Executive Summary: The Plato Compliance Management System is an easy to use revenue cycle monitoring and decision support tool. Especially suited for case mix analysis, CMS compliance risk and financial review of operations, Plato Compliance is designed for flexible drill down to root cause indicators. The Challenge: Our customers came to us with a question: can you help us to bring together key financial indicators from a few data sources and develop numbers or reports that show us how our healthcare business is doing? Next, can you help us drill down into highlighted issues and identify targets for process improvement? Our Response: We’ll help your healthcare business with this challenge – it’s what we do! CPR Technologies takes fragmented, labor intensive process review activities and then applies software to help organize, simplify, and provide access to the information you want to properly run your healthcare business.

Features

Collect Monthly Numbers – quickly and efficiently accumulate DRG and related financial data:

• By Payor – Medicare, Medicaid and All Others
• By Key Metrics – Date, Case Mix, Average Length of Stay, Discharge, Patient Days, Charges, etc.
• Make data available at the point of collection, reducing delays in decision making.

Focus on Key DRG’s – easy DRG targeting allows you to focus on critical indicators:
 

• OIG Pairs
• Targeted OIG DRG’s
• Transfer DRG’s
• Top 20 DRG’s
• By Payor or All Payors
• By other Key Metrics

Trend changes in DRG Indicators – rapidly compare and contrast changes over time:

• By Payor – Medicare, Medicaid and All Others
• By Contributor – Physician, Coder, and All Others
• Identify patient population shifts that impact case mix
• Specify time frames of your choosing

Simplify the Process – rapidly reduce administrative overhead for data collection/entry, spreadsheet development, graphing, etc.

Report Operational Results – powerfully demonstrate performance and opportunities for improvement:

• Case Mix Review and Analysis
• By Medicare, Medicaid and All Others, etc.
• Timely & Complete Documentation accelerates Revenue Cycle
• Coding Standards and Guidelines Adherence minimizes Denials

Qualify Compliance Risks – quickly target DRGs at risk for CMS scrutiny:

• Follow false claim risk DRG’s and indicators
• Data validation proof sources your Monthly Case Mix Review
• Avoid potential compliance fault fines:

• Prevent $11,000 per false claim fine (s)

• Head off additional fines of up to 300%

Drill into to DRG Trend Details – on demand, over time by revenue source:
 

• Top 20 DRG’s trend details

  • By individual DRG

  • With associated metrics - Date, Case Mix, Average Length of Stay, Discharges, Patient Days, Charges

  • By time frames of your choosing

Integrate with existing data sources – state of the art integration leverages XML, HL7 and rapid integration deployment (RID) to eliminate integration headaches.

Identify Process Improvement Opportunities – initiate positive changes by resource and process:
 

• Physician

• Coder

• Documentation & Coding process

  • Education

  • Documentation

  • Standards

  • Bylaw Enforcement

  • Physician Query

  • Discipline

Process Improvement Action Monitoring – staged for subsequent review with the Plato Data Analyzer®
 

• Formalized Internal Review of Coding Processes

• Focus on Quality of Coding

• Survey ICD-9-CM and CPT Coding Processes

• Supports Case Selection Targeting

Standardize Reporting across the Enterprise – account for multiple hospitals over many regions and across multiple states.