Finding the right DRG Finding the Fair Code

Since 2001 $714 Million Recommendations
Accepted

FairCode physicians uncover hidden truths in inpatient documentation, and partner with hospital CDIs and coders to assign the most accurate DRG.

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What We Do

FairCode combines the domain expertise of experienced physicians with modern data science and analytics technologies. We bridge the gap between your attending physicians and hospital coders. The result? Patient acuity and Case Mix Index is more accurately captured; your reimbursement adjusts accordingly.

Physician-conducted medical chart reviews happen in real time, significantly impacting quality and bottom line results. From clinical chart reviews to payor denial defense, our physicians and data scientists are a part of your team! Add us to your existing CDI initiatives, and see the difference.

Outcomes are measurable and significant. We average a greater than 4:1 Gross Return on Investment.

Click Here: What a Typical Client Has to Say About FairCode

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Fair Code CheckPredictive Data Analytics

FairCode has predictive software which provides a list of which charts require review and have the highest probability of documentation error. We are the happy marriage of human intelligence with the algorithms that constitute Artificial Intelligence.

Fair Code CheckPhysician Chart Reviews - DRG Validation

Unlike our competition, at FairCode, physician chart review means just that. 100% of your selected charts are physician-reviewed. And not just any physician: FairCode physicians undergo extensive training in the principles of inpatient coding, and excel at improving the specificity and accuracy of documentation. The competition has only nurse/coder review, with occasional physician input. Every chart is reviewed by a FairCode physician, a hospital coder, and, where necessary, the patient's attending physician, before the DRG is changed.

Fair Code CheckDenials Appeals

Let's face it: denials happen. But a FairCode-reviewed chart is 13 times less likely to be denied by the payor. And, when appealed, is twice as likely to have the denial overturned. But whatever the source of your coding or UM denials, FairCode can help. Our dedicated appeals team of physicians has years of experience reasoning with recalcitrant payors -- and winning.

AI and Our Industry: Is the Computer Better Than the Brain?

AI (Artificial Intelligence) seems to be everywhere. Increasingly, our hospitals are using it for coding optimization. Here is the data we obtained when AI was layered on top of physician-conducted reviews at a multi-hospital health system, over a period of years:

Where AI Exceeds Human Intelligence

When the rules are simple and decision making is linear, AI can now exceed human intelligence. (It is more accurate in predicting which moles are melanoma, for example. And it will beat you at chess.)

Does AI Know the Coding Rules?

Not yet. Coding rules are Byzantine, but essentially linear. In time, AI may master those rules. Current AI programs do not incorporate the coding rules but review the EMR for “key words”.

Is Medical Review and Decision-Making Linear?

No. Medicine and medical decision making is not linear. While there are criteria (e.g. sepsis,) they require the “neural net” of the clinician for analysis and determination of the correct principal diagnosis.

What Can AI Find?

In our analysis of the data before and after the addition of AI to our human reviews, we determined that currently, AI finds ~ 25% of available coding dollars; but misses 75% that the trained physician (the “neural net”) finds. This is approximately the same ratio that CDI programs provide. AI and CDI nurses find the “low hanging fruit.” However this portion of the anaysis included the decline in our ROI because of our capturing more inappropriately over-coded cases.

Implementation of AI Increases Over-Codes by 29%

AI has virtues, but be very careful that an AI program does not increase your denials or decrease your compliance. In our experience across a large hospital system, implementation of AI increases over-codes by 29%. The physician reviewer has to catch these mistakes and correct them. You still need a safety net.

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Working with FairCode has enhanced who I am as a person as well as who I am as a clinician. They are truly the most sincere, compassionate, cooperative and diligent people I have had the pleasure to work with.

Udele J. Tagoe M.D. Gynecology

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Udele J. Tagoe M.D.

Our Results

We have returned over $714 million to our clients in our 20 years' experience.


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I love working with Fair Code. I have a very good working relationship with their team. They are very customer friendly and receptive to the needs of the client. They have a good understanding of revenue cycle and changes from an HIM Director perspective.

Susan Denny Jupiter Medical Center, Director of HIM

3.8

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Average number of cases reviewed per physician per hour

2.4 Million

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Total number of cases reviewed

6 weeks

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Average time for to positive financial return.

4:1

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Average gross ROI for all clients

Get Your Free DRG Assessment

We will provide you a free, custom analysis, detailing the potential value of physician reviews at your facility.

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Fair Code Partnerships

We work with clients from across the country. Click Here: What Our Physicians and Partner Hospitals Have to Say About Us Here are some of our partners who make it possible:

Kentucky Hospital Association
Alabama Hospital Association
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