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Revenue integrity · hospital revenue leakage
Find the money Indian hospitals write off as “policy terms”.
Denial management starts after the insurer has decided. Revenue integrity starts at admission — where room caps, pre-auth clocks and tariffs decide most of the shortfall — and ends with every settlement line explained.
Room, surgery, OT, investigations
Room cap → proportionate deduction
Co-pay and non-payables
No reason stated — your query
Illustration from the Drapto test suite; not customer data.
- ABDM · ABHA at the desk
- NHCX · FHIR R4 bundles
- ICD-10 coding engine
- NABH evidence
- DPDP Act 2023
- Indian data centres
- On-premise or managed
A deduction you predicted is a decision you can still change.
The mechanisms
Nine places money leaves a hospital. Drapto watches all nine.
Room-rent cap breach
Proportionate deduction across surgery, OT, consumables and nursing — modelled before the room is allotted.
Explore →Eligibility & sub-limits
Waiting periods, procedure sub-limits and exclusions checked at the desk.
Explore →Notification clock
Cashless converts to reimbursement when the window is missed. Clocks run per payer.
Explore →Enhancement
Flagged at 85% of the approved amount, before the ceiling.
Documentation deficiency
Codes in the notes that never reached the bill, raised in the ward.
Package unbundling
Packages billed with their components caught before submission.
Unexplained shortfall
The part of a deduction no stated reason covers — your query list.
Explore →Work never billed
Procedures and consumables recorded and never charged, signed off monthly.
Prioritised by exposure
A 12% risk on ₹4 lakh outranks an 80% risk on ₹6,000.
Most worklists sort by probability, which buries the large uncertain claims. Drapto sorts by risk multiplied by amount, and groups claims that share one cause so one fix clears the batch.
Demo workspace · sample names and figures, not customer data.
What we are not claiming
Honest limits, stated up front.
We do not transmit
We build and validate FHIR R4 bundles; transmission runs through your own NHA onboarding.
No recovery percentage
No customer has published one with us, so we do not quote one.
Not generative AI
The ICD-10 engine is deterministic: same input, same code, every time.
Months, not days
Rule calibration needs about 25 decided claims per rule.
Questions
Asked before every demo.
What is hospital revenue leakage?
Money a hospital earned and never collects: procedures done and never billed, deductions that were predictable at admission, tariffs billed above or below contract, and shortfalls nobody queried. Most of it is decided before the patient leaves.
How is this different from denial management?
Denial management works after the insurer has decided. Revenue integrity moves the work earlier — to admission, the stay and coding — so fewer claims reach denial at all, and the ones that do arrive sorted by what is still worth appealing.
How does Drapto handle room rent capping?
It reads the policy’s room entitlement at admission, models the proportionate deduction on every associated charge, offers the best zero-deduction room and records consent against a named user if the patient still upgrades.
Is the claim scoring AI?
It is 24 auditable rules weighted probabilistically, not a black box. Calibration needs roughly 25 decided claims per rule, so it improves over months on your own data.
Do you quote a recovery percentage?
No. There is no outcome data we would stand behind yet. We publish mechanisms, not promises.
Bring one settlement advice to the demo.
We will split it into predictable, contractual and unexplained — live, on your own payer.
Questions? enquiry@drapto.com