Operational Analysis Experts

Intelligent Document Processing for Payer Cost Savings

2023-05-17T15:18:40-04:00By |Operational Analysis, Organizational Analysis, Quality Improvement Programs, Uncategorized|

Intelligent Document Processing (IDP) is a technology that uses artificial intelligence (AI) and machine learning to automatically extract and process data from documents such as claims forms, invoices, and medical records. This eliminates the need for manual data entry and speeds up the processing of claims and other documents.

Understand Claim Denials Affecting Reimbursement in Healthcare

2024-02-07T07:52:10-04:00By |Healthcare Independent Review, IRO, Operational Analysis, Physician Advisor/Peer Review, Revenue Cycle Improvement, Utilization Management|

To understand claim denials affecting reimbursement requires data. In healthcare, claim denials occur when an insurer or payer refuses to reimburse a healthcare provider for a particular medical service or treatment. Claim denials can occur for a variety of reasons, such as inaccurate or incomplete billing information, lack of medical necessity, or failure to follow the proper billing procedures.

Independent Peer Review Streamlines RCM

2023-03-15T13:37:41-04:00By |Healthcare Independent Review, IRO, Operational Analysis, Physician Advisor/Peer Review, Revenue Cycle Improvement, Utilization Management|

Independent peer review plays a crucial role in revenue cycle management for the healthcare industry. Revenue cycle management (RCM) refers to the process of tracking patient care from registration to final payment, including all the administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.

Health System CEOs Share ‘What Keeps Them Awake’ In Survey

2017-12-12T18:52:47-04:00By |Lean Management, Operational Analysis, Organizational Analysis, Population Health, Trends|

CEOs at hospitals and health systems are faced with increasing headwinds as they look to move forward in an uncertain environment. So what are the key issues and trends CEOs are facing? Deloitte interviewed 20 health system CEOs this year to find out. While none of the key themes emerging from our interviews have really changed since Deloitte last spoke with health system CEOs, the urgency certainly has. Instead of thinking about these issues in a futuristic sense, CEOs are ready to address and tackle them now. 

Successful Delegation To Downstream Entities

2018-05-23T16:25:27-04:00By |Compliance, Operational Analysis, Uncategorized|

Healthcare organizations face challenges regarding reduction of their medical and administrative costs because regulatory and administrative demands are increasing. Payers and providers must evaluate new partner relationships and solutions for work processes and potentially outsource administrative functions in order to offer competitively priced services to patients. Successful delegation requires planning.

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