The Quest for RCM Improvement

During the COVID-19 financial disaster experienced by providers, Revenue Cycle Management is at the core of the financial return to profitability. CFO’s are seeking ways to improve free cash flow while elective surgeries and procedures remain low and the profitability from COVID cases remains slim. After all, the total costs for PPE for the four months following the start of the pandemic exceed $2.4 billion in the aggregate. The complete clinical and financial consequences of deferring elective surgeries are yet to be experienced. Hospitals and providers have increased their focus on RCM and each aspect of the revenue cycle to help restore financial stability and add free cash flow. The primary focus on revenue cycle has led to a closer examination of all claims and cases making sure each one is correctly documented, coded and billed.

FairCode emerges as a leader in the quest for providers to recover the appropriate reimbursement for the care provided, avoiding cases being under coded and therefore under billed. Making sure a claim is billed with the correct DRG code is of tantamount importance. FairCode closes the gap between physician documentation and coders. FairCode is the only firm to completely staff its DRG review team with physicians, all of whom are trained in coding; and, uniquely qualified to deliver case mix index and patient acuity accuracy. FairCode physicians provide a clinical perspective to the coding process to ensure the case weight accurately reflects the clinical severity of the patient. FairCode services can be employed for both concurrent and retrospective reviews, each clinically validating DRGs in measurable ways.

FairCode combines 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 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. 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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