Inpatient (IPPS) Module

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The IPPS (Facility Inpatient) auditing module of ReviewMate provides:

  • Accuracy rates for all elements including:

    • MS-DRG (Medicare Severity Diagnosis Related Groups)
    • APR-DRG (All Patients Refined Diagnosis Related Groups - Copyright 3M)
    • SOI (Severity of Illness - Copyright 3M)
    • ROM (Risk of Mortality - Copyright 3M)
    • Diagnosis (ICD-10-CM or ICD-9-CM)
    • Principal Diagnosis
    • Secondary Diagnosis
    • POA (Present on Admission)
    • Discharge Disposition
    • Procedure (ICD-10-PCS)
    • CPT/HCPCS (Current Procedural Terminology/Healthcare Common Procedural Coding System - optional)
    • Procedure Provider
    • Procedure Date
    • MCC (Major Comorbidity or Complication)
    • CC (Comorbidity or Complication)
    • CMS-HCC (Heirarchical Condition Category)
    • HAC (Hospital Acquired Condition)
    • Customizable Overall Accuracy Rate

  • Both MS-DRG and APR-DRG grouping and pricing take place within the software eliminating the need for auditor to “toggle” between an encoder and ReviewMate. This also eliminates the need for auditors to re-enter codes and demographics into an encoder/grouper to make resequencing decisions.

  • Full suite of references including Coding Clinic, CPT Assistant, Coding Clinic for HCPCS, Clinotes, Principal Diagnosis Analysis, DRG Analysis, AHA Coding Handbook, and code look-up eliminating the need for auditors to access an outside product to perform research

  • Identification on the screen of codes with MCC/CC/HAC and CMS-HCC values.

  • Full suite of edits/warnings including gender and age conflicts, MCE edits, critical error and TruCode warnings.

  • Reconciliation of rebuttals occurs inside of ReviewMate.

  • Conversations between the auditor and coder are saved in a chronological manner and can be accessed by any user.

  • Accuracy rates available real-time and can be sliced and diced to accommodate different situations and date patterns.

  • Extensive library of customizable and exportable reports from raw data to Executive Summaries.

  • Customizable dashboards to enhance the user experience.

  • Multiple user levels allow view-only access to any interested parties providing transparency within your organization.

  • “Audit the Auditor” available for a higher-level quality check of any audit in ReviewMate.

  • Support for Profee audit within the IPPS module.