Application
ARBUTUS ANALYZER
Data Analysis in Healthcare...
A Few of the Ways You can Put Arbutus Analytics to Work in Healthcare
- Patient Billing /
Managed Care - Pharmacy
- Physician
- Inventory
- Information
Systems - Compliance
Patient Billing, Accounts Receivable & Managed Care
- Recalculate bad debt and contractor allowance reserves
- Age receivables on date-of-service vs. invoice date to recalculate cash flow
- Age service billing dates to assess timely collections and write-offs
- Analyze rejected payments by financial class, procedure code, cost center
- Calculate average days from discharge to bill, bill to payment, by payor or department
- Calculate days in accounts receivable
- Calculate reimbursement percentages by payer
- Compare date-of-service to invoice date to identify opportunities to re-engineer charge processing
- Compare detailed aging of receivables to timing cycle required by Medicare to identify opportunities for improvements in charge processing
- Determine appropriate level of doubtful accounts reserves
- Determine average billing amount by financial class or cost center
- Determine average number of days from invoice to payment by financial class
Pharmacy
- Analysis of payroll records for higher risk employees (nurses, pharmacists, etc.).
- Identify employees who have not taken a vacation for an extended period of time. Risk: Don’t want to be away from work because of need for drugs or “making sure to cover their tracks”.
- Identify employees with high amounts of overtime or always volunteer to cover a shift.
- Conversely, identify employees who have a spike in number of sick days taken.
- Trend analysis of higher risk employees and higher risk drugs/ controlled substances.
- Analysis over time of higher risk employees and use/ administering of controlled substances.
- Calculation of standard deviation of use of controlled substances compared to other employees for the same time frame.
- Test for unusually high amounts of drug wasting (standard deviation analysis).
- Identify orders of unusually high amounts of opioids/ controlled substances compared to usage.
- Compare use of controlled substances/narcotics compared to job description of the hospital employee
Physicians
- Determine physician contract compliance
- Evaluate physician practice history by patient type, payer, etc.
- Report on incomplete physician profiling information
- Test physicians for current accreditation
- Selectively audit new physicians for reporting compliance
Inventory/Material Management
- Divide inventory into classes and compare percent investment
- Identify duplicate supply items on inventory master
- Identify items with yearly volume under on-hand quantity
- Identify obsolete inventory by sorted turnover analysis
- Identify starting and ending period balances by class or group
IT and Security
- Compare authentication/authorization files to employee files to identify terminated employees
- Identify corrupt data fields
- Identify duplicate records
- Sort current system lists by system privilege to identify people who have more access than required for job duties (including I.S. employees)
- Compare system access to physical security logs
Compliance
- Identify single day stays and subsequent readmissions
- Identify inappropriate unbundling of lab tests
- Identify frequent use of high risk organizations
- Match OIG-excluded providers list with vendor, employee master files
- Identify upcoding
- Analyze patient data access logs to identify possible HIPAA risks/violations
Material de Referencia
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