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Billing Integrity

Billing Integrity

TNM Hospital Billing , Documentation Integrity & Compliance Division Protecting Compliance. Strengthening Revenue Integrity. Elevating Physician Performance. Hospitals are facing increasing pressure from CMS, OIG, MAC, RAC, and commercial payers to ensure physician billing accuracy and defensible clinical documentation—especially in inpatient care. TNM’s dedicated PB-DICD Division provides a comprehensive, AI-supported audit and documentation integrity program that safeguards both revenue and patient safety.

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What We Do

Pre-Bill Documentation Review (Prospective CDI)

We evaluate documentation before claims drop to ensure E/M accuracy, ICD-10 specificity, and medical-necessity compliance.

Post-Bill Coding Accuracy Audits

Independent, unbiased audits of all inpatient specialties to identify coding errors, missed revenue, and compliance risks.

Denial Management & Prevention

TNM uncovers the true root causes of denials and implements corrective strategies that reduce recurrence.

Physician Education & Coaching

Special specific ty-training improves documentation accuracy and strengthens provider confidence.

Executive-Level Reporting & Analytics

Risk dashboards, accuracy scores, denial trends, and leadership-ready reports provide transparency and strategic clarity.

Accuracy Review

Keep it short, three chips or cards.
Built for

Documentation pattern analysis

Predictive denial modeling

CDI query recommendations

Provider risk scoring

Systemwide pattern detection

Revenue integrity map

Where integrity breaks and revenue leaks

Clinical documentation integrity
Documentation compliance
Medical coding and modifier accuracy
DRG validation and case mix integrity
Charge capture and charge lag
Claims edits and rework
Denials and appeals
Underpayments and contract variance
Payment posting and reconciliation
Reporting and governance cadence

We prioritize fixes by financial impact, compliance risk, and speed to correct, then track performance month over month.

Services

Medical Coding

Coding alignment, modifier accuracy, and variance reduction across service lines.

  • DRG audits
  • Query support
  • Trending

DRG Validation

DRG validation and case mix integrity review to reduce reimbursement risk and improve accuracy.

  • DRG audits
  • Query support
  • Trending

Clinical Documentation Integrity

CDI workflows that improve documentation quality, reduce denials, and strengthen coding accuracy.

  • Query workflows 
  • Provider enablement
  • KPI tracking

Documentation Compliance

Documentation compliance checks and audit readiness support aligned to payer and regulatory expectations.

  • Risk flags
  • Audit prep
  • Standard work

Denials Reduction and Appeals

Denial taxonomy, root cause fixes, and appeal playbooks that reduce repeat denials.

  • Denial drivers
  • Appeals workflow
  • Trending

Underpayment and Payment Integrity

Underpayment detection, contract variance review, and recovery workflow with reporting.

  • Variance flags
  • Recovery tracking
  • Scorecards

Who We Serve

Hospital systems

Hospital based and Independent physicians

Allied Health.

Why TNM

Industry-leading compliance protections

Oncology-informed accuracy standards

Improved revenue integrity and reduced denials

Trusted partner to hospital systems nationwide

AI-powered, expert-validated insights

Independent, unbiased physician audit oversight

Ready to Improve Clinical Accuracy and Revenue Integrity? TNM provides end-to-end physician documentation and billing accuracy solutions backed by clinical, coding, and compliance expertise.
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