Optimize DRG Validation: Take Full Advantage of RCM Tools

Keeping on top of the claims review game has never been as important as it is today. The RCM environment is fast paced and ever changing, making a regular program assessment of available resources imperative to ensure the CDI and HIM professionals reach optimal quality and revenue standards.

Long ago, hospitals discovered the value of using outside expertise and specialists in non-core areas, as it manages fixed costs and improves productivity. Hospitals should expect outside RCM vendors to specialize, hire expertise, provide in-depth services and invest capital in state-of-the-art software. The revenue cycle management staff are continually challenged by best practices. Just think of the on-the-fly staff education needed earlier this year when COVID-19 hit. Hospitals that were fortunate to partner with outside vendors that invest in expertise were responsive to change, adapted quickly and addressed cash flow on-the-spot.

Outside expertise respond and work alongside with providers as an integral team member. Hospitals expect FairCode to perform in real time and we do. Our responsiveness to claims review nuances is transparent and FairCode physicians develop and send queries to hospital physicians with peer to peer precision. Attending physicians see specific patient details that lead to the query resulting in on-the-spot decision and clinical education. Hospitals should take full advantage of their vendors’ specific expertise. Only then can optimal quality and revenue standards be met.

FairCode allows hospitals to collect revenue that may otherwise go unnoticed. FairCode offers a feasibility analysis using up to one full years’ data, as well as a 13-week trial period to determine the real time benefit of the FairCode product. FairCode increases clean claim ratios by combining the domain expertise of experienced physicians with modern data science and analytics technologies to increase revenue integrity and hospital revenue. FairCode bridges the gap between a hospital’s attending physicians and hospital coders. The result? Patient acuity and Case Mix Index (CMI) 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, 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.

http://www.faircode.com/