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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

Areas of Applications , CaseWare IDEA



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