Compliance & Quality
Revenue Integrity & Value-Based Care
The discipline that keeps charging, coding, and compliance aligned — plus the analytics backbone to thrive as reimbursement shifts from volume to value.
Business outcomes
What this changes for your organization
Revenue Integrity & Value-Based Care · performance standards
measured continuouslynet revenue typically recovered from leakage
1–3%
audits: undercharging and compliance risk
2-way
performance managed in both models
VBC + FFS
Performance standards we operate to. Actual results vary by specialty, payer mix, and starting position — your free assessment establishes your own baseline.
Every charge accurate and defensible
Charge-to-documentation reconciliation and chargemaster audits keep revenue complete in one direction and compliant in the other.
Leakage found and sealed
1–3% of net revenue typically recovered — then protected permanently by reconciliation workflows that catch tomorrow's gaps automatically.
VBC readiness, built early
Quality, cost, and risk-accuracy tracking stood up before contracts demand it — so you negotiate value-based terms from data, not hope.
One integrity view across both models
Provider performance, contract tracking, and audit posture on one dashboard — FFS and VBC managed as one revenue reality.
The stakes
The problem, in numbers
The honest diagnosis — what this challenge actually costs healthcare organizations that leave it unmanaged.
1–3%
of net revenue quietly leaks through charge capture gaps
Services performed but never charged, chargemaster drift, reconciliation nobody runs — small per-encounter losses that compound into six figures at practice scale.
Both ways
integrity failures cut in two directions
Undercharging donates revenue; overcharging invites clawbacks. Without systematic two-way audits, most organizations are doing some of each — and can't say how much.
Two worlds
fee-for-service and value-based care must both perform
Reimbursement is shifting contract by contract. Organizations tracking only FFS metrics enter VBC negotiations blind — and accept the terms they should be setting.
Wondering what these numbers look like at your organization?
Get a free revenue assessmentOur solution
Revenue integrity asks a simple question continuously: is every charge accurate, supported, and compliant — no more, no less? It's the function that reconciles the chargemaster with the care delivered, catches leakage and overcharging alike, and keeps the revenue you collect defensible under any audit.
As value-based care reshapes reimbursement, integrity work expands: quality scores, risk adjustment accuracy, and total-cost-of-care metrics now carry real dollars. We build the connective tissue — charge capture audits, revenue reconciliation, VBC contract performance tracking, and provider performance analytics — so your organization performs in both payment worlds at once.
What's included
- Charge capture and chargemaster integrity audits
- Charge-to-documentation reconciliation
- Value-based contract performance tracking
- Provider performance and cost analytics
- Risk adjustment accuracy validation
- Leakage and compliance dual-direction reviews
In the field
How organizations like yours use it
USE CASE 01
A surgical group found $190K in uncharged supplies and services
Twelve months of charge-to-documentation reconciliation surfaced implants, assists, and procedures performed but never billed — recovered where payer rules allowed, prevented thereafter.
USE CASE 02
A two-way audit averted a payback before it happened
The same review that found undercharging also caught a miskeyed chargemaster rate billing above contract. Self-corrected and documented — a footnote instead of a finding.
USE CASE 03
A group entered its first ACO contract with leverage
Eighteen months of cost and quality baselining meant the group knew its numbers better than the payer did — and negotiated shared-savings terms to match.
Scenarios drawn from typical engagement patterns; identifying details anonymized to protect client confidentiality.
Common questions
Revenue Integrity & Value-Based Care, answered
Related
More in Compliance & Quality
Ready to fix revenue integrity & value-based care for good?
Start with a free consultation and billing health check. A senior consultant will look at your numbers and give you a straight answer about what we can improve — and by how much.