Healthcare finance teams know the struggle all too well—millions of dollars slip through the cracks each year due to the treacherous gap between clinical care and claims submission.
It’s that middle ground where documentation gets translated into billing codes (or doesn’t) that can make or break your revenue cycle.
That’s exactly where Bulwark Health’s ARC+ comes in. It uses impressive AI-powered solutions to tackle the documentation-to-coding problems that drive finance directors crazy. Let’s take a closer look.
What Are the Mid-Revenue Cycle Challenges?
Let’s face it—the mid-revenue cycle is a mess for most hospitals. It’s when clinically excellent care somehow fails to translate into the reimbursement it deserves.
According to the data,
An average 250-bed hospital loses between $4.5 million to $1 million annually due to inefficient workflows in the mid-revenue cycle.
And it’s not just about money! When documentation falls short, or coding misses the mark, it creates a domino effect that messes with your quality metrics too.
Severity of Illness (SOI) and Risk of Mortality (ROM) reporting get distorted, which impacts everything from your hospital’s reputation to your value-based care performance.
In fact, medical errors, often stemming from documentation inaccuracies, are the third leading cause of death in the U.S., resulting in approximately 251,454 deaths annually.
AI-powered solutions can be a solid way out of this
Bulwark’s ARC+ focuses on the acute care setting, where different documentation and coding challenges pop up.
We’re talking about the inpatient DRG assignment, clinical validation, and getting those SOI/ROM reports right.
The traditional way of handling this is manual audits, which take forever, miss critical documentation gaps, and usually catch problems after claims are submitted—when fixing them costs way more.
No wonder hospitals are bleeding millions through these inefficiencies!
ARC+: A Fresh Take on Mid-Revenue Cycle Management
ARC+ isn’t just another software solution—it’s a comprehensive pre-bill audit system that brings together CDI, Utilization Management, and coding workflows through some pretty sophisticated AI.
Here’s what makes it different:
Streamlines pre-bill reviews
No more drowning in the operational complexity of inpatient DRG reviews. CDI specialists who used to spend hours manually reviewing charts can focus on work that actually matters.
Smart clinical documentation
Instead of just flagging missing codes, ARC+ spots the contextual gaps and connects the dots across notes, labs, and imaging.
It’s like having an extra set of expert eyes, making sure the patient’s full clinical story gets told.
Prevents DRG headaches before they happen
When a doctor documents a respiratory complication but it doesn’t make it into the coding, the platform catches it before the claim goes out—stopping those frustrating clinical validation issues and DRG downgrade denials that nobody wants to deal with.
Makes quality reporting better
Your quality team probably struggles with metrics that don’t seem to reflect what’s actually happening with patients.
ARC+ helps break that cycle by ensuring the documentation and coding actually match reality.
ARC+’s Risk Adjustment and SOI/ROM Reporting Features
Here’s where things get interesting.
ARC+ zeroes in on inpatient documentation integrity for accurate SOI/ROM reporting.
This matters a ton because SOI/ROM metrics directly impact MS-DRG assignment and case-mix index in acute care, plus they affect your quality reporting.
Here’s how ARC+ approaches this issue:
Intuitive Clinical Analytics
The AI engine doesn’t just match codes to documentation like other systems. It analyzes clinical notes, lab results, and imaging studies as a whole to find the disconnect between what’s documented and what’s coded. This means:
- Patient comorbidities don’t get overlooked because they’re buried in progress notes
- Complications get properly reflected in the record, not just implied
- Those clinical indicators that support higher SOI/ROM classifications get captured, even when they’re scattered across multiple documents
- Your documentation can stand up to those increasingly picky payer reviews
Helpful Scorecards
Let’s be honest—most reporting dashboards collect digital dust. But ARC+ generates scorecards that highlight documentation patterns, coding accuracy, and query response rates that people find genuinely useful:
- Doctors get specific insights about their documentation habits that they can actually use
- CDI specialists get performance metrics that help them improve
- Coders get accuracy measurements tied to specific areas they need to work on
- Managers can spot systemic issues, not just individual performance problems
EMR Integration That Benefits Doctors
Getting physicians engaged in documentation improvement is usually like pulling teeth. ARC+ tackles this by:
- Working directly within the EHR workflow so doctors don’t have to jump between systems
- Offering a mobile app that actually respects how doctors work
- Streamlining queries so they don’t disrupt clinical workflows
- Speaking in medical terms, not billing jargon that makes clinicians roll their eyes
ARC+: Real Impact on Healthcare Operations
Here’s where the rubber meets the road—what kind of difference does ARC+ actually make?
More Financial Edge
- Hospitals using ARC+ see real ROI through better reimbursement accuracy and lower operational costs
- Denial rates drop, usually 12-18% in the first six months, because claims go out right the first time
- Staff get reallocated to more valuable work instead of chasing denials and fixing documentation problems
Quality and Compliance
- SOI/ROM accuracy improves so your metrics actually reflect how sick your patients really are
- Those annoying false-positive PSIs and HACs that make your quality metrics look bad? They drop dramatically.
- Your risk of payer audits and regulatory headaches goes down because your documentation is solid from the start
Workflow Improvements
- CDI, UM, and coding teams stop duplicating efforts and actually communicate better
- Query response times drop from days to hours because doctors can respond easily
- You can make continuous improvements based on actual data instead of hunches
ARC+: AI That Works With People, Not Against Them
This is important. ARC+ doesn’t try to replace human expertise—it enhances it:
- The platform flags potential issues, but clinical staff apply their expertise to resolve them
- The system gets smarter by analyzing documentation patterns specific to your organization
- It’s designed by people who actually understand healthcare, not just tech developers who’ve never set foot in a hospital
ARC+ Implementation: How Long Does It Take?
We’ve all seen tech implementation projects that drag on for months or years. Bulwark takes a different approach to integrating its solutions into the existing tech stack:
- We configure ARC+ to fit your existing workflows, not the other way around
- The cloud-based platform gets up and running quickly without monopolizing your IT resources
- Training is thorough and efficient, with ongoing support from our experts, who understand both the technology and healthcare operations
Time to Transform Your Mid-Revenue Cycle with ARC+
Mid-revenue cycle optimization isn’t just a nice-to-have anymore. ARC+ gives you a strategic approach by combining AI technology with real healthcare expertise.
By tackling clinical documentation, coding accuracy, and quality reporting issues head-on, ARC+ helps you:
- Cut down on denials and revenue leakage
- Boost revenue and performance
- Stay compliant without the constant stress
- Streamline operations and reduce costs
If you’re looking for end-to-end revenue cycle solutions, Bulwark’s platforms work together beautifully:
- ARC+ handles inpatient documentation integrity, DRG validation, and SOI/ROM accuracy
- RAQ+ takes care of outpatient and ambulatory HCC capture and risk adjustment for value-based care
Together, they cover your entire revenue cycle, ensuring excellent clinical documentation at every stage.
Want to see how ARC+ could transform your clinical documentation and coding?
Reach out to us for a customized demo!
