Revenue Integrity

Revenue integrity is a discipline in the revenue cycle that supports optimal revenue recognition for all providers. Pairing best practices with an optimal use of technology, revenue integrity ensures compliance and mitigates regulatory risks through effective, efficient, and replicable processes, delivering results (revenue) to your organization.

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Signs You Need Wilshire

Problems we can help solve

Lost Revenue
Convoluted Charging Workflows
High Volume in Work Queues
Deficient Reconciliation Processes
Inconsistent Pricing Strategy

How Wilshire Can Help

We are Experts in Collaboration

Our team prides itself on a collaborative approach. We leverage team members from patient access, clinical applications, coding, and billing to solve revenue integrity issues and improve workflows at the source.

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It’s Better With Wilshire

How your operations will improve

  • Comprehensive Charging Strategy
  • Streamlined Charge Capture
  • Focused Pricing Strategy
  • Successful Reconciliation Processes
  • Compliant Financial Practices
  • Clear Financial Impact
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We Can Improve Your Processes

Revenue Integrity Elements We Consult On

CDM/Chargemaster services
Eliminate issues related to incomplete, outdated, or erroneous chargemasters. Plan for consolidation and build related to implementations and mergers/acquisitions. Develop charging protocols that define how services, drugs, and supplies are to be charged while assuring compliance. Develop strategies around CDM maintenance and system integration.
Strategic pricing initiatives
Develop an overall pricing strategy that is defensible, streamlined, maintainable, and transparent. Review and align mark-up factors across pharmacy, supplies, and implants. Take into account market comparators and overall financial goals.
Net revenue optimization
Identify missed revenue opportunities. These come in a variety of forms such as missed charges, inefficient provider scheduling, incomplete documentation or charge triggering, or inaccurate contract build. We know where to look for revenue to make a direct and immediate impact to your bottom line.
Clinical charge capture
Review charge triggering workflows across the various Epic and interfaced modules. Ensure accuracy, improve efficiency, create standard documentation, and provide education to clinicians. The focus and approach are varied to account for the complexities in each clinical area.
Charge reconciliation
Improve department charge reconciliation compliance, understanding, and tools. Establish clear accountability structures for late charges, missing charges, and other charging issues.
Charge router services
Aid with charge router build, configuration, and maintenance.
Charge review and Revenue Guardian
Design a comprehensive approach to charge review, work queues, and code integration. Leverage the power of revenue guardian to prevent missed revenue.
Hospital compliance and government audit
Establish a methodology for cataloging and responding to external audits, conducting internal reviews, and reporting on the results of appeal efforts.
Revenue Integrity program development
Develop a comprehensive plan for creating or maturing your revenue integrity department and services. Evaluate staffing, workflows, processes, and policies to decrease risk and standardize processes. Implement focused process improvement initiatives to see immediate results.

We Provide a Framework

Signature Solutions for Your Organization

See how we helped our clients improve their revenue capture with our Clin-to-Fin solution.

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Our Service Line leaders will take the time to learn about your challenges and develop a unique approach to solving your most pressing issues.

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