YAKIMA, WA–(Marketwired – Jun 7, 2013) – VitalWare, the leader in business intelligence for ICD-10 and beyond, today announced the introduction of VitalSigns, a new claims auditing and ICD-10 financial risk assessment tool. Since predictive modeling is not the answer for accurate budgeting, payer negotiations and focused physician training programs, VitalSigns was developed to go beyond the limits of traditional predictive modeling services.
Standard ICD-10 predictive modeling generally utilizes a crosswalk (GEMs or another crosswalk) for mapping one year’s worth of ICD-9 claims to ICD-10 to create pseudo ICD-10 claims. However, using predictive modeling, hospitals and health systems get a limited, basic view of financial risks due to crosswalk limitations.
VitalSigns goes beyond predictive modeling by uncovering the true cause of a hospital’s DRG shifts in ICD-10 to reveal complete and accurate financial risks and specific clinical documentation and improved coding opportunities.
“With our VitalSigns tool, hospitals see which of their specific DRGs shift, why they shift, and the impact of that shift. This critical information assists organizations in assessing true ICD-10 financial risk, which helps hospitals develop laser-focused physician and coder training and negotiate payer contracts in ICD-10,” said Kerry Martin, CEO and Founder of VitalWare.
Cottage Health System, Genesis Healthcare System, Kforce, Labette Health, Norman Regional and Rice Memorial used VitalSigns to identify a subset of cases to be ten-coded based on the facility’s actual risk criteria. With VitalSigns, these hospitals and healthcare organizations were able to uncover their most impactful MS-DRG shifts, and identify high-risk documentation and coding deficiencies.
“Through our VitalSigns ten-coding projects, we’ve found that a hospital’s highest risk DRGs may not be their top 10 or even top 20 grouped DRGs. It is the remaining DRGs, and in many cases those that contain complex comorbidities, that are at a higher risk of a significant DRG shift if not completely and accurately understood and documented,” said Martin.
VitalWare also offers the VitalSigns ‘Quick Start’ program. Rather than utilize a hospital’s valuable internal coder resources, which are often stretched thin, VitalWare’s expert coding team reviews chart documentation and ten-codes a group of “at risk” claims, helping hospitals get a jump start on their ten-coded claims data repository. Using VitalSigns Quick Start, hospitals can determine, within a short period of time, their true financial risk and discover documentation and coding risks.
The VitalSigns Quick Start team helps by:
- Analyzing claims data in ICD-10,
- Identifying records to be audited, based on the facility’s definitions of risk, and
- Performing actual ten-coding of a subset of claims to identify specific MS-DRG shifts and documentation and coding deficiency opportunities.
VitalWare leads the market in transforming healthcare intelligence into useful and actionable information, thereby allowing their clients to focus their time and resources on core business. Headquartered in Washington State, VitalWare was established to help organizations with the overwhelming task of navigating the many regulatory changes taking place in today’s healthcare environment. For more information visit www.vitalware.com, email firstname.lastname@example.org, or call 855.464.2310.