MedeAnalytics Revenue Integrity is a powerful data analytics solution designed for healthcare providers, including hospitals and health systems, to gain complete visibility into their "mid-cycle" performance—the critical point between patient access and the business office where clinical operations impact revenue. The solution is part of the broader Revenue Integrity Suite, which includes specialized modules like Audit Monitor, Compliance+, CDI Insights, and Physician Insights.
The platform's core value proposition is to maximize reimbursements, minimize audit risks, and ensure documentation, coding, and compliance performance are optimized. It leverages an intelligent, cloud-based platform with advanced analytics, including machine learning, guided analysis, and predictive analytics, to deliver actionable, evidence-based insights.
Key Features and Capabilities:
- Audit Monitor: Comprehensive tracking and management of government and commercial audits with robust workflow tools.
- Compliance+: A risk rules engine to proactively identify potential billing and coding risks, including mid-cycle denials and PEPPER analysis.
- CDI Insights (Clinical Documentation Improvement): Consistent reporting on coding trends and clinician documentation to increase specificity and reduce denials.
- Physician Insights: Complete data sets and dependable analytics to foster provider performance improvement and targeted training.
- Executive Dashboards: Top-level, easy-to-interpret data visualizations for a single view into revenue improvement areas.
- Drill-Down Analytics: Granular data analysis to pinpoint root causes of denials and identify physician-level insights.
- Real-Time Benchmarking: Compare performance metrics against peers across the nation.
Target Users and Use Cases:
The primary users are CFOs, CMOs, Revenue Cycle Managers, CDI specialists, Audit teams, and Compliance officers at large healthcare organizations, including hospitals and health systems. The main use cases are: revenue capture optimization, audit defense, clinical documentation improvement (CDI), compliance risk mitigation, and physician performance management to support the transition to value-based care.
