Use Technology like RACs with DRG √ and CLAIMSauditor: Uncover Risks and Fix Issues Proactively While Uncovering New Net Revenue Opportunities

Now, Panacea’s clients do not have to wait for the other shoe to drop while wondering about the extent of RAC, MIC, MAC or OIG activities – or any other audit or financial exposure their organizations might have. With Panacea’s DRG Check, cloud-based technology clients can uncover inpatient audit risks and begin to correct any root causes proactively before outside auditors bring such issues to their attention. And operating off of the same technology platform, those hospitals wishing to assess risk, coding or quality issues – or to uncover new incremental net revenue opportunities for both inpatient and outpatient records – can utilize CLAIMSauditor.com.

"No longer do hospitals have to be sitting ducks, hoping they won’t be targeted for recoveries – instead they too can deploy technology to identify coding, compliance, billing and reimbursement issues and correct those areas of concern proactively," Panacea CEO Frederick Stodolak said. "And the best part is that this same technology will easily find offsetting incremental net revenue opportunities in the inpatient area – often related to the effect of late documentation not present at time of coding due to short billing cutoff time frames – and in the outpatient areas related to lost charges."

Both DRG v and CLAIMSauditor allow users to write their own rules or to choose from an ever-increasing library of RAC, OIG, AHRQ, lost charge and other rules created by Panacea consultants and clients. One of Panacea’s first CLAIMSauditor clients received correspondence from the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) requiring them to repay more than $1 million due to a billable unit error on one drug, and that client successfully used CLAIMSauditor to identify the full scope of financial exposure they might have on other drugs so they could address those issues proactively.

About the Author

Kim T. Charland, BA, RHIT, CCS is Sr. Vice President, Clinical Consulting Services of Panacea. A thought-leader in HIM with extensive clinical consulting services project management experience, Kim has 20-plus years in health information and reimbursement management for hospitals and physician offices. She is responsible for all aspects of Panacea’s clinical consulting products. Contact Kim at 800-252-1578 x3417 or at kcharland@panaceahealthsolutions.com.