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Casematch – Coding
Using algorithms to integrate more medical know-how into billing and thus improve the earnings situation and patient management
Casematch is a web-based software for analysing, auditing and improving DRG coding. It can be used across departments. The support and analysis of DRG coding is not rule-based as usual, but is based on statistical methods and self-learning algorithms. For this purpose, the latest technologies from the field of artificial intelligence (machine learning, deep learning and natural language processing) and a large data set of DRG-coded cases from Swiss hospitals are used. This allows errors in documentation or coding to be identified. Furthermore, case populations can be selected and analysed according to individually defined criteria. The software is also able to use implicit knowledge from the data to make predictions within the framework of case-related coding. Especially in complex cases, Casematch has proven to be an excellent tool for quality improvement and revenue optimisation. A retrospective check of conspicuous cases that have already been coded is also possible without great effort.
- Consistent billing of all services and the associated revenue optimisation.
- Directly integrated into ID DIACOS.
- Real-time coding suggestions help to code cases efficiently.
- Identification of incomplete or incorrectly documented patient cases.
- By creating individual checking rules in the rule editor, you can select conspicuous cases in a targeted manner and thus save time.
- Simulation of individual, conspicuous cases with coding scenarios.
Interface to ID CCC
Casematch can also be used within the framework of ID Clinical Context Coding (CCC). ID CCC analyses digital and digitised free text. Possible document locations for diagnoses or procedures are evaluated and sorted with the help of our models. This makes the suggestions more plausible and minimises the coding effort. The connection of Casematch to ID CCC is in productive use and can be booked without great effort.
Application example: Coding
During the coding work, Casematch runs along and continuously provides the user with a dynamic checklist / code suggestions (main, secondary diagnoses and procedures).
In this specific case, the ICD code C34.0 is suggested as the main diagnosis. The checking rule “Main diagnosis check MDC 17” also hits. It is therefore worth taking another closer look at the case. With the statistical analysis, a casematch calculates what effect a change of principal diagnosis has on the DRG. In this case, the change from HD C77.1 to C34.1 also means a change from DRG R62B to DRG E71A. This leads to a cost weight of 0.172, or the equivalent of about CHF 1,700 more remuneration.
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