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Revenue Integrity
Pre-bill review, denials, and fraud, waste, and abuse (FWA) compliance. Documentation that supports the claim before it drops, and exposure found before a regulator finds it.
Revenue Integrity Services
Pre-Bill Review
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- DRG ValidationInpatient DRG assignment reviewed against the record before billing.
- Clinical Documentation IntegrityE/M accuracy, ICD-10 specificity, and medical necessity confirmed prospectively.
- Coding QualityIndependent review of coding across inpatient specialties.
- Physician QueriesCDI queries issued while the encounter is still open.
Denials
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- Root Cause AnalysisEvery denial traced to the documentation, coding, or authorization failure behind it.
- Appeals Filed by TNMTNM prepares and submits appeals on the hospital’s behalf.
- PreventionCorrective actions built into the workflow so the denial does not return.
- Recovery ReportingOverturned denials and recovered revenue reported to the CFO.
Fraud, Waste, and Abuse (FWA)
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- FWA ReviewBilling and documentation patterns reviewed against OIG and CMS guidance before a regulator does.
- Risk ScoringProvider and specialty risk scored. Outliers reviewed and corrected.
- Post-Bill Accuracy AuditsIndependent, unbiased audits of physician billing and documentation.
- Physician EducationSpecialty-specific coaching on documentation accuracy.
- Executive ReportingAccuracy scores, denial trends, provider risk, and audit exposure reported to leadership.
Why revenue integrity is hard to hold
Timing
Most documentation questions become visible only when a claim is denied, weeks after the care was delivered.
Denials
Denial work is spread across billing, coding, and clinical teams, so root causes are hard to trace and the same denial can recur.
Payer scrutiny
CMS, OIG, MACs, RACs, and commercial payers review inpatient billing for fraud, waste, and abuse with more precision each year.
Visibility
Revenue accuracy is usually reported by the teams that produce it. An independent view for leadership is rare.
Review before the claim drops
Prospective, not retrospective
Most vendors audit claims after payment and report what was lost. TNM reviews the record before the claim drops, so the revenue is billed correctly the first time.
Clinical, coding, and compliance in one review
Physician-level clinical review, coding accuracy, and OIG/CMS compliance checked together, not by three separate vendors.
TNM files the appeals
Denials are not handed back to the hospital as a report. TNM prepares and submits the appeal and reports the recovery.
Independent, reported to the CFO
Findings go to finance leadership, not through the coding department being reviewed.
Sized to the exposure
Baseline accuracy review
A defined sample of claims reviewed. Accuracy, denial, and compliance findings reported to the CFO.
Pre-bill review
Ongoing prospective review of inpatient claims before they drop.
Denials management
Root cause, appeals, and prevention across the service line.
Full revenue integrity
Pre-bill, denials, FWA review, physician education, and reporting under one agreement.
Revenue targets set with the CFO.
Accuracy, denial rate, recovery, and audit exposure reported monthly. Findings reported to leadership, not through the department.
- Documentation accuracy and denial rate tracked by specialty.
- Appeals filed and recoveries reported.
- Audit exposure reviewed against OIG and CMS guidance.
Submit your organization, payer mix, denial volume, and current concerns, in confidence.
TNM responds with a defined review scope and timeline.
Team Net Medical 