DRG Audit Platform

AuditShark DRG Audit Platform

DRG and Clinical Chart Audit Platform

AI-Assisted Chart Audits

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THE PROBLEM

Health plans are under increasing pressure to find more savings, and DRG and Chart reviews present a huge opportunity. However manual processes on disparate, aging technologies are leading to low hit rates and slow reviews, which drives abrasion and erodes margin. Auditors must toggle between multiples screens hunting for clues buried in enormous volumes of clinical text. Manual repricing makes it hard to prioritize savings opportunities.

We want to insource, but we can’t: Many plans wish they could insource DRG audits, but legacy approaches to DRG auditing prevent them from making the investment.

DO THESE ISSUES SOUND FAMILIAR?

Growing Inefficiency

Low Hit Rates: Audit teams suffer from low hit rates because they cannot leverage insights to prioritize audits based on actual findings or likelihood of error.

Currently At Capacity: Many audit teams are maxed out already, even though they are being asked to do more each year. But without a fundamental transformation in the audit process, teams are stuck.

Manual Processes: Auditors are often forced to toggle across multiple platforms to perform their work, reducing cycle times and leading to admin waste. These processes are holding the teams back from increasing capacity.

Unable to Prioritize Audits based on Price: Audit teams often take a brute force approach to their queues, unable to know what an audit finding could be worth before ever performing the audit. This is because each health plans pricing methodology is locked away in another system Growing Administrative Burden

Growing Administrative Burden

Operate at Top of License: Clinical auditors are highly skilled yet are forced to perform tedious administrative tasks. Clinical leaders want their team operating at the Top of their License, not sidelined by manual admin work.

Fatigue and Human Error: Medical charts are over 50% copy-pasted today due to multiple different providers and specialists looking for their own workflow efficiencies. Auditors must carefully review these entire records, looking for the ‘needle in the haystack’, where the hay is growing exponentially. This can lead to time wasted, fatigue and human error, and contribute to low hit rates, avoidable appeal overturns and provider abrasion.

OUR SOLUTION

Transform your internal DRG Auditing operation with AuditShark DRG!

Our DRG and Clinical Chart Audit platform combines AI techniques using clinical NLP, intelligent workflows, and machine learning to streamline the extraction and auditing of data from clinical charts. With AI-Assited reviews leveraging GenAI, auditors streamline their investigation on a single screen, with pinpoint accuracy and total efficiency.

Automated repricing ensures the right reviews are prioritized. Machine learning techniques improve claim selection and hit rate. Automation improves review time, increasing throughput and operational efficiency. Detailed reporting informs claim selection and uncovers hidden insights, including detailed efficiency and quality metrics.

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What could faster Audit Reviews
mean for your team?

audit solution

OUR PLATFORM

  • Enterprise clinical chart repository
    Access clinical charts, across the enterprise, from a single comprehensive location
  • Smart audit selection
    Select the right claim the first time with advanced analytics and machine learning to prioritize audits
  • Clinical chart data extraction
    Leveraging Clinical NLP and other AI techniques, pinpoint the most important information in the audit with machine grade precision and accuracy
  • Automated re-pricing
    Save time with automated re-pricing, prioritize the right reviews, and optimize the efficiency of the entire audit process
  • Advanced analytics
    Detailed insights and patterns on billing behavior, auditor efficiency, and audit quality

BENEFITS

  • Improve Hit Rate and Claim Selection
  • Increase Throughput and Operational Efficiency
  • Reduced Provider Abrasion
  • Maximized Savings
  • Discover Hidden Insights

Get in touch today to supercharge
your DRG audit team!

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