VitalIntegrity

VitalIntegrity™ is a web-based application that enables hospital systems to improve the hospital charge-capture process, capture more earned revenue, decrease A/R days and rebills, and detect and remedy compliance issues. It enables teams to recognize inefficiencies and revenue leakage from missed charges, inaccurate or late coding, gaps in your chargemaster, and compliance issues from over-charging while facilitating tracking of these issues all the way to the root cause.

This adaptable revenue integrity auditing solution enables you to process itemized bills or 837 files daily to identify a wide variety of problems that have gross and net revenue implications.

The VitalIntegrity account detail view highlights data that triggered an account for review.

The problem

Hospitals are under constant pressure to reduce denials and the number of A/R days while optimizing cost and efficiency. This is complicated by inherent obstacles such as manual processes, the lack of integrated workflows, and different IT systems. External challenges like regulatory issues and shifting reimbursement methodology make it difficult to generate revenue. This all results in charges getting missed, errors in coding, and overcharges—which not only have a negative impact on hospital revenue but also create budgeting and utilization challenges, patient satisfaction issues, and significant compliance risks.

Revenue professionals know that hospitals leave a portion of net revenue on the table due to a variety of factors: changes in billing practices; installing new technologies; staff training or lack thereof; and charging practices that become obsolete through complacency. By addressing these obstacles, hospitals can become more efficient, more productive, and gain insights from data to drive standardization and reduce costs.

Our approach

VitalIntegrity empowers users to efficiently manage hospital charge capture processes and detect compliance issues. VitalIntegrity enables teams to minimize revenue leakage from under (and over) charging, late or missing coding, mismatched charges and supplies, and a wide range of CDM-related issues while facilitating issue tracking—all the way to the root cause. This focus on root cause stems from our commitment to providing rule and data transparency and enabling self-sufficiency by leveraging the power of tailored workflows, flexible reporting, and analytics in a dynamic, interactive query engine.

Whether you choose to use it pre-bill or retrospectively, this technology-enabled charge capture solution is specific to your charging protocol and ready to help you remediate issues at their root cause.

Benefits and features

• Save time with fast analysis results. Perform daily reviews of 100% of your inpatient- and outpatient-itemized charges or 837 files. VitalIntegrity provides a full view of soft-coded, hard-coded, diagnosis, and root-cause information.
• Identify systemic issues and close financial gaps. Analyze your capture and compliance opportunities, including missed charges and over-charges.
• Identify a wide variety of hospital-based charge capture issues. Our comprehensive rules engine is continuously updated by experts.
• Customize rules based on your charging protocol. Our adaptable solution can be optimized to identify gaps and root causes.
• Increase efficiency and productivity. Automate work assignments for your analysts or team with easy-to-use, pain-free maintenance. The account level view allows you to address all charge capture issues at once. 
• Optimize implementation. Partner with our consultants for retrospective analysis, initial rule refinement, and workflow routing to ensure a successful implementation.

Use cases

• A chief financial officer needs to address increasing revenue leakage, with rising denials and write-offs reported by an outside consulting company. Her organization has no tool specifically tailored to monitor charge capture processes. After implementing VitalIntegrity, they are able to identify systemic issues. The CFO gains confidence about closing financial gaps as denials and write-offs trend downward.
• A director of revenue integrity is concerned with decreasing revenue capture, particularly in surgery. The difficulty in maintaining his organization’s internally developed rules has spiraled and may be contributing to the revenue decrease in that area. The implementation of VitalIntegrity empowers him to increase revenue capture by providing the data needed to identify not only surgical-related revenue opportunities, but a wide variety of other hospital-based charge capture issues.
• A revenue integrity analyst is having difficulty prioritizing charge capture tasks and achieving revenue integrity goals for her team. Once VitalIntegrity is implemented, the ability to automatically route cases to specific team members, review case history, and produce case reports reveals opportunities for process improvements and educational opportunities.