Revenue integrity has evolved far beyond charge capture and claim submission. In today’s regulatory environment, healthcare organizations face increasing pressure to ensure that coding, documentation, billing, reimbursement, and compliance processes are aligned across the entire revenue cycle. Even small breakdowns can lead to denied claims, lost revenue, repayment demands, audit exposure, and allegations of improper billing. This session provides a practical and compliance-focused approach to revenue integrity for physician practices, outpatient departments, ambulatory surgery centers, and healthcare organizations. Attendees will learn how revenue leakage occurs, where compliance vulnerabilities frequently emerge, and what steps can be taken to strengthen internal controls while supporting appropriate reimbursement. Through real-world examples, regulatory updates, and proven auditing strategies, this session will help organizations identify risk areas before they become costly problems. Special attention will be given to documentation integrity, charge capture accuracy, coding compliance, payer requirements, denials management, and the growing role of data analytics in revenue integrity programs. Whether the goal is maximizing compliant reimbursement, reducing denials, preparing for audits, or improving operational performance, this session delivers actionable guidance that can be implemented immediately.
This session examines the critical connection between compliance and financial performance within the healthcare revenue cycle. Participants will gain a deeper understanding of revenue integrity principles, identify common sources of revenue leakage, evaluate compliance risks that impact reimbursement, and explore practical strategies for strengthening organizational controls. The session also addresses emerging audit trends, payer scrutiny, and opportunities to improve revenue cycle performance without compromising regulatory compliance.
Toni Elhoms is an internationally known speaker and recognized subject matter expert on medical coding, reimbursement, compliance, and revenue cycle management. She is the Founder and CEO of Alpha Coding Experts, LLC (ACE). She holds multiple credentials with the American Health Information Management Association (AHIMA) and the American Academy of Professional Coders (AAPC). Ms. Elhoms’ expertise extends to both inpatient and outpatient coding, compliance, billing, and reimbursement. Ms. Elhoms serves as ACE’s Senior Consultant and conducts training and educational seminars across the country on a variety of topics including, but not limited to, Medical Coding, Medical Billing, Practice Management, Managed Care, Revenue Cycle Management, Revenue Maximization, Regulatory Compliance, etc.