RCX helps detect suspicious payment trends and target claims with the highest potential for waste, fraud and abuse.
Our seasoned physicians, CDI nurses and certified coding and DRG validators, comprehensively review claims to ensure the accuracy of diagnoses, procedures, coding and DRG assignment submitted on hospital claims.
The RCX team of 32 professionals, consists of Physicians, Clinical Data Integrity, Coding and DRG Specialists with a combined 100+ years of Healthcare documentation, coding, and Diagnosis Related Groups (DRG) auditing expertise .
The RCX experience includes partnering with CDI nurses and certified coding and DRG validators to successfully safeguard health insurance company's revenue by our strict, yet fair validation process.
RCX maintains workflow that is not intrusive or disruptive to clients processing turnaround time. RCX review process validates every impactful diagnosis and procedure, to ensure that DRG assignment on the claim is accurately supported by the clinical documentation in the source document (Patient Medical Record).
RCX has partnered with healthcare payers and payment auditing organizations to assist in payment integrity validation using our clinical and coding classification expertise.
RCX is the perfect payment integrity partner to safeguard your organization’s revenue by helping you reduce paying inaccurate claims, be they simple provider processing error, fraud or abuse.
RCX has partnered with some of the leading healthcare claim-payers and auditing firms as well as providers over the years.
DRG Claim Integrity Services. Our multidisciplinary approach ensures our recommendations follow established industry / regulatory guidelines, definitions & best practice.