In June 2019, by the swipe of a pen on an executive order, healthcare price transparency was assigned to HHS directing hospitals and insurers to make publicly available the prices they charge for their healthcare services. Patients are on the hook for a greater percentage of their medical bills than ever before including nonurgent choices on where to receive their care. The logic flowed that patients will be provided a procedure’s costs before nonurgent surgery in order to make an informed financial decision. Price transparency allows patients to be able to take costs into account when making provider decisions.

Now that we are in the midst of HHS price transparency, we see great disparity in the hundreds of prices for the same procedure at various hospitals. Costs vary greatly on a local basis, and in many cases billed revenue is reflective of the costs incurred. In any event, whether it is a published rate or negotiated rate, hospitals need to get paid for every bit of services they perform for their patients. With the amount of under coding present in the market, a hospital can maximize billed revenue by using a well-tested DRG validation process.

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.

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