Compliance Risk Analyzer

Risk-Based Auditing for Healthcare Organizations

Compliance Risk Analyzer® (CRA) is a true risk-based auditing tool that delivers an effective, efficient, accurate, and rapid identification of potential audit risks for all your physician and inpatient services.

• Analyze critical risk areas
• Replace probe audits
• Produce summary and drill-down reports
• Completely customizable and scalable

Reduce the risk of recoupment and keep more of the money you collect.

For physician services, CRA® instantly identifies potential coding and billing compliance risks for each provider. Risk is assessed for the five most important categories — those that the auditors consider when deciding whether or not to audit your providers:

1. Evaluation & Management procedure codes
2. Non-E&M procedure codes
3. The impact your RVU utilization has on audit risk
4. Modifiers and modifier/code relationships
5. Providers’ assessed work-time versus OIG’s audit tolerance

For hospital services, CRA instantly identifies potential coding and billing compliance risks for DRG codes as well as other audit targets, including those based on:

• OIG
• RAC
• PEPPER
• CERT
• Your own custom risk algorithms to support carrier-specific rules

Easy to use

The key is that all CRA risk assessments are distilled to a straightforward scale that defines risk in one of four levels: None, Low, Medium, and High. With this, you can quickly compare risk within and between categories.

CRA seamlessly integrates with our Audit Trakker® tools, allowing you to select claim samples of areas of risk that concern you and record those internal reviews.

• True Predictive Analytics
• Risk Mitigation

Key Benefits

• Compliance Risk Analyzer® (CRA) is a true risk-based auditing tool that quickly and accurately identifies potential audit risks for your providers and codes across outpatient and inpatient sites of service.”
• Analyze critical risk areas to focus compliance efforts
• Save time by performing targeted audits based on CRA’s analysis
• Generate risk drill-down reports and detailed audit summaries
• Providers’ assessed work-time versus payer expectations and time studies
• Ease of Use Facilitates Implementation & Employee Adoption
• Streamlines and Automates Audit Workflow
• Analyzes Utilization and Revenue Opportunities
• Reduces Costs & Resource Requirements
• Enhances Documentation & Tracking
• Promotes Regulatory Risk-Mitigation Mindset

Key Features

• Near Real-Time Analytics – spot high-risk claims with laser-like precision for 100% of your providers’ claims.
• Identify Risk Quickly – quickly rank risk within and between categories using CRA’s straightforward ranking scale.
• Easy to Navigate – find information quickly and easily. CRA’s user-friendly interface requires minimal clicks and offers countless drill-down options.
• Time Tested – CRA has been used by over 500 organizations to analyze the billing of over 85,000 providers.
• No Long-Term Contracts – there are no long-term contracts or automatic fee increases
• CRA seamlessly integrates with our Audit Trakker® tools, allowing you to select samples of claims flagged as potentially high risk by CRA and audit them for errors.

How It Works

Builds and Prioritizes Your Audit Plan in a Secure Cloud-Based (Saas) Environment

CRA analyzes 100% of your claims and identifies the most important codes to review and costs much less than probe audits. With probe audits, you have a 1% chance or less of finding no more than 20% of your risk, which means that auditors have about a 99% chance of finding risk you didn’t find. CRA levels the playing field with payers by delivering sophisticated technology to healthcare facilities.

Secure Compliance Management System

HIPAA & GDPR Compliant and HITRUST CSF Certified® – CRA eliminates data security risks utilizing Microsoft Azure to ensure patients’ personal data and sensitive data are safe.

Respond and Mitigate Faster with True Risk-Based Auditing

Work on real issues right away – CRA creates an audit plan of the top critical risk issues for each provider and code. Rather than using your limited resources to pinpoint vulnerabilities by conducting initial probe audits, bypass that step and go directly to examining real risk.

Modules

AUDITTRAKKER™ THE INTELLIGENT AUDIT SOLUTION

AuditTrakker™ is a documentation, tracking, and real-time analytics application that gives you the ability to make the most of your risk management and audit strategy. AuditTrakker™ helps you maximize outcomes and efficiency by developing an education and remediation workflow.

AuditTrakker is available for both physician-based and inpatient claims.

AuditTrakker makes it easy to:

• Establish a sound workflow
• Gain real-time access to reports and analytics
• Schedule future reviews based on results
• Perform provider/coder education and remediation

Free Risk Analysis

Contact us to see the Compliance Risk Analyzer in action using your data.

CRA was developed by The Frank Cohen Group, a division of DoctorsManagement.

Download the CRA brochure for more info.