98%+ first-pass clean institutional claim target
Hospital & Institutional Revenue Cycle Management
Institutional RCM built around facility claim integrity, payment methodology and high-dollar revenue risk.
CareMedox supports institutional workflows where UB-04/837I claim structure, DRG/APC/HIPPS logic, revenue codes, bill type, charge integrity, denials, payment reconciliation and aging require a different operating model from physician-office billing.
Institutional model
Facility billing is not simply professional billing on a larger claim.
Institutional reimbursement may depend on MS-DRG, APR-DRG, OPPS/APC, ASC payment logic, PDPM/HIPPS, IRF or LTCH methodology, revenue codes, Type of Bill, discharge status, claim frequency, payer contracts and facility-specific rules.
CareMedox connects certified coding review with senior revenue-cycle operations, claim edits, payment posting, denial work queues, reconciliation and 60/90/120+ AR prioritization.
Five institutional workflows
Choose the facility revenue-cycle area you want to review.
Each page begins with the care setting, then moves through institutional claim risks, coding/revenue integrity, CareMedox resolution, operating targets, audit scope and FAQs.
01
Inpatient Hospital & Acute Care RCM
CareMedox supports inpatient hospital billing, MS-DRG accuracy, ICD-10-CM/PCS review, CDI coordination, UB-04 claim integrity, discharge-status accuracy, denials, and hospital AR.
Explore institutional workflow 02Hospital Outpatient Department & ASC RCM
CareMedox supports HOPD and ASC billing with OPPS/APC review, revenue-code validation, 340B reporting checks, procedure sequencing, denials, payment posting, and AR.
Explore institutional workflow 03Emergency Department & Trauma Center Facility RCM
CareMedox supports ED facility billing, facility-level integrity, trauma response billing, observation-hour accuracy, UB-04 claim review, denials, posting, and AR.
Explore institutional workflow 04Post-Acute Care RCM
CareMedox supports SNF PDPM/HIPPS billing, consolidated-billing review, IRF claim integrity, LTCH RCM, post-acute denials, payment posting, and AR.
Explore institutional workflow 05Hospital Chargemaster & Complex Denials Management
CareMedox supports hospital chargemaster review, CDM crosswalks, revenue-code integrity, UB-04 claim edits, high-dollar denials, zero-balance review, posting, and AR recovery.
Explore institutional workflowCareMedox institutional targets
Measured after onboarding and workflow stabilization.
Institutional targets are operating goals, not guaranteed payer outcomes.
Under 2% preventable front-end / clearinghouse rejection target where required pre-bill data is available
Approximately 5–6% overall denial-rate target after stabilization
Active 60/90/120+ institutional AR prioritization
Institutional reporting
See the claim, payment and denial story—not only the collection total.
Institutional reporting can include payer behavior, denial category, claim status, revenue-code activity, payment variance, posting corrections, aging and recovery visibility. If a prior-period posting is corrected, that change should remain visible in the next reporting cycle.
30-Day Institutional Audit
Request a 30-Day Institutional Audit Find where institutional revenue is leaking before the balance becomes permanent aging.
Start with claim, code/revenue-code, denial, payment, aging, TFL and workflow analysis tailored to the facility type.