The CFO Challenge: Improve Claims Revenue Using Artificial Intelligence

These times demand creative and new hospital revenue generation opportunities. Since the pandemic began, providers have prioritize finding new sources of revenue a top priority. As provider reimbursement rates continue to decline, many CFOs make sure revenue is not lost throughout their billing process. Coding departments across the nation have become laser focused on getting top dollar on their current cases, most of which are COVID-19 cases. For months now, the medical and surgical cases that were aborted under a CMS mandate are slowly returning to hospitals generating much needed cash. Is that revenue enough for hospitals to begin to thrive again? In most cases, the answer is no, as hospital CFOs continue to seek creative revenue to flow to the bottom line.

CEOs and CFOs are responding. They are challenging revenue management departments to re-evaluate claims review programs to generate much needed revenue. Some vendors also are stepping up to make revenue generation a priority and some even offer advanced machine learning and artificial intelligence (AI) as a tool to improve claims coding. AI, for example, can be effective in “hand picking” the past 12 months of cases that are ripe for review or denial. Once the cases to be reviewed have been selected, the hospital can then start an enhanced retro-bill strategy adding valuable case specificity onto the coding. Also, many hospitals insist on vendor partners that can offer case review by physicians who are trained in coding alongside AI. Together the pulled cases can be re-billed with precision in order to achieve added DRG specificity and thereby generating new revenue.

FairCode increases clean claim ratios 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 (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