From DRG Accuracy to RAF Optimization: Mastering CDI for Payer Profitability

Accurate coding is the lifeblood of health plan profitability. Improper coding can lead to missed revenue opportunities, inaccurate DRG assignment, and financial penalties. This webinar explores how Clinical Data Integration (CDI) empowers you to achieve optimal coding accuracy and maximize your bottom line.

Health Chain dives deep into the power of CDI for unlocking hidden financial benefits, including:

Unearthing Missed Revenue & DRG Accuracy: Identify under-coded diagnoses and procedures. Leverage CDI to pinpoint these missed opportunities and ensure accurate DRG assignment, leading to higher reimbursement from Medicare and Medicaid. A 2021 study by AAPC found that effective CDI programs can identify up to 10% of missed coding opportunities, translating to millions in additional revenue for large health plans [1]. This translates to improved DRG accuracy, a critical factor for appropriate reimbursement.
Optimizing Risk Adjustment: Capture all relevant factors impacting patient health complexity. CDI programs enable comprehensive data, ensuring accurate risk adjustment through optimized RAF scores. This translates to higher revenue under risk-based payment models.
Minimizing Reimbursement Risk: Ensure complete and accurate data to minimize the risk of improper coding and potential recoupments. CDI empowers you to comply with current coding guidelines, reducing the threat of financial penalties from regulatory audits.

Takeaways:

Learn how a well-designed CDI program can significantly improve the accuracy of DRG coding and RAF calculations, leading to increased revenue potential.
Discover how optimized risk adjustment through effective CDI translates to a significant financial advantage for your health plan.
Gain insights into how improved data practices, facilitated by CDI, can ensure coding compliance and minimize the risk of financial penalties.
Get a free copy of Gartner’s report on “How Clinical Data Integration Improves U.S. Healthcare Payer Interoperability”

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