Revenue Integrity Analytics

Cloud-based revenue integrity analytics solution to improve net revenue

Value Proposition:

At CentraMed, we believe that a provider should recover full economic value of a claim the first time. Claims should be accurate and submitted in a timely manner to eliminate rework. CentraMed’s Revenue Management Analytics’ primary goal is to minimize revenue leakages and improve net revenue across the patient continuum.

On an average, our clients realize 3% to 4% in net revenue gain per year. While expensive software tools and outsourced companies focus on the high dollar accounts, we focus on the last few cents and literally deliver “found” money that always delights the C-Suite.

Leveraging big data powered patient-centric analytics platform, Revenue Management Analytics expands from individual patient account level detail to illustrate potential enterprise-wide revenue gain. Intelligent algorithms detect potential revenue improvement accounts and route them into work queues in real time. From RAC audits to 3rd party Defense audits, from payment variance reviews to missing charges, coding and CDI documentation reviews, Revenue Management Analytics provides for the tracking and trending of transactional and process correction – thereby prioritizing findings and prevent future revenue leakages.

Leveraging big data powered analytics platform, CentraMed Denials Analytics solution is designed to analyze remittances daily to help providers alert potential denials, uncover hidden problems, highlight trends, and realize cash opportunities.

Key Features & Benefits:

• Concurrent Charge Audit of High Value & Price Sensitive Accounts
• Source System agnostic; Seamlessly works with inhouse Hospital Financial Systems (No outsourcing)
• Algorithms to identify potential missing charges & underpayments
• Improves CDI, Clinical Coding Compliance
• JCAHO Compliant Process Improvement Initiatives
• Improve staff productivity with intelligent work queues
• Real-Time Visibility – web, tablet, smart phone
• Easy-To-Use Pre-built dashboards & reports with adhoc reporting
• Modular Cloud-based solutions; Quick Time to Value
• 3% to 4% in Net New Revenue Recovery

Solution Suite:

Revenue Management Analytics Suite contains several modules that allow the user to import all patient relevant data on pre-determined claim types and populations – thus creating daily work queues and priorities by review type.

• Charge Audit: This concurrent Charge Audit module supports concurrent, defense, and special audit charge capture audit results. Special queries are setup to generate automated work queues based on the business need. All itemized audit results are posted to the patient account and kept in the data repository for tracking and further analyses.
• Managed Care: This retroactive payment variance module contains audit results for managed care, commercial and denials management payment discrepancy reviews. Special queries are setup to generate automated work queues based on the business need. Underpayments are kept in their own A/R system and cash collections are tracked and posted daily.
• CCDR (Coding Compliance & Documentation Review): This module allows for retroactive specialized, targeted audits for high risk CMS documentation and coding errors that often result in underpayments.
• Trend Tracker: This module transforms process improvement observations into quantified process improvement initiatives by reconciling revenue and usage data with transactional results – and providing overall revenue impacts by initiative. The process used is JCAHO (Joint Commission) compliant for systemic and error correction activities.
• RACovery ToolKit TM: This module supports Providers response to Medicare Fee for Service (FFS) Recovery Audit Program. Providers can rely on RACovery Toolkit to defend their claims against RAC audits. This web based application is work flow driven, supports in/out patient, rehab, skilled-nursing facility and all government audits. Providers can track from a RAC Demand Letter all the way to Providers’ response to RAC. The application has a robust library of pre-built dashboards, reports, and also supports adhoc report generation. The solution is one of the few certified by Executive Health Resources (E.H.R.), an Optum Company.
• RM Analytics: Leveraging a comprehensive remit and audit national database compiled over the last 15 years, RM Analytics provides metrics driven dashboards and reports that allow providers to bench-mark with similar size systems, regional state and national levels geographical regions, etc. Users can leverage pre-built dashboards with KPIs and have the flexibility to create adhoc dashboards, and multi-source reports. The mobile friendly platform is user friendly with simple drag and drop functions, benchmarks and alerts.

Bottom Line:

CentraMed Revenue Management Analytics is one of the most comprehensive and cost-effective audit and analytics solutions available in the market today. Whether you have an internal or vendor-based Revenue Integrity Department or outsource audit services, CentraMed Revenue Management Analytics fits all. Net Revenue gain is in our DNA. Click here and find out how !!