Chiroptera – Jubula (DRG audit) - Fraud prevention

Module for audit and post-audit activities

Jubula is a system consisting of two separate modules designed specifically for reviewing physicians. Its primary goal is to identify unjustified services reported by healthcare providers and streamline the audit of hospitalization cases. This process is carried out either during an audit before the invoice due date or as part of a subsequent review of already registered and settled invoices.

Outputs from the application serve as a basis for external audits conducted directly at healthcare providers. The module also includes a statistical section that allows tracking the results of post-audit activities by physicians and monitoring the savings achieved after audits for each month.

Product sheet:

Jubula

Key Functionality

Reviews of individual hospitalization cases in general or in terms of the insured
Checks of compliance with DRG coding rules; implementation of over 2000 controls
Automated processing and evaluation of the data received from the insurance information system

Main benefits

Improvement of post-audit activities related to DRG
Fraud detection – identification of the ineligible services reported by healthcare providers
Automated assessment of the correctness of hospitalization case coding

References

Union zdravotná poisťovňa, a. s., SR
Všeobecná zdravotná poisťovňa, a.s. , SR