Healthcare operations rely on technology and technological improvements to advance both the clinical and operations of providers. In the past, barriers existed preventing widescale adoption of technological solutions in hospitals. These barriers were physical, financial and operational in that new technologies were not being implemented due to the hurdles lying within organizations. As providers look to increase patient revenue, reduce costs, enhance clinical outcomes and reduce waste, relying on high-performing technology, techniques and procedures is becoming tantamount. Simply stated, goals cannot be accomplished without technological advances, automation, data analytics and ingenuity.
Imbedded within the onslaught of technological advances is the need to reduce manual operations and replace them with technology and data driven operations. Part of the move to technology in healthcare brings on the advent of machine learning and artificial intelligence. Predictive analytics through artificial intelligence and machine learning are driven by data and algorithms using past data to predict future outcomes. In revenue cycle management, by incorporating years of DRG data and outcomes, hospitals can isolate the cases needing special coding attention before billing. By using predictive analytics post-discharge, hospitals are able to cull the cases most likely to be denied or most likely to be under-coded. The technological advance in billing uses the history of paid claims as an indicator of future payments.
More and more hospitals are using outside vendors to optimize their DRG billing and ensure they are getting paid properly for the services being rendered to patients. Vendors using predictive analytics, machine learning and artificial intelligence are leading the way towards optimizing hospital DRG revenue. The right business intelligence partner with an emphasis on modern technology can target high value cases to deliver the greatest and fastest ROI.
FairCode allows hospitals to collect revenue that may otherwise go unnoticed. FairCode offers a feasibility analysis using up to one full years’ data, as well as a 13-week trial period to determine the real time benefit of the FairCode product. FairCode increases clean claim ratios by combining the domain expertise of experienced physicians with modern data science and analytics technologies to increase revenue integrity and hospital revenue. FairCode bridges the gap between a hospital’s attending physicians and hospital coders. The result? Patient acuity and Case Mix Index (CMI) 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, CMI and bottom-line results. From clinical validation and chart reviews to payor denial defense, FairCode’sphysicians 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.