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.

  • Predict where denials are likely to occur next and drive the operational change needed to reduce denial rates
  • Understand what non-obvious factors are correlated and contributing to your initial denial rate
  • Get denial overturn rates with associated net revenue
  • Benchmark on a payer-to-payer and peer-to-peer basis
  • Aggregate disparate data streams into one analytic application that delivers the revenue cycle decision support needed in today's climate
  • Audit of your final denial rate
  • Storage of your claim & remittance data within one application

As a revenue cycle leader, you want to gauge the denial risk of an account before the claim leaves your organization. You want denial issues and trends identified by payer, at the plan and service level to give pointed direction as to where the originating denial issues lie. You want to know about the hidden denial patterns that are attributing to your net revenue leakage. You want your revenue analyst team working in just that capacity, and getting away from simply preparing reports. Finally, you want to view commonalities among your peers with respect to denial patterns, and see where your organization stands out from the rest of the pack.

Alphalytics will give you the strategic lens that is sorely needed when it comes to denials avoidance. It will provide your Revenue Integrity team with specific areas of revenue-risk to focus efforts to correct the originating issue(s). It complements your current denials management and workflow systems as it highlights initial denial issues based on predictive modeling and leaves the claim-by-claim management to your existing systems. Benchmarking will provide you with comparative analysis of initial denial rate at the peer group and payer level.