The use of predictive analytics is becoming more and more prevalent in healthcare from patient care to billing to palliative care. Predictive analytics and machine learning are readily being used in patient care as systems now predict patient outcomes, assist in radiology diagnoses and identify cases needing extra attention or care. Hospitals accumulate massive amounts of data from patient care to billing and collection. By using past billing and claim data experiences in combination with the right business intelligence tool, hospital billers can improve collections and denials management by learning from experience and taking action to adjust claims and increase revenue.
Predictive analytics and machine learning are driven by data and algorithms using past data to predict future outcomes. The predictive ability of machine learning not only delivers results in patient care but also in administration and particularly in hospital billing. By applying years of DRG data, a hospital can isolate the cases needing special coding attention before billing. By using predictive analytics post-discharge hospitals are able to cull the cases most likely to be denied or most likely to be under-coded. Under-coding is the equivalent of not being paid for the services performed, and it leads to hospitals leaving significant revenue on the table.
More and more hospitals are using outside vendors for to optimize their DRG billing. Vendors using predictive analytics, machine learning and artificial intelligence are leading the way towards optimizing hospital DRG revenue. The right business intelligence partner can target high value actions to deliver the greatest and fastest ROI.
FairCode combines the domain expertise of experienced physicians with modern data science and analytics technologies to increase hospital revenue. We bridge the gap between your attending physicians and hospital coders. The result? Patient acuity and Case Mix Index are more accurately captured with the correct DRG; hospital reimbursement adjusts 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. From clinical validation and chart reviews to payor denial defense, our physicians and data scientists are part of your team! Add us to your existing CDI initiatives, and see the difference. Outcomes are measurable and significant. FairCode averages greater than 4:1 Gross Return on Investment in client hospitals and has been delivering hospital revenue solutions for over 18 years.
Source: Predictive Analytics & Machine Learning in Hospital Billing | Fair Code Associates | DRG Assessment