Transition To Pre-Bill eValuator Increases DRG Change Rate By 80% and Enhances Coding Integrity

topics:

auditing

,

change rate

,

drg

,

pre-bill

Posted On :

OVERVIEW

Switching from an outdated manual coding audit program to tech-enabled pre-bill eValuator™ increased the average DRG change rate from 10% to 18%, boosted auditor productivity and identified coder education for improved accuracy.

CHALLENGES

  • Manual audit process with use of spreadsheets and random case selection.
  • Lacked visibility into audit program contributions (financial impact, productivity metrics, & quality improvements).
  • Program did not include outpatient encounters.
  • External audit firm failed to meet expected ROI.

GOALS

  • Automate case selection to prioritize high value encounters (financial and quality aspects) for both inpatient and outpatient claims.
  • Implement automation for the auditor & coder rebuttal process, eliminating the use of spreadsheets.
  • Enhance the ease and depth of reporting.
  • Achieve the organization’s ROI goals by enhancing financial outcomes for the enterprise.

OUTCOMES

  • eValuator™-flagged encounters increased the DRG change rate from 10% to 18%.
  • Auditors, concentrating solely on eValuator™-flagged encounters, achieved an average net new reimbursement of $660 per DRG change.
  • Identified additional coder education opportunities for improving overall coding accuracy rates.