Project Description
The purpose of the study was to review the charges on the claim with an application that could predict errors using the analytics from outpatient Medicare claim data. We examined the medical record to determine if there was a charge omission or if there was a charge error made. We used predictive analytics to alerts our client of claims to review. We examined all the evidence before jumping to any conclusions. We helped them source the root cause of errors. We created a grid with columns that itemized the following:
- Department charge CPT/HCPCS codes
- Coders’ entered CPT/HCPCS codes
- Codes that arrived on the UB claim form
We helped them generate more than 1 billion.
