CLAIMHEALTH
What is ClaimHealth®?
ClaimHealth® is an AI claims diagnostic software that will audit 100% of your organization’s radiation oncology patient claims, for any defined time period, with the most up-to-date authoritative rules and industry standards.
ClaimHealth® will quantify the R.O.I [Revenue – Opportunity – Institutional Risk] based on your claims data.
CLAIMHEALTH
With ClaimHealth® your Radiation Oncology Department will be able to know the following key information about their revenue cycle and operations
- Billing and coding errors based on all of Medicare and Commercial Payor authoritative guidelines
- Missed billing opportunities (i.e. lost revenue from codes not billed)
- Inconsistent payment trends or partial payments by payor
- Potential institutional risk
- How to reduce backend denials
- Technology utilization trends by cancer type
- Fractionation patterns by cancer type
- Estimate the potential impact of the RO-APM
- Operational statistics displayed on a customizable dashboard
CLAIMHEALTH
ClaimHealth® R.O.I. Audit Report
Executive Summary
Provides a granular view that can serve as a guide for revenue integrity process improvement
Marker 2Overall Error Rate
Based on the performance of the data you submitted. It can serve as a baseline and be reference in subsequent reviews to monitor improvement
Overall Results
This section gives you an at-a-glance summary of all errors and missed opportunities
Codes Billed in ErrorCodes Billed in Error
This section gives you a summary of billing errors by payer type and the financial impact
Missed OpportunitiesMissed Opportunities
This section gives you a summary of missed opportunities by payer type and the financial impact
Total Financial ImpactTotal Financial Impact
Graphs provides concise visualizations for reference
CLAIMHEALTH
ClaimHealth® RO-APM Audit Report
Cancer Type Analysis
Automatically assigns a cancer type based on CMS guidelines and summarizes impact
APM AdjustmentsAPM Adjustments
Adjustments based on statistical formulas on the RO-APM
Detailed Professional & Technical Analysis
Shows the details of your practice patterns and the impact of the RO-APM on professional and technical revenue
CLAIMHEALTH
What you get with ClaimHealth®?
- In-depth audit report and customizable dashboard, including:
- All rule findings associated with CPT® Codes
- Overall opportunity and risk percentages by each CPT® rule
- Opportunity or risk highlights for specific patients
- Authoritative guidance for findings
- CMS APM analytics with potential impact analysis
- Exit phone call to discuss all findings
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