Two divisions,
one goal:
Get paid in full.
Operations and Compliance Alignment
The 10 Commitments
1. We Start Before the Patient Arrives
The revenue cycle does not begin with a claim; it begins with intake. Errors at this stage cannot be “fixed later,” no matter how aggressive the follow-up. Renalliance establishes coverage certainty by validating eligibility, payer responsibility, authorization requirements, and correct order of coverage at the source.
2. Dialysis-Specific Rev Cycle
Dialysis claims demand specialized knowledge of ESRD billing rules, modifiers, unit calculations, and medication reporting. Renalliance audits deliberately, applying dialysis-specific expertise to ensure that every billable item is captured and supported by documentation.
3. Processes and Grit Drive Financial Results.
Single-layer claim review is insufficient in a high reimbursement environment. Renalliance applies a structured, multi-layer redundancy framework that subjects every claim to repeated validation across eligibility, documentation, coding, and payer-specific rules before submission.
4. We See Revenue Risks Before They Hit.
Payer rules shift constantly. We monitor real-time guideline changes, denial trends, and reimbursement patterns to adjust immediately and keep cash flow steady. Vigilance is our risk-prevention engine.
5. Our 10x Review System Eliminates Errors.
Every claim receives ten layers of checks — eligibility, coding, documentation, payment accuracy, and more. It’s not excessive; it’s essential. It prevents losses, captures missed revenue, and closes gaps that lead to denials.
- Denial trend analysis by payer and reason code
- Root-cause identification tied to intake, documentation, or billing
- Corrective action implementation at the source
- Formal appeal preparation with supporting documentation
- Escalation to payer review and reconsideration levels
6. Payment Posting & Reconciliation
Accurate payment posting and reconciliation are essential to confirming revenue integrity. Renalliance ensures that payments received align with amounts billed and identifies discrepancies that require follow-up or correction.
- Accurate payment posting by claim and service line
- Reconciliation against original billed amounts
- Monthly reconciliation of cash receipts
- Identification of payment variances and discrepancies
- Follow-up on short payments or missing remittances
- Revenue confirmation and close-out reporting
7. Transparency Isn’t Optional.
We report every level of detail and communicate clearly. No vague updates, no hidden transactions, no frustrating delays. We surface issues early, explain what’s happening in clear terms, and take direct action to resolve them. It’s the bedrock of every Renalliance partnership.
8. We Protect Your Revenue, So You Can Safeguard Patients.
Your priority is delivering high-quality patient care. Ours is making sure the financial engine behind the care is stable and secure. When revenue is protected, your team can stay focused on outcomes, quality, and operational excellence.
9. We Act Like a Strategic Partner. Never a Vendor.
Vendors execute tasks. Partners take responsibility. Renalliance aligns closely with your leadership team, understands your goals, and owns the results. We collaborate, advise, and act with the mindset that your success is directly ours; because it is.
10. “Paid” Is the Only Outcome That Counts
Submitting a claim is just the beginning. Full, accurate reimbursement is the only measure of success. We challenge underpayments, appeal incorrect decisions, and escalate relentlessly. If a claim hasn’t been paid in full, our work isn’t finished — and we don’t disengage until you are paid in full.
Operations & Compliance
1. Regulatory Compliance & Survey Readiness
Renalliance keeps your facility continuously survey-ready by aligning daily operations, documentation, and staff practices with CMS Conditions for Coverage, state regulations, and accrediting body standards.
- Expert guidance on CMS, state, and accrediting body requirements
- Mock surveys, readiness assessments, and documentation review
- Real-time support during CMS and state survey activities
- Corrective action plans and Plan of Correction monitoring
- Regulatory updates and staff education on new clinical guidelines
2. Quality & Clinical Outcomes
Renalliance partners with your QAPI committee to translate data into action, helping your team identify what’s working, correct what isn’t, and sustain improvements across the metrics that matter most.
- Active participation in scheduled QAPI meetings
- Customized QAPI tools, templates, and Root Cause Analysis training
- Tracking and benchmarking of Kt/V adequacy, vascular access, and anemia management
- Hospitalization and missed-treatment trend analysis
- Development and execution of clinical improvement initiatives
3. CMS QIP & Star Ratings Improvement
Renalliance turns QIP and Star Rating performance into a managed process — diagnosing where scores are slipping, building targeted interventions, and reinforcing clinical and operational excellence.
- Detailed analysis of QIP scores and underperforming measures
- Targeted improvement plans for clinical and operational indicators
- ICH-CAHPS strategy and patient satisfaction initiatives
- Evidence-based interventions to lift Star Ratings
4. Operational Efficiency
Operational inefficiencies quietly erode margins and morale. Renalliance brings a structured, data-driven approach to surfacing those inefficiencies and resolving them before they affect patient care or financial performance.
- Cost-per-treatment analysis, labor benchmarking, and supply utilization reviews
- Revenue enhancement strategies, including TDAPA optimization
- Staffing pattern, scheduling, and productivity assessments
- Implementation support for home dialysis, peritoneal, and SNF dialysis programs
- Census, capacity, and resource utilization evaluation
5. Analytics & Reporting
Renalliance builds the dashboards and reporting frameworks that give leadership a clear, ongoing view of clinical, financial, and operational performance, with peer benchmarks that put your numbers in context.
- Custom dashboards for census, missed treatments, hospitalizations, and cost
- Clinical, financial, and operational KPI reporting
- Peer benchmarking against industry and RenAlliance network averages
- Data-driven recommendations to close performance gaps
6. Product & Supply Procurement
Renalliance gives client facilities access to the collective purchasing power of our network, securing competitive pricing that single facilities cannot access. Renalliance also evaluates products, medications, and supplies for effectiveness and cost.
- Evaluation of clinically effective, cost-efficient products and supplies
- Vendor comparisons, trend monitoring, and contract negotiation support
- Supply standardization to minimize variation and waste
- Access to RenAlliance tiered pricing agreements
7. Staffing Strategy & Workforce Optimization
Renalliance helps facilities build the workforce systems — including recruitment, training, evaluation, and development — that produce stable, competent teams and maintains exceptional care quality and operating margin.
- Recruitment, retention, and compensation strategy support
- Staffing models, workflows, and patient care assignment design
- New hire orientation and ongoing training programs
- Tools for evaluations, competency assessments, and skills testing
- Personnel policies, employee handbooks, and HR forms
8. Policies & Procedures
Renalliance keeps your policy library current, aligned with regulation, and reflective of how your team actually operates — so policies serve as protection rather than exposure.
- Drafting of new policies aligned with federal, state, and CMS Conditions for Coverage
- Regular review and updating of existing policies
- Collaboration with leadership to reflect actual workflow
- Formal approval workflow before implementation
- Centralized, version-controlled policy library accessible to staff