What we do…
What is clinical revenue integrity?
As health care moves from fee-for-service to value-based payment, organizations must have the ability to connect cost with clinical outcomes. Clinical revenue integrity is essential for each individual patient and across entire care populations. It prevents the recurrence of issues that create risk for revenue, for patients and for the healthcare provider organization. “Revenue integrity means right revenue, right delivery, and right protocols to ensure right [accurate] reimbursement and compliance. Revenue integrity doesn’t begin with a charge.” – Suzanne Lestina, revenue cycle technical director for the Healthcare Financial Management Association (HFMA).
Clinical revenue integrity is:
- Process efficiency – people and technology
- Compliance – following rules of engagement
- Correct payment – proper pricing, charging, coding and documentation
Clinical revenue integrity programs
Smart Platform
R1 is the smart platform for generating and using structured data in support of your need to optimize PrioR1ty, ClaR1ty and ensure program IntegR1ty.
Until now, facilities of all sizes have chosen the ‘best-of-breed’ approach to many technology decisions. The unintended consequences are now the major obstacles in moving forward — primarily, conflicting priorities in IT.
R1 is a smarter way forward.
R1 Modules
CDI
Coding
Quality
Audit & Compliance
Analytics
nSight-Driven
Because facilities and health systems have not aggregated all of the clinical information into a single repository, there is a lack of visibility into what information exists, making it extremely difficult to be proficient in prioritizing cases, providing clarity and ensuring integrity.
R1 assembles and normalizes the pertinent clinical criteria into one place to enable nSight-driven decision making.
Modules
CDI
Clinical Documentation Improvement
This is the most powerful tool you haven’t seen or heard about — yet!
Already in use by dozens of hospitals nationally, R1 CDI raises the bar and sets the standard for efficiency, productivity and return on investment.
Coding
Computer-assisted Coding
Computer-assisted coding does not have to be a bad word any more. One of the single greatest challenges in health care is providing efficiency to the knowledgeable staff utilizing tools. RecordsOne nCode sets the standard for providing tools that do not solely rely on CAC accuracy for accelerating coding efficiency! Get ready to be excited.
Quality
Optimal quality drives reimbursement
Clinical Quality Measures are integral to optimal reimbursement, not to mention providing benchmark care quality.
R1 Quality utilizes our nSight Formulas to identify HAC, PSI and Core Measures cases and notify the staff that needs to know, whether that’s at admission or at any point during the encounter. Be efficient!
Audit
When’s the best time to do a coding audit?
Concurrently, of course. While it’s great to conduct retrospective audits to improve revenue long-term, and to avoid making repeated mistakes that effectively create revenue leakage or open the door to RAC scrutiny, the better time to address these errors isn’t 6 months later, it’s right away. R1 Audit allows you to review high-priority cases as soon as they’re coded enabling true risk-based auditing and compliance. Best of all, you get to define what ‘high-priority’ cases means to you, because with R1 it’s always configurable to your needs. If you don’t agree, then you don’t need v6 Audit & Compliance.
Analytics
Dynamic Analytics for real-time insight
ClaR1ty Analytics provides users and management with real-time, dynamic visibility into virtually every aspect of use, from number of cases reviewed to Query outcomes (how many times was ‘clinically undetermined’ answered).
Do you have visibility and access into your organization, like this?
Connect
nSight-driven workflow
Connect creates and connects data to users when, where and how they need it — data for population health management; data for meaningful use via CDA; data for case management and utilization review… You need DATA! Do you have the data you need? And perhaps more importantly, ‘do you have to find the data‘ OR ‘does the data find you‘…
One of the major hurdles in care coordination is the inability to automatically inform the CM/UR team of changes in the length-of-stay (LOS). Connect is an extension of CDI, so when the CDI changes the DRG resulting in a change in the LOS the case managers are instantly made aware. The notifications can occur through a variety of programmable settings including email, SMS or EHR-notification.
RecordsOne Transcription
Dictation & Transcription
Developed in 1999, the BayScribe dictation and transcription platform supports hundreds of Hospitals across the country — securely, and HIPAA/HITECH compliant. RecordsOne Transcription provides unparalleled service and support, with 100% US-based Transcription, at highly competitive rates complete with eSignature, workflow, EHR integration, faxing and numerous client features.
Are you willing to send your transcription offshore and deal with the consequences of a breach? Don’t risk it. Contact us today.
nSight-Driven Workflow
What does it mean to be nSight-driven in health care? RecordsOne defines data-driven as getting usable and meaningful clinical information to users when, where and how they need it. Why is that important? Consider this: when a patient is admitted, how many different staff need to be aware of that single admission? CDI? Case Management? Quality? Research?
Obviously, it can vary a great deal based upon the reason for the admission, as well as many other contributing and historical factors. Many in the industry believe that the EHR will solve this issue… not so. Others believe that Natural Language Processing (NLP) is the ‘key’ to uncovering the ‘hidden gems’… not exactly.
It takes the right combination of technologies to truly create nSight-driven workflow. NLP is but one component of a sophisticated set of tools that creates an optimal ‘nSight-driven workflow’.
