FAQ

Phare Audit reads the full EHR for 100% of cases, consults current national and local guidelines and delivers evidence-based recommendations with a clinical evidence trail. It works pre-bill to prevent errors and post-bill to recover missed revenue.

Phare Audit can audit 100% of both inpatient and outpatient claims, including missing charges. With OP Audit, providers have the added safety net of knowing their outpatient claims have the same strong coding integrity before the bill goes out the door. The story is the same: we find and fix coding and CDI gaps before they become revenue leakage, denials, or compliance risk.

Phare Audit is the direct replacement and upgrade to DRG-V. We recommend running Phare Audit pre-bill as best practice, since it provides the strongest safety net, though it can also be run post-bill.

For clients below the NPR threshold, please discuss with your manager.

Audit runs after coding is complete. CDI runs during the patient's stay.

Always lead with pre-bill as best-practice. Post-bill is available if the customer demands it.

Our go-to-market approach is to sell Outpatient Audit as part of the broader Phare Audit offering, covering both inpatient and outpatient claims.

We have supported coding at scale for years and already apply AI in our coding operations for enterprise customers. Autonomous coding is a natural extension of Phare Audit and we recommend starting with Audit for fast ROI, then expand to autonomous coding when it’s ready.

Phare Audit delivers about $165–250 per discharge, compared with about $37 from DRGV (Erlanger example). Lead with value, not cost.

"We get paid on outcomes — it's a variable-cost model, not a license fee sitting on your expense line whether it works or not. What the number looks like depends on volume and scope, which is what I'd want to understand first."

Don't quote a rate; pricing runs through your RVP.

Accuracy means the AI's code is correct (about 88%). Acceptance means the client's auditor agrees with the finding (95%, after R1's review).

Phare Audit typically takes 8–12 weeks to implement and requires FHIR and HL7 data feeds. Once the data is flowing, we can tune the AI to the health system in about 14 days, significantly faster than traditional AI tuning that can take months.

Possibly, but the ROI covers it. At Novant, less than half a full-time employee handles about $23.8M a year in findings.

"A guarantee against a projection and an estimate built on your own numbers are different things. We can build out an estimated ROI from your data, accounting for your pre-bill edits and your retrospective work, and walk through what we expect to find. Then we can talk about what a commitment looks like."

Do not commit to a multiple in the room.

About 15% contingency, sometimes as low as 8%, and sometimes on identified rather than realized findings.

Customers who use Smarter find that they have to hire additional auditors to vet Smarter’s recommendations (coder agreement rate is around 50-60% for Smarter) . R1 is fully at risk and paid only on realized results.