Case Studies
This is but a small sample of our return to clients: in compensation, case mix, and reduced coding denials.
A FairCode Case Study :: A Mid-Sized Community Hospital
Improving Case Mix and Reimbursement
A 140 bed community hospital in rural Tennessee contacted FairCode for help. Busy attending physicians were unable to document to suit the coder's needs, and case mix index was falling. FairCode began reviewing in early August of 2012, and by the end of 2017 had successfully recoded 1,697 cases for a net return to the hospital (both corrected under-coded cases and over-coded cases) of $4.577 million: a 4.28:1 gross ROI.
Case Study Duration
5 1/2 Years
Total Return
$4.577 Million
Gross ROI
4.3:1
A FairCode Case Study :: A Children's Hospital in a Multi-Hospital Academic Medical Center
Matching Reviewer Specialties to Client Needs
A multi-hospital academic health system in the south included a Children's Hospital. FairCode assigned a team of pediatricians to review the inpatient coding on a carefully defined list of DRGs. 14,378 discharges were reviewed in a two year period, with recommendations to reconsider 1,221 of these cases. After coder review and return of attending physicians' queries, 776 cases were recoded -- both moving the DRG to higher and lower case weights, as was accurate and appropriate. The net of all the recodes for the facility was an additional $4.3 million dollars -- a gross 4.55:1 return on their investment.
Case Study Duration
2 Years
Total Return
$4.3 Million
Gross ROI
4.5:1
A FairCode Case Study :: A Multi-Hospital, Not-For-Profit Health System
Conquering the Problem of Payor Denials
A large multi-hospital, for profit health system in the south has had FairCode physicians on their coding team since 2013. At the same time, they asked us to help them with coding denials on all denied cases, whether reviewed by FairCode or not. A study of the data reveals that payor denial rates on FairCode-reviewed cases is 0.18%. Denials on non-FairCode reviewed charts is 2.32%. A FairCode-reviewed chart is 13 times less likely to have a payor denial. Further, denials were almost twice as likely to be overturned by the payor on FairCode-reviewed charts than non-FairCode reviewed charts, suggesting that FairCode review not only captures increased case mix, but improves facility compliance.
Facility Denial Rate on Non-FairCode Reviewed Cases
2.32%
Facility Denial Rate on FairCode Reviewed Cases
0.18%
Difference in Denial Rates
13 Fold
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 Director of HIM, Jupiter Medical Center
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