80% of all medical
bills contain errors*
What if you could catch coding
errors prior to billing?

PwC SMART® (Systematic Monitoring and Review Technology) increases the efficiency and effectiveness of your inpatient and outpatient coding quality evaluation process, and enables a mechanism for quality and compliance review. Coupled with the support provided by PwC's Health Information Advisory, SMART bolsters your efforts to monitor coding and data quality.

LET'S TALK
*Source: "Medical Billing." Healthcare Business & Technology, 2019
 
 
80% of all medical
bills contain errors*
What if you could catch coding errors prior to billing?

PwC SMART® (Systematic Monitoring and Review Technology) increases the efficiency and effectiveness of your inpatient and outpatient coding quality evaluation process, and enables a mechanism for quality and compliance review. Coupled with the support provided by PwC's Health Information Advisory, SMART bolsters your efforts to monitor coding and data quality.

LET'S TALK
*Source: "Medical Billing." Healthcare Business & Technology, 2019
 
The SMART® way
to tackle coding errors
SMART
Inpatient

SMART Inpatient includes 1,000+ pre-defined business rules that identify potential coding inaccuracies and documentation improvement opportunities. You can also customize business rules for your specific areas of focus. Reporting and data analysis help you evaluate your staff’s performance and pinpoint education opportunities for Coding, Clinical Documentation Improvement (CDI), Quality and Providers.

SMART
Outpatient

SMART Outpatient improves the accuracy of claims and identifies charge capture issues and areas for workflow improvements. It also improves regulatory compliance by decreasing the risks caused by inaccurate coding across all ambulatory services and selected areas, such as emergency departments or observation patients.

SMART
Professional

SMART Professional, coming later this year, will leverage the proven success of our coding accuracy workflow to analyze 100% of claims for all medical specialties and services. Coding and billing related edits will be designed to both improve coding and charge capture and reduce compliance risk. Custom reports will give management insight on areas to focus physician education, outliers compared to peer benchmarks and E&M profiling.

 
 
The SMART® way
to tackle coding errors
SMART
Inpatient

SMART Inpatient includes 1,000+ pre-defined business rules that identify potential coding inaccuracies and documentation improvement opportunities. You can also customize business rules for your specific areas of focus. Reporting and data analysis help you evaluate your staff’s performance and pinpoint education opportunities for Coding, Clinical Documentation Improvement (CDI), Quality and Providers.

SMART
Outpatient

SMART Outpatient improves the accuracy of claims and identifies charge capture issues and areas for workflow improvements. It also improves regulatory compliance by decreasing the risks caused by inaccurate coding across all ambulatory services and selected areas, such as emergency departments or observation patients.

SMART
Professional

SMART Professional, coming later this year, will leverage the proven success of our coding accuracy workflow to analyze 100% of claims for all medical specialties and services. Coding and billing related edits will be designed to both improve coding and charge capture and reduce compliance risk. Custom reports will give management insight on areas to focus physician education, outliers compared to peer benchmarks and E&M profiling.

The SMART difference
Customizable to fit your needs

Unique flexibility to reconfigure processes, edits, and settings.

Visibility into what can get better

Easy to identify opportunities for ongoing operational improvements through data analysis and reporting.

Time-saving automation

Seamless audit tracking to review past results and monitor the progress of all ongoing audits.

The SMART difference
Customizable to fit your needs

Unique flexibility to reconfigure processes, edits, and settings.

Visibility into what can get better

Easy to identify opportunities for ongoing operational improvements through data analysis and reporting.

Time-saving automation

Seamless audit tracking to review past results and monitor the progress of all ongoing audits.

Success starts with SMART
Get the right reimbursement

Alerts your staff when there are potential coding errors or opportunities which gets your billing out the door quicker.

Meet regulatory requirements

Multiple updates to include revised filters and new proprietary flags targeted to reduce the risk of errors stemming from new coding rules and standards.

Make your team more efficient

Automates the review process so your staff can cover more cases and simplifies the coding evaluation process, allowing for more efficient use of scarce or costly coding auditor resources.

Success starts with SMART
Talk to the people behind SMART

With 25+ years in the market, SMART is built on decades of coding and billing process work resulting in the most extensive business rules in the market. Talk to our professionals about what SMART® can do for you.

Shannon O'Shea
Partner

"It's difficult for our clients to review thousands of claims before they bill. SMART flags help them to pinpoint which cases need a second look and reduce time wasted on those with no errors."

David Agan
Director

"SMART really shines when you bring in new coding staff because it can closely monitor their accuracy and identify areas of concern so that training can be provided quickly."

Diane Cahalan
Director

"You have to be ready to respond in a timely manner. But I think a better way to prepare yourself is to determine how to stop denials from happening in the future. That is where SMART comes in to maximize accuracy and reduce rework."

Talk to the people behind SMART

With 25+ years in the market, SMART is built on decades of coding and billing process work resulting in the most extensive business rules in the market. Talk to our professionals about what SMART® can do for you.

Shannon O'Shea
Partner

"It's difficult for our clients to review thousands of claims before they bill. SMART flags help them to pinpoint which cases need a second look and reduce time wasted on those with no errors."

David Agan
Director

"SMART really shines when you bring in new coding staff because it can closely monitor their accuracy and identify areas of concern so that training can be provided quickly."

Diane Cahalan
Director

"You have to be ready to respond in a timely manner. But I think a better way to prepare yourself is to determine how to stop denials from happening in the future. That is where SMART comes in to maximize accuracy and reduce rework."

The real impact of SMART

As a result of corrections identified by SMART, the net reimbursement impact across the enterprise was $1.8M.

Healthcare provider network

PwC brings a sophisticated approach to customer insights on a leading platform. PwC aims to be a one-stop shop for healthcare analytics and professional services.

The Forrester Wave™
Healthcare Analytics, Q4 2018
Read the Forrester report here.
Coding quality improvement leads to $1.8M in net reimbursements.

The situation

A network of independent healthcare providers in New Jersey were striving to keep up with a rapidly-changing regulatory environment They were looking to leverage technology to monitor and improve inpatient coding quality on a pre-bill basis to promote both compliance with government regulations and obtain appropriate reimbursement to the institution for the services provided.

They needed to be current with both coding and guideline updates and regulatory initiatives.

Shannon O’Shea
Partner, PwC US
Now they can automate the review process and identify cases requiring validation prior to billing.
Diane Cahalan
Director, PwC US
What we did…

To support our client’s coding quality monitoring initiatives, PwC implemented SMART® Inpatient throughout the enterprise, with installations at 12 facilities; 11 inpatient and 1 behavioral health facility.

In addition to leveraging over 1,000 standard SMART edits, we worked hand-in-hand with our client to build and incorporate 35 custom edits to accommodate their specific organization initiatives. They were able to incorporate both coding and regulatory initiatives such as MS-DRG changes, CMS’ RAC initiative, and Pay for Performance, including quality initiatives such as Patient Safety and Hospital Acquired Condition monitoring, to improve their inpatient coding quality.

By incorporating pre-bill reviews into their workflow across the enterprise, they can stay on top of coding and regulatory requirements.
Shannon O’Shea
Partner, PwC US
How did it do?
$1.8M

in net reimbursement impact across the enterprise as a result of corrections identified by SMART.

17%

of flagged cases reviewed by SMART required corrections, including a Diagnosis Related Group (DRG) revision in over half of the 5.5K cases flagged. The DRG revisions made by the SMART Quality Officers resulted in $13.9M in total claims revised.

Let’s talk about what SMART
can do for you
Let’s talk about what SMART can do for you
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