As revenue cycle experts we thrive on metrics produced from our data. Metrics are used to measure performance in all areas of revenue cycle management. One of the measurements that is continually viewed for improvement is the first pass resolution rate (“FPRR”) also known as the “clean claims ratio”. This ratio tells the provider what percentage of claims are paid on the first submission to a payor for review and payment. From a practical side, the costs associated with a delay in payment from the payor when added to the time needed to fix a denied claim can have a serious financial impact on the provider’s finances.
There are a number of factors that can minimize claim denials and increase the FPRR in a cost-effective manner. Besides knowing your payor contracts and keeping your coders trained on the latest documentation and coding changes, an easy way to increase FPRR is through systems using artificial intelligence to show claims needing more attention before the claim is filed. Through AI, a provider is alerted of certain cases (typically sorted by DRG) that are typically rejected on their first submission. AI can also learn the DRG codes that are most likely to be improperly or under-coded so the provider can pay special attention to those claims before submission. A number of vendors provide systems that claim to increase the FPRR. As a matter of course, a provider should request vendors’ metrics detailing their direct contribution to the FPRR.
FairCode directly contributes to the first time clean claim ratio 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.