This case study highlights the optimization of revenue in healthcare settings through strategic audits and training. AAPC analyzed over 500,000 medical records across seven hospital systems from 2020 to 2023. DRG accuracy improved from 94% to 96% with targeted training. Key findings include frequent errors in coding sepsis, digestive issues, and cellulitis, impacting revenue. Emphasis on precise coding, including secondary diagnosis and Z codes, is crucial. Programs like MIPS and MACRA offer financial gains, but missed physician queries and coding inaccuracies can affect reimbursement. Effective audits, targeted training, denial analysis, and compliance are essential for financial growth.

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