Financial improvement opportunities are not always found in major operational changes. For many rural and community hospitals, the difference between financial stability and financial strain comes down to how effectively a hospital captures, codes, charges, and defends the services it provides.

WHAT IS REVENUE INTEGRITY?

Revenue integrity is the process of protecting earned revenue by ensuring hospital services are accurately documented, coded, charged, and reimbursed in accordance with payer and regulatory requirements. It is making sure that the submitted claim accurately reflects the services provided so that the hospital can be reimbursed appropriately.

WHY IS REVENUE INTEGRITY IMPORTANT?

Hospitals today face increasing reimbursement complexity, payer scrutiny, staffing shortages, and regulatory demands. Without strong oversight of charge capture, the chargemaster, coding, pricing, and billing processes, organizations risk avoidable revenue leakage and reimbursement inaccuracies.

Revenue integrity helps hospitals maintain financial performance by strengthening revenue capture processes, supporting compliant reimbursement practices, and reducing operational and financial risk.

THE SOLUTION

CHC’s Revenue Integrity team works collaboratively with hospital leadership, finance, compliance, and clinical departments to identify practical revenue integrity solutions that support stronger financial outcomes in several key areas:

• Chargemaster compliance and charge capture: A complete and compliant chargemaster along with an effective charge capture process is essential for accurate reimbursement. CHC helps hospitals evaluate, maintain, and optimize chargemaster structures and charging workflows to support compliant and accurate billing practices and to keep up with ever-changing code updates.
• Hospital Pricing Strategies & Services: Hospitals continue to face growing scrutiny surrounding pricing transparency and pricing methodologies. CHC works with hospitals to develop pricing structures that support financial sustainability, market competitiveness, and compliance requirements.
• Coding Audits & Education: Accurate coding directly impacts reimbursement and compliance. CHC provides coding audits and education designed to identify opportunities for improvement while helping hospitals strengthen internal knowledge and processes.

BENEFITS OF REVENUE INTEGRITY

Revenue integrity touches nearly every stage of the revenue cycle. From charge capture, chargemaster and coding to pricing, billing and reimbursement, the accuracy of upstream processes directly influences downstream financial performance.

When revenue integrity processes are aligned, hospitals are better positioned to:

• Reduce revenue leakage
• Improve reimbursement outcomes
• Strengthen compliance efforts
• Create greater operational consistency across departments

For rural and community hospitals managing increasing financial pressure, a proactive revenue integrity strategy can play an important role in supporting long-term financial sustainability.

CHC REVENUE INTEGRITY SERVICES

• CDM code compliance reviews (desk reviews OR comprehensive reviews which involve meeting with each department lead) to evaluate CPT/HCPCS codes, descriptions, modifiers, revenue codes
• Current state pricing analysis to review current hospital prices and compare them to fee schedule, peer market average and identify pricing errors
• Price transparency mock audits to identify any CMS requirements not currently met
• Charge capture process reviews
• Pharmacy conversion factor audits
• Quarterly CPT/HCPCS code education
• Clinic desk reviews for code compliance and pricing

LEARN MORE

CHC’s Revenue Integrity team works collaboratively with hospital leadership, finance, compliance, and clinical departments to identify practical revenue integrity solutions that support stronger financial and compliant outcomes.

CHC also offers revenue cycle management services through Options RCM, providing hospitals with additional operational and reimbursement support solutions.

Contact us to to learn more.

Download a PDF of the Revenue Integrity Solution