Overview
This Acceptable Use Policy ("AUP") describes what you may and may not do with the Revenue Optimization & Intelligence platform ("ROI," "the Platform"). It supplements our Terms of Service and applies to all users, subscribers, and anyone accessing the Platform.
ROI exists to help healthcare billing professionals work more accurately and efficiently. We take the integrity of healthcare billing seriously. Misuse of this platform — particularly any use that facilitates billing fraud or the improper handling of patient information — will result in immediate account termination and may be referred to appropriate authorities.
✅ Permitted Uses
The following are examples of appropriate use of the ROI Platform:
✅Denial management and research — Using the EDI Code Intelligence Lab to research CARC and RARC denial codes, understand denial reasons, and develop appeal strategies for legitimate claims.
✅Revenue cycle auditing — Running the Revenue Integrity Master Audit to identify gaps in your practice's billing processes and develop improvement plans.
✅Appeal letter preparation — Customizing and using ROI appeal templates to submit good-faith appeals for legitimately denied claims.
✅Staff training and education — Using platform content to train billing staff on denial codes, revenue cycle best practices, and coding standards.
✅Internal business use — Using ROI outputs (audit results, action plans, denial guidance) within your organization's internal revenue cycle operations.
✅Consulting client support (with BAA) — Using the Platform as part of professional RCM consulting services provided to covered entity clients, subject to a signed Business Associate Agreement.
🚫 Prohibited Uses
The following uses are strictly prohibited and will result in immediate account suspension, termination, and where applicable, referral to regulatory or law enforcement authorities:
Healthcare fraud is a federal crime. Using this platform in any way that facilitates the submission of false claims to Medicare, Medicaid, or any other payer violates the False Claims Act (31 U.S.C. §§ 3729–3733), the Anti-Kickback Statute, and the HIPAA Fraud and Abuse provisions. Violations carry civil and criminal penalties including exclusion from federal healthcare programs.
🚫Healthcare billing fraud — Using ROI tools, denial code guidance, or appeal templates to submit, facilitate, or conceal fraudulent claims, upcoded claims, unbundled claims, or any claim that does not accurately reflect services rendered.
🚫Unauthorized PHI submission — Entering, uploading, or transmitting Protected Health Information (PHI) into any Platform tool, form, or communication channel without a fully executed Business Associate Agreement on file with ROI.
🚫Content scraping or database extraction — Using automated scripts, bots, crawlers, or any other automated means to access, copy, download, or extract the EDI Code Intelligence Lab database, audit checkpoints, templates, or any other Platform content.
🚫Unauthorized redistribution — Reselling, sublicensing, republishing, or distributing Platform content — including denial code guidance, audit frameworks, appeal templates, or methodology — without express written permission from Revenue Optimization & Intelligence.
🚫Competitive reverse engineering — Using the Platform to reverse-engineer, replicate, or develop a competing product or service, including but not limited to copying the audit framework, denial code database structure, or action plan methodology.
🚫Credential sharing — Sharing, selling, or transferring your login credentials or subscription access to any third party. Each subscription is for individual or organizational use as specified at purchase.
🚫System interference — Attempting to gain unauthorized access to any portion of the Platform, its underlying infrastructure, or any connected system; probing, scanning, or testing the vulnerability of any ROI system without express written authorization.
🚫False identity or misrepresentation — Creating an account using false information, impersonating any person or organization, or misrepresenting your credentials, affiliation, or intended use of the Platform.
🚫Unlawful purposes — Using the Platform in any way that violates applicable federal, state, or local law, including HIPAA, the False Claims Act, the Anti-Kickback Statute, HITECH, state fraud and abuse laws, or any applicable export control regulations.
🚫Harassment or abuse — Using the Platform or any ROI communication channel to harass, threaten, or abuse ROI personnel, other subscribers, or any third party.
Special Notice: Healthcare Fraud
ROI's denial code database and appeal templates are designed to help billing professionals recover revenue for legitimate claims that have been incorrectly denied. They are tools for accurate billing — not for gaming the system.
Using an appeal letter template to appeal a claim that was correctly denied because the underlying claim was fraudulent, upcoded, or did not reflect actual services rendered is a misuse of this platform and may constitute healthcare fraud.
If you become aware that ROI tools are being used to facilitate healthcare fraud — by yourself, your colleagues, or your organization — you have a legal and ethical obligation to report it. You may report suspected healthcare fraud to the HHS Office of Inspector General at oig.hhs.gov or by calling 1-800-HHS-TIPS.
Consequences of Prohibited Use
Violations of this Acceptable Use Policy may result in: immediate suspension or permanent termination of your account without refund; legal action to recover damages or enforce intellectual property rights; referral to the HHS Office of Inspector General, the DOJ, or other regulatory bodies where required; and reporting to relevant licensing boards where applicable.
Revenue Optimization & Intelligence cooperates fully with law enforcement investigations involving misuse of the Platform. We reserve the right to preserve and disclose any account information, usage data, or communications as required by law or court order.
