Clamping Down on Upcoding Risk: 3 Steps to Ensure Proper Payment & Compliance

In today’s lean climate, hospitals and health systems need to minimize risk that could lead to non-compliance and future loss of revenue. Holistic revenue integrity strategies that bring together the strengths of prospective and retrospective auditing can go a long way towards containing risk as it relates to upcoding. Within this framework, hospitals and health systems can leverage technology to bring compliance and billing teams together in a collaborative way, while taking three key steps to improve the outlook. 2. Technology-enabled retrospective auditing: Manual efforts to mine thousands upon thousands of claims lines across denials and identify problematic trends for process improvement are typically a non-starter for most resource-strapped compliance departments. Upcoding risk is one area that hospitals and health systems especially need to focus on in terms of applying progressive revenue integrity strategies that get out in front of problems.