As payors unilaterally decide to deny claims, revenue cycle management seeks methods to avoid denials before they become denied claims. There is tremendous financial pressure on providers from declining reimbursement rates and the shift to value-based payments. The change in the billing landscape is forcing providers to identify and implement changes to their billing procedures and to bill with greater specificity.
Many providers are working with vendors to locate and assess the patient files that have a high propensity of being denied. Artificial intelligence (“AI”) is being used in many cases to predict which cases are ripe for denial and then paying particular attention to supplement and ultimately properly file the claims. Many providers are properly using AI from outside vendors to address issues in claims before they are submitted. The ongoing measurement of clean claims should be increasing as you learn more from payments and denials. An ever-increasing clean claim ratio is very healthy for providers.
FairCode increases clean claim ratios by combining 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.