Healthcare reimbursement for services is getting more complicated every year. We bridge the gap between the attending physician and hospital coder so patient acuity is accurately reflected and you are reimbursed fully. Physician-conducted medical chart reviews can happen in real time and significantly impact quality and bottom line results. From clinical chart reviews to payor denial defense, our physicians are a part of your team.
Our physicians are trained in the principles of coding and focused on improving the specificity and accuracy of documentation.
We provide ICD-10, ICD-9, best practices, documentation tips, and software to create DRG specific query templates.
Physician support in responding to CMS and payor denials. Strong physician documentation leads to winning appeals.
Founded in 2001, we have had over $270 million in accepted recommendations for our clients.
3.8 cases per hour
$355 per case
$2447 per case
Our physicians quickly review cases once they’re coded and on average review 3.8 cases per hour.
We review a lot of cases, close to 1 million since we were founded. The average return per case reviewed last year was $355.
We typically make recommendations on 13-15% of the cases we review. Greater than 55% of recommendations are accepted and the average return is $2447 per case re-coded
For every 1000 cases reviewed, the average return is $286,000 after expenses
On average, for every $1 invested in FairCode reviews, $5 is found and returned back to the client.
For every 1000 cases reviewed, the average return after expenses
Total # of cases reviewed
Average number of cases reviewed per physician per hour
Average gross ROI for all clients
Average gross return per case reviewed across all clients
Average gross return per case re-coded across all clients
We train physicians in the rudiments of inpatient coding. They review your charts after the coder has assigned the DRG and before the bill is dropped. They connect the clinical indicators in the chart and write peer-to-peer physician queries to gain the appropriate medical diagnoses for the coder to evaluate. This approach will be even more valuable when ICD-10 goes into effect. Your hospital coder always has the final say on our recommendations.
Increase clinical accuracy and reimbursements. 93% average response rate across all hospitals.
Take advantage of physician recommendations but retain the final say on everything. Together we are a great team.
Leverage an evidenced based approach to CDI reviews by utilizing a statistically significant pull list
Get real-time reporting of financial and CMI index impact. Detailed reports for physician/coder education.
Quickly and easily launch reviews with limited intervention of hospital IT departments.
Decrease fraud and abuse penalties by identification of incorrect coding. Augment compliance efforts through external audit process.
A 66 year old female was admitted for weakness and near-syncope. Her case was coded as DRG 392, Esophagitis and Miscellaneous Digestive Disorders, without MCC (average Medicare compensation $3,984.)
Evaluation of the chart by the FairCode physician revealed that the patient had a severe iron deficiency anemia, and that the anemia was responsible for the patient’s symptoms.
The hospital coder agreed, and the chart was recoded to DRG 812, Red Blood Cell Disorders without MCC (average Medicare compensation $4,401.)
A 72-year-old male, a smoker, was admitted with chest pain. A heart attack was ruled out. The hospital coder coded the primary diagnosis as chest pain, resulting in a MS DRG assignment of 313 (average national Medicare payment: $3,309)
The FairCode physician reviewed the chart and noted that the attending physician performed further studies, and that a mediastinal mass was discovered on a CT scan of the chest. The tumor was pressing on sensory nerves to the chest.
A query to the attending physician resulted in the primary diagnosis being assigned as lung cancer, resulting in a MS DRG assignment of 182 (average national Medicare payment: $4,361.)
A 66-year-old female was admitted and treated for pneumonia. Her hospital stay was complicated by angina. The coder coded the case as MS DRG 195, Simple Pneumonia and Pleurisy without Complications or Co-morbidities/Major Complications or Co-morbidities (average national Medicare reimbursement: $3,798.)
The FairCode physician noted that sputum culture results had been added to the chart after the patient’s discharge, indicating heavy growth of Klebsiella pneumoniae. The attending physician had initialed these results and noted that the organism was sensitive to the antibiotics given.
The addition of code 482.0 (pneumonia, due to Klebsiella pneumoniae) was recommended and accepted immediately by the coder. The MS DRG was changed to 179, Respiratory Infections and Inflammations without CC/MCC (average national Medicare reimbursement: $5,227.)
We work clients from across the country, below are some of our partners who make that possible.
Based on your last 12 months of DRG volumes, groupers, and case weight multipliers, we can provide you a free analysis detailing the overall value of physician reviews at your facility. Also included is a targeted list of DRG's for a physician to review for possible recommendations.