Navigating Growing Ambiguities in DRG Payments

At the heart of the revenue cycle is the goal to be compensated properly and fully for each procedure performed. At a time when case complexities already challenge DRG payment certainty, COVID-19 enters and adds yet an extra layer of potential ambiguity. Inconsistent volumes and higher costs of care result in the growing need to have a holistic long-term strategy for financial stability in place. Many providers embrace fundamental methodologies to promote revenue protection excellence. This means that applying battle-tested workflows and tactics to underpayments, denials and patient affordability becomes tantamount to financial survival.

Fortunately, current market dynamics produce some out-of-the-box thinking that improves payment certainty and shores up all revenue due to them for services performed to their patients. One such approach couples physicians trained in coding with coding teams to ensure all cases are billed with the specificity and detail necessary to garner the correct payment. When the physician used to validate DRG billing is properly trained in coding an extra layer of payment certainty results. They spot clinical nuances and specificities that otherwise may get overlooked and positively impact billing. Physicians trained in coding deployed during the post-discharge chart review will increase revenue, improve quality reporting, and ensure the completeness and accuracy of claims.

During the global response to address COVID 19, FairCode recognizes that our top priority must be the health of our employees, partners, neighbors and communities. FairCode combines the domain expertise of experienced physicianswith 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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