Enhance reimbursement and quality through data driven, actionable insights.

ezDITM analysts and consultants perform in-depth analysis of a hospital’s KPIs, including Case Mix Index (CMI), Coder and CDI Productivity, Denials and a host of other metrics.

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Case Mix Index

Case Mix Index (CMI) is the average of DRG weights of all inpatients.

did-you-know

Did You Know?

  • 14-site hospital system lost $3M in reimbursement in a year from an unspecified code (F32.9), where more specific code (F32.3) could have been assigned.

CMI Consulting

  • Improve CMI by analysing high-impact MS-DRG pairs
  • Identifying reasons for any increase or decrease in CMI
  • Comparison of a Hospital’s CMI against National, State and Regional Peer group.
  • Identification of the top 10 MS-DRGs within a fiscal year.
  • Comparison of the Geometric Mean Length of Stay (GMLOS) to the Actual Length of Stay (ALOS) for the top 10 MS-DRGs, with impact and opportunity assessment.
  • Tracking of trends in patient mix (total cases, medical/surgical cases).

Coder/CDIS Productivity

Coder Productivity is defined as the time required to code a patient record.

Coder/CDIS Productivity Consulting

  • Benchmark productivity levels to determine the gaps
  • Productivity level analysis by individual Coder/CDIS
  • AI-based optimization modeling on past data designed to enhance current Coder/CDIS productivity and accuracy levels
  • Coder Productivity by service lines, LOS, DRGs
did-you-know

Did You Know?

  • 271-bed hospital identified 25% increase in coder productivity level, and thus savings of $276K with analytics driven case allocation. This was in addition to 47% increase with CAC adoption.

Denials

Denial is the refusal by payor to honor a request of a provider to pay for healthcare services.

did-you-know

Did You Know?

  • Approximately 9% ($262 billion) of hospital charges in 2016 were initially claim denials. However, roughly $165B of denied claims were recoverable.

Denials Consulting

  • Manage denials by knowing potential “at risk” MS-DRGs in advance
  • Uncover and eliminate root causes for Denials
  • List of denied claims that are likely to be appealed based on higher rate of approval
  • Denials analysis by service line/MDCs, CDS, coder, physician, top 10 DRGs

Miscellaneous

Detailed analysis will be conducted on following KPIs and shared with the provider in order to achieve efficiencies and prevent any revenue leakage in the existing processes:

  • DNFC days
  • LOS Variance
  • 30- day Readmission cases
did-you-know

Did You Know?

  • A 271 beds hospital enhanced its cashflow by $2.3M by decreasing its DNFC from 7.6 days to 4.7 days (38% drop)

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