Beginning in June of 2011, the Centers for Medicare and Medicaid Services (CMS) started streaming all fee-for-service (FFS) claims through predictive modeling protocol. The technology designed to profile medical providers, billing patterns and networks enables CMS to flag and investigate potential fraudulent claims activity. Utilizing advanced technology and traditional investigative strategies together to identify, or prevent, improper billing allowed CMS to recover a staggering $19.2 billion in a five year span, according to the agency’s June 25, 2014 press release.
While innocuous billing does not prevent payment, it delays reimbursement to enable a thorough review and transaction data funnels back into the predictive modeling system, refining …show more content…
Physicians, hospital administrators and other ancillary service providers can exploit data to improve financial performance and manage risk scores to reduce the number of red flags that trigger claim investigation, which delay reimbursements.
An ideal predictive model allows practice managers to capture a clear snapshot that anticipates monthly cash flow and helps financial leaders identify key payers and patient groups. Responsive solutions not only uncover negative trends, but also provide remedial options for decision-makers to consider. For example, health information technology enables financial leaders to aggregate, assess, and convert data into real-time information via simple and sophisticated search parameters to quickly identify payer reimbursement levels. If the system detects a payer with lower than expected performance, predictive analytics programs provide valuable strategic insight that empowers the practice or service provider to develop an appropriate corrective action plan to overcome the …show more content…
The convergence of advanced technology and leadership oversight supports a healthier revenue cycle from end-to-end.
The five steps recommended by AHIMA include:
Assessing and mapping the coding process
Outlining the future: Identifying key personnel, payers, patients and stations within the clinic or practice
Recognizing gaps and implementing remedial solutions
Defining realistic expectations and establishing performance timelines
Implement coding process policies
Utilizing analytics helps practice managers design an efficient billing and coding protocol in the office that enables better communication with payers, third-party billers, patients and outside service providers. Health information technology enhances each of the five steps recommended by
While innocuous billing does not prevent payment, it delays reimbursement to enable a thorough review and transaction data funnels back into the predictive modeling system, refining …show more content…
Physicians, hospital administrators and other ancillary service providers can exploit data to improve financial performance and manage risk scores to reduce the number of red flags that trigger claim investigation, which delay reimbursements.
An ideal predictive model allows practice managers to capture a clear snapshot that anticipates monthly cash flow and helps financial leaders identify key payers and patient groups. Responsive solutions not only uncover negative trends, but also provide remedial options for decision-makers to consider. For example, health information technology enables financial leaders to aggregate, assess, and convert data into real-time information via simple and sophisticated search parameters to quickly identify payer reimbursement levels. If the system detects a payer with lower than expected performance, predictive analytics programs provide valuable strategic insight that empowers the practice or service provider to develop an appropriate corrective action plan to overcome the …show more content…
The convergence of advanced technology and leadership oversight supports a healthier revenue cycle from end-to-end.
The five steps recommended by AHIMA include:
Assessing and mapping the coding process
Outlining the future: Identifying key personnel, payers, patients and stations within the clinic or practice
Recognizing gaps and implementing remedial solutions
Defining realistic expectations and establishing performance timelines
Implement coding process policies
Utilizing analytics helps practice managers design an efficient billing and coding protocol in the office that enables better communication with payers, third-party billers, patients and outside service providers. Health information technology enhances each of the five steps recommended by