Healthcare organization lose a significant amount of revenue annually due to their inability to identify claim coding errors that contribute to charge capture leakage. TriumpHealth’s proactive coding and medical necessity documentation audits help discover hidden revenue opportunities to ensure that we proactively correct claim errors to maximize reimbursement and coding compliance.
Predictive analytics and rule-based audits verify the claims regularly to prevent missing, duplicate, under, and over charges. TriumpHealth’s claims auditing team detects missing claim codes for both institutional and professional charges. In addition, the team assesses each claim for CPT and ICD-10 code sets to identify incorrectly coded claims. We investigate the integrity of charges by scrutinizing whether claims should have been bundled, examining medical necessity policies, and identifying charges posted in error.