The Revenue Integrity Playbook

Is your revenue integrity program catching risk before the claim goes out, or after?

Payer audit at-risk dollars have reached $19 million per organization, up from $4 million two years ago. Coding-related denials rose another 26 percent after a 126 percent jump the year before. Medicare Advantage medical necessity denials increased nearly fivefold. These changes aren’t temporary, and post-bill operating models weren’t built for them.

This playbook defines what revenue integrity means, who owns it, and how to judge where your program stands today.

What’s Inside

• Why reimbursement, compliance, and efficiency break down when they’re managed separately
• The executive decisions that shift an organization from post-bill recovery to pre-bill prevention
• What leading revenue cycle, coding/HIM, and billing compliance teams do differently
• Why AI governance is now a core leadership responsibility
• Four trends from the 2025 MDaudit Benchmark Report to plan for now
• A maturity model for scoring your program and deciding what to fix first