Compliance Risk Analyzer: How it works

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

The CRA dashboard shows you the most important claims to review and costs 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. Payers are out-maneuvering healthcare facilities because, until now, facilities didn’t have access to sophisticated technology.

Risk Assessments Comparable to Payers’ Evaluations – CRA is the only solution that uses similar technology–true predictive analytics–to what Medicare and commercial payers use to assess risk.

Ongoing Improvements Based on Your Auditing Patterns – CRA comes with a built-in machine learning feature that continuously improves the accuracy of predictions based on your auditing styles and audit findings.

Comprehensive Risk Assessment for for Every Single Provider Across – CRA reviews every single claim for every single provide and ranks the provider’s risk compared to all other provider claims in that same specialty across the entire country. CRA uses advanced statistical technologies similar to what the CMS uses to identify and audit fraud and abuse.

Trending analysis for both risk and post-audit pass/fail rates

  • Audit Pass Rate Trend
  • Track provider improvement 
  • Track effectiveness of education and training programs at the provider level

Manage Pre-Billing and Proactive Audits – CRA indicates managed provider claims that need to be run through a pre-bill audit. CRA holds those claims until they are reviewed by the coder and approved for submission.

Sample size calculator for risk-identified encounters – takes the guess work out of sample size determination.

Set Audit Size Preference Based on Resources – CRA uses a sample size calculator that balances audit needs with budgetary limitations. Users can select either a SVRS or a non-probability sample. Ability to select a SVRS or a non-probability sample. 

Machine learning capabilities – using a built-in audit feedback loop, CRA will continually improve its own system based on your auditing styles and audit findings to increase the accuracy of predictions as the system. 

Notification of cross-over risk in facility settings – CRA warns you of risk related to a cross-over audit. 

User Friendly with Minimal Training Required – CRA’s intuitive and user-friendly interface enables users to easily drill down to view critically important information in greater detail. Reports are straight-forward. The time from data input to being fully operational can happen within a matter of days.

Best in class solution!

Simplify your transition to risk-based auditing

Most healthcare facilities are way behind the times when it comes to spotting compliance risk. Government and commercial payers are using advanced analytics tools that, until now, most compliance professionals could afford. CRA provides you with an expert-based software system using predictive analytics in order to help predict the likelihood of an audit and identify which providers and procedure codes are most likely to get audited.

Key Benefits

  • Facilitates Implementation & Employee Adoption
  • Streamlines Audit Workflow & Management
  • Reduces Costs & Resource Requirements
  • Enhances Documentation & Tracking
  • Promotes Risk-Mitigation Mindset

Key Features

Real-Time Analytics – spot high-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 1 to 100 ranking scale.

Easy to Navigate – find information quickly and easily. CRA’s user-friendly interface requires minimal clicks and offers countless drill-down options.

Documentation and tracking – track and prioritize by potential risk-areas 

Audit Workflow

No Long-Term Contracts – there are no long-term contracts or automatic fee increases.

Simplify your transition to risk-based auditing!

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