ZirMed Expands Innovative Charge Integrity Solution to Improve Health System Reimbursement

Credit: ZirMedCredit: ZirMed

ZirMed Inc., a recognized leader in cloud-based revenue cycle software and predictive analytics, announced an expansion of its proven Charge Integrity solution, which more than 500 hospitals rely on each day. Health systems will now be able to further integrate professional charges to uncover coding and charging discrepancies between hospital and professional billing.

The expanded solution leverages ZirMed’s deep experience in predictive analytics—coupling extensive data-mining algorithms and coding guidelines to automatically analyze the unique charging practices of each hospital, health system and their employed physicians. By automating review of the complete patient encounter, ZirMed® helps health systems prevent revenue leakage from missing charges, avoiding duplicate or overlapping charges, and prevent DRG anomalies that spark compliance audits and denials.

According to the Healthcare Financial Management Association, one to three percent of gross charges are lost due to charge integrity leakage. As a result, health systems are losing millions of dollars. ZirMed’s Professional Charge Integrity enhancements redefine how health systems assimilate hospital and physician charges. As Medicare moves steadily towards a MACRA reimbursement model, 95% of providers now qualify under the Merit-based Incentive Payment System (MIPS).

“Comprehensive revenue integrity has the dual benefit of not only contributing to additional reimbursement today, but also shoring up cost capture to positively impact MIPS payment scores of tomorrow,” says Jeff Kaplan, Chief Strategy Officer.

“In the past 12 months we have netted $1.2 million by recovering missing hospital charges and coding variances identified with ZirMed’s technology,” says Kettering Health Network’s Executive Director of Patient Financial Services, Susan Knight. “I expect the performance to continue to improve through our integration of professional charges. ZirMed technology gives insight on the root causes to prevent revenue leakage from charge capture operations.”

To see how ZirMed gets providers paid and for a demonstration of its expanded Charge Integrity solution or any of its other dynamic RCM products, please visit ZirMed at HIMSS booth #4871.