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Balanced Analytic Revenue and Compliance Reporter (The BARCR): The Use of Data Analytics to Reduce Compliance Risk and Enhance Revenue

 

Hospitals are being subjected to increasing audits and reviews by Medicare and contractors, as well as other payers and regulatory agencies. The advantage those reviewers have is the power of data analytics, or ‘data mining’, which translates into inconsistencies, the ability to use a hospital’s claims data to identify potential vulnerabilities and compliance problems.

 

By using claims data analysis these reviews identify errors, trends, and other issues readily identified, thereby allowing for prospective resolution before any significant repayments or even identifying trends of concern. Most hospitals and other health care providers don’t have the tools or dedicated resources to do comparable analysis and get ahead of the Government and other auditors. As a result, the errors are only identified once the audits are done and repayments made. As the hospital focuses on fixing those issues, the auditors have moved onto others.

 

In addition, the inability to conduct data analysis can cause lost revenue when billing opportunities are missed and money is left on the table. With the challenging regulations and intense audit environment, health care providers absolutely need to create a level playing field and know their own data.

 

The Solution

 

Kohler Healthcare Consulting utilizes a data analytics tool that can identify regulatory risks lurking in your claims data, and can also identify potential lost revenue. This tool, referred to as the Balanced Analytic Revenue and Compliance Reporter (BARCR), allows us to analyze the risks for lost income and compliance concerns present in your 837 claims files. This tool, combines with edits from all MACs, RACs, CCI, clinical indicators and OIG focus issues, and MEDPAR data to analyze individual data fields and the claims in total (services and diagnoses). It includes comparison of your data to the data of peer organizations to identify outliers and trends. It helps point to the direction of actions needed in a time of limited resources.

 

KOHLER HealthCare Consulting, Inc. (KHC) has been a leader in understanding the importance of data and process analysis, and is excited to assist health care providers to analyze and interpret their data using a powerful data analytics tool. Data analysis is no longer an ancillary, optional, piece of compliance reviews, due diligence, or revenue cycle analysis: it is a core function to allow hospitals and other healthcare providers to achieve compliance and maximize revenue appropriately.

 

Analyzing claims data can be difficult due to multiple billing systems, lack of internal resources, and the constant pressure of ongoing audits, creating difficulty to proactively address compliance risks and potentially lost revenue. This total is cost effective. There is no other tool that does both: compliance risk and potential lost revenue, while allowing you to focus on the specific claims identified for investigation.

 

Our team provides support in conducting analysis of claims data to provide a focused review of compliance risk areas and potential revenue lost. Whether for a one-time analysis, or over time, the Kohler HC team can assist. We can help you decide what audits or criteria to run, what period of time to review, and how to interpret and address the results. In addition, the BARCR tool is available for up to 6 months after the Kohler HC analysis is complete. You can learn to run updated data and verify the success of improved processes, or Kohler HC is able to support you as a “utility” team member, playing in whatever role is necessary to support your efforts.

 

 

Contact us to help
put the pieces together
KHC Offices (410) 461 – 5116

 

Collaboration + Knowledge = Sustainable Results

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