Healthcare

CaseWare IDEA Applications

Accounts Receivable, Patient Billing and Managed Care

• Calculate average days from discharge to bill and bill to payment by payer or department
• Determine appropriate level of contractual allowance and doubtful accounts reserves
• Age receivables on date-of-service rather than invoice date to recalculate cash flow
• Analyze rejected payments by financial class, procedure code, and cost centre
• Identify underpaid managed care accounts
• Determine profit margin by physician and financial class

Charges

• Identify late charges by department and by month
• Look for invalid, high dollar, or duplicate charges on patient bills
• Look for lost charges by matching supplies used to supplies billed
• Check procedure codes and billed charges to identify inappropriately billed charges

Clinical Subsystems

• Compare patient visit data on clinical subsystems to patient master data
• Identify interface failures
• Identify pricing discrepancies between subsystems and master data

Marketing

• Develop patient statistics by postal codes or other demographic data
• Look for incomplete or miscoded patient demographic information
• Identify profitable segments of the patient population

Materials Management

• Analyze usage and ordering to improve inventory reordering
• Report on stock and high value balances using any selection criteria
• Identify obsolete inventory by turnover analysis
• Compare speed and accuracy of delivery by product and vendor
• Profile supply usage by month and by department

Medical Claims

• Analyze timeliness of claims payments by comparing claim date, claim received date, and claim paid date
• Look for duplicate billings and claim payments based on patient, provider, date of service and amount

Medical Records

• Identify duplicate medical records for the same patient
• Track diagnosis coding deficiencies and incomplete records
• List incomplete records and incompatible coding
• Report on procedure codes by physician, department, or patient

Specialists

• Determine specialist/doctor contract compliance
• Evaluate specialist/doctor practice history by patient type and payer
• Report on incomplete specialist/doctor profiling information

Purchase Order Management

• Report on purchasing performance by location.
• Identify pricing and receipt quantity variations by vendor and purchase order
• Identify duplicate purchase orders and receipts without purchase orders
• Reconcile receipts by comparing accrued payables to received items
• Compare vendor performance by summarizing item delivery and quality