PayRight℠ Rules Engine
Paytegrity algorithms are designed from coverage, billing, coding, clinical, and reimbursement guidelines and optimized by advanced analytics and machine learning.
Paytegrity algorithms are designed from coverage, billing, coding, clinical, and reimbursement guidelines and optimized by advanced analytics and machine learning.
PayRight℠ Compliance Audits
Paytegrity utilizes season auditors with years of experience in chart reviews. Our staff is abrasion conscious.
Our reviews and denial rationale are both thorough and clear to ensure minimal rework. We know experiene and expertise matters.
PayRight℠ Advisory Services
Paytegrity is a results-driven, client-focused, strategic partner, specializing in end to end PI services and solutions. Our team specializes in detection, correction and prevention.
Our collaborative problem-solving approach is centered on partnership and discipline – using tried, tested, and proven methods to identify the nature of the problem and provide you the best practical solution to address, correct, prevent, and monitor ongoing performance.
Sample Case Studies
MS-DRG
- DRG Coding Review is an important Payment Integrity Solution.
- Hospital Spend represents significant spending. P
- Payer was experiencing sub-optimal performance, less than $1m in savings across a 1 year period.
- Paytegrity deployed our existing DRG algorithms and added experienced inpatient coders to perform reviews.
- Within the first 8 weeks, results climbed from an 18% success rate to 59% success rate (real-time monitoring).
- Our team continued to monitor daily and refine results during the following 8 weeks to drive improved performance and reduce false positives.
- Performance improved overall to 68% success rate.
- $6.2m in savings in first year.
ESRD
- End State Renal Disease is also an important PI solution with significant spend.
- Payer had some post pay oversight
- Paytegrity deployed existing ESRD concepts using a Prepay approach.
- Payer experienced immediate, ongoing month over month savings, resulting in over $6m in savings during the 1st year and yields above $4m the 2nd year.
- Additionally, several root causes were identified and corrections implemented.
ER Leveling
- Outpatient spend also represents significant spend.
- It is estimated that > 20% of ER claims are improperly coded.
- Client uses an existing program but sought audit support
- Paytegrity deployed our existing ER Leveling concepts, added outpatient coders to perform validations.
- Savings identified $7.9m