RCX - Payer side

Healthcare Revenue Cycle Consulting

RevCycle Xperts, Inc. - a Clinical Documentation, Coding and DRG Assignment Integrity services company
RCX Services

The complexity of healthcare claims requires a partner like RCX

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.

Sample Client Milestone

Client ID#
223-CL
DRG Validation
Audited Period
24 Months
Total Cases Audited to Date
15,230
Gross Revenue Recovered
$4,560,720
Net Revenue Recovered
$3,420,000
Percentage ROI
75%
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The Perfect Payment Integrity Partner

Bridging the gap between Provider claims and Payer reimbursements

The RCX team experience

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 Review 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).

Partnerships

RCX has partnered with healthcare payers and payment auditing organizations to assist in payment integrity validation using our clinical and coding classification expertise.

The perfect payment integrity partner

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.

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The RCX Promise

DRG Claim Integrity Services. Our multidisciplinary approach ensures our recommendations follow established industry / regulatory guidelines, definitions & best practice.

Team
Knowledgeable and seasoned professional coders certified by AHIMA / AAPC as partners
Experienced Clinical Documentation Integrity Specialists certified by AHIMA and ACDIS
MDs experienced in Coding and DRG systems' reliance on clinical documentation as partners
Quality of service
Improved Clinical Documentation
Minimize DRG Denials / Appeals
Improved quality of communication between clinicians and the Revenue Cycle Team

For enquiries, contact us

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RevCycle Xperts

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