American hospitals are highly dependent on Medicaid and Medicare reimbursement, much of which is based on the DRG (Diagnosis Related Group)-based classification of the clinical acuity of the case. DRG assignment, in turn, is determined by coders - hard-working professionals who are well-versed in the regulatory requirements of coding, but who usually have limited medical training.

FairCode Associates works from an entirely new model: Train physicians in the basics of coding, and put them on a team with the coder. The physician performs a focused audit on pre-identified DRGs, and provides the coder insight to additional diagnoses and procedures that are addressed in the chart. The physician and the coder meet for 15 minutes each review day to discuss the findings. The synergy of the clinical knowledge of the physician and the regulatory knowledge of the coder results in more accurate coding of the hospitalization.

Prevention of erroneous up-coding, and of equal significance to the hospital - correction of costly under-coding, are important elements of FairCode’s contribution. Hospitals partnering with FairCode can expect:

• A decrease in risk from Medicare/Medicaid penalties for incorrect up-coding
• An increase in revenue from identification and correction of incorrect under-coding
• Ongoing training of your physician and coding staff
• Assistance with the Medicare Program for Evaluating Payment Patterns Electronic Report (PEPPER)
• QM support

All data is stored in our HIPAA-compliant, secure database, and is available to clients 24/7. Outcomes are available at the touch of a button.