Compliance & Integrity Shield
Compliance & Integrity Shield
Protecting Revenue. Enforcing Accuracy. Defending Compliance.
In healthcare RCM, revenue strength depends on integrity. SCIO’s Compliance & Integrity Shield is designed to prevent leakage, enforce billing accuracy, and ensure every dollar collected is compliant, defensible, and audit-ready.
This shield operates across charge capture, reimbursement validation, payment reconciliation, and revenue performance intelligence—creating a continuous control framework that protects financial outcomes and regulatory standing.
Charge Integrity Intelligence
Accurate Charges Are the First Line of Revenue Defense
SCIO delivers 98% charge accuracy with a ≤2-day turnaround, ensuring every service, drug unit, and procedure is translated correctly from clinical care to the claim.
Each charge passes through completeness, compliance, and documentation validation—preventing missed charges, incorrect units, and downstream denials, especially in high-risk specialties such as Oncology and Surgery.
Charge accuracy builds a resilient revenue cycle
How Charge Integrity Is Enforced
- End-to-end validation of clinical-to-charge translation
- Oncology drug unit and dosage validation
- Surgery-specific logic (global periods, MPPR, bundling rules)
- Specialty-aware charge rules for complex encounters
- Documentation and coding alignment before submission
System Reliability & Continuity
- Seamless EHR–PM–Billing integration
- Interim interfaces to prevent disruption during system outages
- Stable workflows even during platform transitions
Revenue Impact
- Higher clean claim rates and faster reimbursements
- Fewer charge-related denials and coding queries
- Reduced missed or incomplete charges
- Shorter AR cycles through timely, accurate charge capture
- Greater financial predictability and operational stability
Reimbursement Integrity Audits
Every Claim Validated. Every Dollar Defended
SCIO’s Reimbursement Integrity Audits protect practices from revenue leakage, compliance exposure, and silent underpayments. Our audits examine coding accuracy, medical necessity, drug-unit billing, modifier usage, NCCI edits, authorization alignment, documentation completeness, and payer adjudication behavior.
For high-value specialties—including Oncology, Surgery, and Imaging—SCIO identifies hidden risks such as downcoding, incorrect bundling, underpayments, and stale or unworked claims.
Revenue protected. Compliance assured. Integrity guaranteed.
Audit Intelligence Model
- Automated audit triggers combined with expert review
- Identification of underbilled and underpaid services
- Detection of payer variance and contract non-adherence
- Actionable correction and recovery workflows
Measured Outcomes
- 10–25% recovery of missed or underbilled revenue
- 30–50% reduction in coding-related denials
- Improved net collection rate and reduced write-offs
- Stronger audit readiness for payer and regulatory reviews
- Reduced compliance exposure through documentation alignment
Payment Reconciliation Intelligence
Every Payment Verified. Every Adjustment Accounted For.
SCIO delivers 99% payment posting accuracy with a 1-day turnaround, ensuring that every payment received is posted correctly, reconciled completely, and reflected accurately in AR and financial reporting.
Our reconciliation intelligence validates payer payments against deposits, ERA/EOB data, and contractual expectations—eliminating posting errors and financial blind spots.
Accuracy at every step. Value in every dollar.
Technology & Controls
- OCR-driven EOB-to-835 conversion
- Automated ERA ingestion and mapping
- Auto-posting for insurance and patient payments
- Payer-to-bank deposit reconciliation
- Automated secondary and tertiary billing triggers
- Audit-ready posting trails and reporting
Operational Impact
- Clean AR aging and reduced rework
- Correct patient responsibility allocation
- Improved cash forecasting and financial control
- Faster downstream AR resolution
- Greater compliance confidence across posting workflows
Revenue Performance Intelligence
From Reporting to Revenue Foresight
SCIO’s Revenue Performance Intelligence connects the entire revenue cycle into a unified intelligence framework—transforming raw billing data into actionable, predictive insight.
Instead of showing only what happened, SCIO explains why it happened and what to do next, helping practices stay ahead of payer behavior, compliance shifts, and reimbursement risk.
Data that guides you. Intelligence that grows your revenue.
Intelligence Capabilities
- AI-powered variance detection for AR, underpayments, and bottlenecks
- Predictive revenue modeling and collection forecasting
- Payer trend and adjudication behavior analysis
- Denial root-cause intelligence across access, coding, auth, and billing
- Service-line profitability analysis for drugs, procedures, and imaging
Business Impact
- 10–20% increase in net collections through targeted interventions
- Reduced AR > 90 days via early risk detection
- Sustained 98%+ clean claim rates
- 30–50% reduction in denials through predictive prevention
- Improved oncology drug reimbursement accuracy
- Stronger month-to-month revenue predictability
How the Compliance & Integrity Shield Works
This shield is not a point solution.
It operates as a continuous control layer across the revenue lifecycle:
- Charge integrity prevents leakage at the source
- Reimbursement audits validate payer accuracy
- Payment reconciliation ensures financial truth
- Performance intelligence guides corrective action
Together, they create a defensible, compliant, and resilient revenue cycle.
