Hospitals typically audit coding to make sure it is accurate, complete and compliant with national correct coding guidelines. Audits are usually retrospective and often focus on high volume diagnoses, procedures or Diagnosis Related Groups (DRGs). Audits may also include a random sample of inpatient and outpatient coding.
Coding audits are a valuable tool for educating coders and improving coding quality and compliance. However, the sample sizes are frequently insufficient to identify problematic patterns that result in lost revenue.
JTS' analytics services include:
- Coding and Revenue Enhancement Analytics and Services (nCREAS™): Target specific areas of MS-DRG’s to assess the extent to which revenue is lost to incomplete or inaccurate coding.
- CC/MCC Capture Rate Analytics: Target trends of data for facilities comparing their MS-DRG rates to established Centers for Medicare & Medicaid Services (CMS) MS-DRG benchmarks.
- Revenue Cycle Management Analytics: A full analytical suite of reports and trends that analyzes cash and accounts receivables. The suite also analyzes accounts from highest to lowest level in a multitude of meaningful ways.
- Denial Management Analytics: As denial rates continue to increase, JTS has developed a comprehensive denial management tool. This tool provides analysis of denial rates based on location and payors with predictive analytics representing total expected reimbursement outcomes.
JTS then works with key organizational stakeholders to create the following:
- More accurate, complete and compliant coding
- Increased revenue by building a roadmap for reducing lost revenue caused by incomplete or inaccurate coding
- Resources to retrospectively correct coding and rebill third party payers
- A means to concurrently find and correct coding and billing errors
- A program through which coders, CDI and clinical staff learn where to focus energy for improved documentation quality, improved patient care, and enhanced revenue
- Enable a clearer path through which clinicians and CDI staff can improve documentation, facilitate better coding, and generate the appropriate reimbursement