Features

Collect Monthly Numbers – quickly and efficiently accumulate DRG and related financial data:

• By Payor – Medicare, Medicaid and All Others
• By Key Metrics – Date, Case Mix, Average Length of Stay, Discharge, Patient Days, Charges, etc.
• Make data available at the point of collection, reducing delays in decision making.

Focus on Key DRG’s – easy DRG targeting allows you to focus on critical indicators:
 

• OIG Pairs
• Targeted OIG DRG’s
• Transfer DRG’s
• Top 20 DRG’s
• By Payor or All Payors
• By other Key Metrics

Trend changes in DRG Indicators – rapidly compare and contrast changes over time:

• By Payor – Medicare, Medicaid and All Others
• By Contributor – Physician, Coder, and All Others
• Identify patient population shifts that impact case mix
• Specify time frames of your choosing

Simplify the Process – rapidly reduce administrative overhead for data collection/entry, spreadsheet development, graphing, etc.

Report Operational Results – powerfully demonstrate performance and opportunities for improvement:

• Case Mix Review and Analysis
• By Medicare, Medicaid and All Others, etc.
• Timely & Complete Documentation accelerates Revenue Cycle
• Coding Standards and Guidelines Adherence minimizes Denials

Qualify Compliance Risks – quickly target DRGs at risk for CMS scrutiny:

• Follow false claim risk DRG’s and indicators
• Data validation proof sources your Monthly Case Mix Review
• Avoid potential compliance fault fines:

• Prevent $11,000 per false claim fine (s)

• Head off additional fines of up to 300%

Drill into to DRG Trend Details – on demand, over time by revenue source:
 

• Top 20 DRG’s trend details

  • By individual DRG

  • With associated metrics - Date, Case Mix, Average Length of Stay, Discharges, Patient Days, Charges

  • By time frames of your choosing

Integrate with existing data sources – state of the art integration leverages XML, HL7 and rapid integration deployment (RID) to eliminate integration headaches.

Identify Process Improvement Opportunities – initiate positive changes by resource and process:
 

• Physician

• Coder

• Documentation & Coding process

  • Education

  • Documentation

  • Standards

  • Bylaw Enforcement

  • Physician Query

  • Discipline

Process Improvement Action Monitoring – staged for subsequent review with the Plato Data Analyzer®
 

• Formalized Internal Review of Coding Processes

• Focus on Quality of Coding

• Survey ICD-9-CM and CPT Coding Processes

• Supports Case Selection Targeting

Standardize Reporting across the Enterprise – account for multiple hospitals over many regions and across multiple states.