims
Option to deploy staff augmentation services
Dedicated R5RCM team members can act as fully-integrated members of an organization’s coding, billing or revenue cycle teams
Skip the Trade-off:
Value-Based vs. Fee-For-Service
R5RCM's Concurrent Review adapts to your reimbursement model, offering distinct strategies for both Value-Based Care and Traditional Fee-For-Service in a single solution
Value-Based Care Solutions
Meeting risk adjustment requirements and comprehensively reporting on quality measures is key to accessing favorable risk economics
Risk Adjustment Coding
Concurrent, Prospective, and Retrospective Reviews to improve documentation, coding, billing workflows, identify actionable insights, and ensure accurate claims based on medical records
HEDIS Quality Gap Closure
Embed payor-specific quality reporting requirements in the revenue cycle process, along with the flexibility to immediately adapt as requirements change
Provider Education
Resolve documentation issues prior to claim submission and provide meaningful provider education for improved accuracy and real-time performance visibility without unnecessary administrative burden
Revenue Cycle Management Extension
Expand into full Revenue Cycle Management (RCM) for end-to-end performance improvement
Option to Deploy Staff Augmentation Services
Dedicated R5RCM team members act as fully-integrated members of an organization’s coding, billing or revenue cycle teams
Fee-For-Service Solutions
Accurate coding and billing are vital to success, but it’s tough to do alone—leveraging external expertise allows managing guideline changes efficiently, ensuring scalability, optimizing costs, and capturing opportunities
Professional Fee-for-Service Coding
Ensure accurate coding to support proper reimbursement with Concurrent Review
Facility DRG Coding
Concurrent and Prospective Reviews to enhance documentation, coding, and billing workflows while identifying actionable insights and areas for improvement within provider documentation
Revenue Cycle Management Extension
Extend improvements in overhead costs and performance with full RCM support
Option to Deploy Staff Augmentation Services
Dedicated R5RCM team members can act as fully-integrated members of an organization’s coding, billing or revenue cycle teams
Why R5RCM for Clinical Documentation Integrity?
- Proactive: Early issue detection and real-time interventions
- Expertise: Ongoing provider education and documentation compliance
- Tailored: Customized services for both VBC and FFS models
- Cash Flow: Right-size reimbursements with accurate coding, streamlined billing, and cost-effective workflows
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