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 analytical 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.  Based on outcomes, accounts are reviewed to determine if deviations from the national mean are due to incorrect MS-DRG assignment or are supported by documentation.  The CC/MCC Capture Rate of a facility is a good indicator to determine if a facility is overreporting or underreporting CCs or MCCs within a MS-DRG pair or triplet.

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

Facts about JTS Health Partners

  • Holding company, JTS Ventures, Inc., established in 2002
  • Healthcare management consulting subsidiary, JTS Health Partners formed in 2009
  • A state-of-the-art virtual organization with a broad and growing footprint
  • Current team operates in approximately fourteen (14) states within the United States
  • Headquarters based in Norcross, Georgia