Stop losing inpatient revenue to preventable denials and downgrades
CodeGuard gives inpatient coders real time, contract aware guidance so high value claims go out clean the first time.
Inpatient is where revenue and denial risk collide
- High-dollar DRG claims are magnets for downgrades, clinical validation reviews and coding denials.
- Denials tie up cash, burn staff time and often get fixed only after long appeals.
- Traditional edits and audits miss payer nuance and only see a fraction of cases.
What CodeGuard is
An assistant for hospital billing and coding personnel.
- Validates with citation UB-04 and DRG, and payer requirements before submission.
- Focuses on the administrative claim submission process, not diagnosis fishing.
- Helps coders see denial risk and found revenue while they work.
- Humans always decide what to change and when to submit. CodeGuard simply accelerates personnel efforts.
How it works
Step 1: Analyze the patient's stay
- Pulls key chart sections, procedures and current codes.
- Brings in payer contracts, provider agreements and policies
Step 2: Assess the Risk and Opportunity
- Checks DRG, CC/MCC and HAC/POA patterns.
- Spots likely downgrades or denials by payer.
- Finds missed or downgraded procedures and coding that are clearly supported.
Step 3: Give actionable clear guidance in existing workflow
- Sends results into coder and biller tools (Epic workqueues or existing worklists).
- Each item shows: short description, evidence, rule reference, est dollar impact.
- Coder can accept, reject or escalate; everything is logged, auditable, and Appeals support ready.