Hospitals & Health Systems
Strengthen enterprise-level revenue integrity and compliance.
Today, large healthcare organizations are dealing with the rising complexity of reimbursements, scrutiny from payers, changing compliance regulations, and mounting pressure to safeguard margins and provide top-notch patient care. ZechionMed provides medical claims audit solutions tailored to hospitals and integrated health systems in the changing U.S. reimbursement environment that are scalable and data-driven.
We help healthcare organizations of every size build enterprise-class audit capabilities, enhance coding accuracy, minimize denials, and boost financial performance.
What We Cover
Compliance Monitoring · Audit Areas Include
Inpatient Coding Review · Audit Areas Include
Detailed audit of inpatient claims for accuracy, documentation and reimbursement optimization.
- ICD-10-CM diagnosis coding
- Procedure coding validation
- The information provided here is based on Present on Admission (POA) indicators.
- Complication and Comorbidity (CC/MCC) captured
- Severity of illness validation
- Risk adjustment accuracy
Outpatient Coding Validation
- Accurately bill provider based services and out-patient hospital departments.
Outpatient Coding Validation · Audit Areas Include
- Emergency department encounters
- Observation services
- Same-day surgery claims
- Diagnostic testing
- Imaging services
- Infusion and injection services
DRG Accuracy Review · Audit Areas Include
Minimize under and over payments, payer disputes by validating assignment of DRG.
- DRG optimization opportunities
- MCC/CC validation
- CMIX improvement
- Severity level verification
- Surgical DRG review
- DRG downgrade prevention
Clinical Documentation Validation
Audit Areas Include Determine if clinical documentation is adequate in support of codeable diagnosis and reimbursement.
- Physician documentation review
- Clinical indicators validation
- Query opportunities
- Documentation specificity
- Hierarchical condition capture
- Documentation improvement recommendations
Charge Capture Review
- Detect revenue leakage, duplicate charges and missed charges across departments.
Charge Capture Review · Audit Areas Include
- Operating room charges
- Pharmacy charge capture
- Supply utilization review
- Implant billing validation
- Ancillary service billing
- Revenue leakage analysis
Medical Necessity Audits
- Review the Payer's needs and utilization management criteria.
Medical Necessity Audits · Audit Areas Include
- Admission status validation
- The difference between outpatient and in-patient reviews
- Utilization management support
- Compliance with CMS Determination for Coverage
- Prior authorization documentation
- Level-of-care validation
Denial Risk Identification · Audit Areas Include
Proactively identify claims that are likely to be denied by payers before they are submitted or claims that will be denied for payment.
- DRG validation denials
- Clinical validation denials
- Medical necessity denials
- Coding-related denials
- Technical billing denials
- AUDIT RISK: RAC and Payer audit risk
Compliance Monitoring
- Enhance organizational compliance and minimize regulatory risk.
Compliance Monitoring · Audit Areas Include
- CMS regulations
- OIG work plan priorities
- Medicare compliance reviews
- Medicaid billing requirements
- Commercial payer policies
- Internal compliance monitoring
Healthcare Revenue Integrity Trends We Address
Healthcare organizations in 2026 are facing more and more challenges, such as:
- Growth of AI-based claim audits from payers.
- Growing use of clinical validation denials.
- More RAC, MAC and commercial payer audits.
- More stringent review of in-patient admissions and medical necessity.
- Further attention to risk adjustment precision and specificity of documentation.
- As reimbursements have decreased, pressure to boost margins has risen.
- Enterprise wide revenue integrity analytics and predictive auditing.
- ZechionMed's audit programs are tailored to meet these new challenges.
Ready to strengthen your revenue cycle?
Let our specialty billing team handle the codes, claims, and follow-ups — so your clinicians can focus on patients.
What We Cover
Advanced Analytics & Benchmarking
Advanced Analytics & Benchmarking
- Determine trends, causes and systemic opportunities for improvement.
What We Cover
The Advantages of Working Together with ZechionMed:
The Advantages of Working Together with ZechionMed:
- An improvement in net patient revenue.
- Reduced denial rates.
- Improved DRG accuracy.
- Improved performance of Better Case Mix Index (CMI).
- Enhanced documentation quality.
- Lower compliance exposure.
- Decreased risk of payer audit.
- Consistency of coding within the facilities.
- Quick identification of revenue loss.
- Executive reporting and dashboards with actionable insights.
Frequently Asked Questions
Yes. ZechionMed performs comprehensive audits across inpatient, outpatient, emergency department, observation, surgery, and ancillary service lines.
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