Hospital Audit Readiness & Revenue Integrity
Walk into every payer and RAC audit with the file already built.
Denials already written off can still have a filing date. The recovery register labels each one curable, appealable, clinical, or lost, and works the ones inside 30 days first. Audit Ready is the next step. It checks the claim before it drops, flags a gap already in the chart, and drafts an appeal the hospital reviews and sends.
CFO outcomes
Engineered for health system CFOs, vice presidents of revenue cycle, and compliance leadership navigating aggressive commercial audits, line-item downcodes, and RAC recoupments.
Audit exposure by service line and clinician
Continuous documentation gap detection across inpatient and outpatient encounters. Quantify audit risk by service line, department, and attending clinician before commercial payers, RAC auditors, or MAC contractors initiate recoupment audits.
Revenue Radar: earned-but-unbilled and undercoded revenue, with no up-coding by rule
Identify legitimate, earned reimbursement left on the table due to under-coding or missing secondary diagnoses. Deterministic rules ensure strict compliance: zero up-coding, zero speculation, only fully substantiated clinical care.
Appeal-ready letters for downcodes, underpayments and takebacks
Prepare a sealed package for a clinical downcode, a line-item denial, or a silent contract underpayment. The hospital reviews it and sends it. The package cites the contract in force on the date of service, the note that was already in the chart, and the sealed Audit Ready Evidence Bundle. It has not been filed.
Curable, appealable, clinical, or lost
The AR aging demonstration reads the synthetic file and labels each denial that still has dollars. Curable means a coding or clerical correction from a record already on file, including a CARC 16 whose missing fact is already in the chart. Appealable means a document that already existed. Clinical means medical necessity, including a CARC 50, and a clinician has to read it. Lost means the deadline passed, the remittance says the filing limit expired, a step such as an authorization (CARC 197) that had to be met at the time of care was not, or the file has no contemporaneous document. Medicare shows days left. Every other product shows the bucket and no day count. No recovery is promised.
Interactive Demonstration: Gulf Children's Health System
Simulated hospital. No patient data. Walk through the complete provider revenue-cycle defense loop: