Predictive Analytics

A powerful solution for CFOs/Revenue Cycle Leaders determined to enhance net revenue and cash flow.

 

PROBLEM: Denials and Underpayments

Every day, the stakes get higher – but the “solution” remains the same. The challenge of bundled payments and re-admission rates is increasing billing complexity and denials. Underpayment has become so commonplace it is assumed. Denial patterns have become increasingly impenetrable. ICD-10 is poised to usher in an entirely new class of billing mistakes. In this environment, CFOs/Revenue Cycle Leaders are being judged by their ability to recover revenue and accelerate cash flow.

The problem: The traditional means of dealing with such new realities doesn’t work. Throwing staff and spreadsheets at challenges like these is tried but not true. By the time you get the numbers, they’re yesterday’s news. All this is occurring within a system that is all about the next claim. As a result, you’ve been forced to accept untenable levels of underpayment and denials as the cost of doing business.

 
SOLUTION: Alphalytics™ for Denials Prediction and Revenue Risk Mitigation  A

Alphalytics impacts organizations across many departments. Click below to read more on how they are positively affected. For more information, contact alphalyticsinfo@alpha-sys.com or call 800-732-9644.

  • Predictive daily revenue risk-scoring for prevention of readmissions and level or care downgrades served up and ready for action
  • Integrate care management reporting module into larger analytic framework
  • Lessen dependency on historical final denial reporting - gain more meaningful perspective from initial denial rates

As a Care Management leader, you want to know the specific data patterns that have historically resulted initial denials due to level of care issues. You also seek denial overturn rates and associated net revenue recovered based on your staff’s efforts. You also want insights on high-denial risk patients that are still in-house.

Alphalytics will empower you with the targeted insights needed to aid you with clinical denial reductions. Historical patterns arm you with the specific types of cases that are being denied, as well as the frequency of the denial and net dollars at stake. Establishing daily risk-scoring will allow focus on cases with data patterns that, based on past experience, serve as a warning sign of a future denial.