While technology has touched every aspect of revenue cycle, most agree charge capture is the is the primary component of revenue cycle management. Capturing the clinical documentation is critical for both compliance and as a starting point for the revenue cycle. Coders can only code if the documentation is in order with sufficient clarity. When the documentation is not in order there are many areas of lost revenue and compliance suffers.
Missing charges otherwise due to a provider (i.e., lost revenue), is not a good place to start the revenue cycle. Simply stated, not getting paid accurately for all of the care provided to patients leads to lost revenue and a bottom line that doesn’t financially reflect all of the care provided. Further, case mix indexes (CMI) suffer as a result of improper classification of the complete services performed by the provider.
In recent years, artificial intelligence (AI) and machine learning (ML) have brought new insight to rationalize and improve the healthcare provider revenue cycle. Now, we can teach computers to predict, with some level of certainty, cases that meet certain criteria set by providers. Artificial intelligence can alert providers to cases that are ripe for denial or cases that need to be coded a certain way in order to be properly billed. Depending on the data used by the provider or a vendor, AI can lead to significant revenue benefits.
FairCode combines the domain expertise of experienced physicians with modern data science and analytics technologies to increase hospital revenue. FairCode bridges the gap between a hospital’s attending physicians and hospital coders. The result? Patient acuity and Case Mix Index are more accurately captured with the correct DRG, and hospital reimbursements adjust accordingly. DRG Validation and physician conducted medical chart reviews happen in real time, significantly impacting hospital quality rankings, case mix index (CMI) and bottom-line results. From clinical validation and chart reviews to payor denial defense, FairCode’s physicians and data scientists are part of a hospital’s coding team. Add FairCode to your existing CDI initiatives and see the difference. Outcomes are measurable and significant. FairCode averages greater than 4:1 Gross Return on Investment.