Data Analytics & IT
Frank Cohen Group
The Frank Cohen Group became part of DoctorsManagement in 2014. This division of DM specializes in all areas of healthcare analytics, including data mining and analysis, applied statistics, predictive modeling, process improvement and decision support. While the primary focus is healthcare, the group has worked in other industry settings to provide analytical consulting services to a wide array of clients.
The following examples represent just a few of the diverse solutions that this dynamic team delivers to clients:
- Coding Compliance Risk Analysis (CPT and DRG)
- Post-Audit Extrapolation and Mitigation
- Statistical Sampling and Overpayment Estimation (SSOE)
- Corporate Integrity Agreement Statistical Sampling
The Analytics & Business Intelligence Division specializes in litigation support and post-audit analyses, working with physicians, healthcare organizations, state’s attorneys general and private legal firms to aggressively defend physician’s rights against payers and regulatory agencies
Read more about the coding compliance and auditing solutions offered by our Compliance Division of DoctorsManagement here. For Risk Mitigation and to learn more about the Compliance Risk Analyzer click here.
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Upcoming Compliance Quickinars™
Understanding and Using RAT-STATS
Thursday, September 21 | 2:00pm-3:15pm ET
For those that have successfully completed all four parts of this series, we will be offering a bonus session on RAT-STATS, the statistical software program that was developed by OIG and is the go-to statistical software for pretty much every government contractor and third-party insurance company. In this bonus session, you will learn how to estimate sample size, created a statistically valid random sample and conduct an extrapolation calculation. This session is a must for anyone involved in compliance management and analytics.
Cost: Free | 1 AAPC CEU | 1 Hour Presentation | 15 Minute Q&A
OnDemand Compliance Quickinars™
Introduction to Statistics for Healthcare Compliance Professionals
In this session, we will start from the beginning. Frank Cohen will talk about statistical definitions and terms that are critical to understand so that we can all be on the same page moving forward. He will teach you the difference between descriptive and inferential statistics and why that is important when it comes to things like extrapolation. We will also cover different data types and how they impact sample size calculations.
DRG Risk-based Audit Planning
So often we focus our internal review efforts on the low-hanging fruit, which has traditionally been E&M codes. And while risk-based auditing demands that we extend our reach way beyond just E&M services, we also need to extend our reach way beyond the professional component. Whether you are a free standing inpatient facility or a health system that integrates physicians with hospitals, you must dedicate necessary resources to also audit your DRGs. DRGs are significantly more complex, result in much higher payments and have more moving parts than the linearity found in outpatient and professional services. As a result, building a risk-based audit is also more complex and without the use of more advanced computer and statistical technology, a challenge that many facilities can’t meet. In this session, Frank Cohen, director of analytics for Doctors Management, will show you different successful models and vectors for targeting those DRGs that are most likely to be subject to an external audit.
CERT: It’s More Than Just A Mint
CERT is a program that was started by the OIG in 1996 to study the rate of improper payments to healthcare providers. Every year, CMS collects tens of thousands of random claims submitted to the Medicare database and requests providers submit documentation to substantiate the payments made on those claims. The purpose is to determine whether the payment made to that provider was made in error due to any number of reasons reported within the study. For example, the payment may have been made to an ineligible recipient or for an ineligible service. Or maybe the documentation was insufficient to support the level of code or any code at all, for that matter. What’s important to know is that auditors, both public and private, rely upon the results of the CERT study in order to target specific procedure codes, specialties and even providers in specific locations for recoupment audits. The more you know about CERT and the study results, the better position you will be in when it comes to understanding both the general risk of an audit and the specific areas that might be at risk within your organization. In this session, Frank Cohen, statistician and risk analyst, will walk you through the most recent CERT study, emphasizing how auditors use the results to target the practice and how you can use the same information to prepare for the audit when it occurs.
Benchmarking For Compliance | Risks and Benefits of the Medicare Claims Database
Even after decades of access to Medicare claims data, the jury is still out on the benefits of using these data for benchmarking for the purpose of determining compliance risk. In fact, there should always be a healthy amount of skepticism about benchmarking your practice against any outside data set. Who are those physicians against you you are being compared to anyway? What is the culture of the organization? How much data are missing? What are their goals and objectives? And the questions go on.
In this Quickinar™ we will explore the general concept of benchmarking and then take a deeper dive into to benefits and risks of using the Medicare claims database to benchmark your providers.
Understanding the Crosswalks for the 2023 E&M Guidelines
Just two years after the 2021 change to the E&M guidelines for coding office visits, CMS is rolling out a similar change to most of the other E&M codes. Understanding how to code for those changes is important, but this Quickinar™ will walk through the analytical aspect of these changes and reveal the methods used to crosswalk utilization from codes that will be eliminated to codes that will be either introduced or will remain active. This is critical information for anyone that wants to better analyze and understand their compliance risk.
In 2021, the E&M guidelines went through a significant rewrite, and this resulted in a more than significant shift in the trend for coding office visits. We saw greater utilization of the higher-level codes and the big question that our clients had was whether this right-shift increased their compliance and audit risk. To answer this, we reviewed hundreds of thousands of audits on these office visits. Join us in this Quickinar™ to review and discuss the results of our studies.
Building a Risk-Based Audit Plan
The times they are a changing . . . or so the song goes. For those of us in healthcare, this is so true when it comes to audits and recoupments. Recovery and recoupment audits are back with a vengeance and they have more tools at their disposal than ever before. In fact, with the new advanced technologies employed by CMS and private payers, auditors have an inherent advantage over providers. In this webinar, we will show you how to level the playing field and learn about how payers identify high-risk providers and what you can do to mitigate the risk of recoupment. Frank Cohen, healthcare statistician and compliance analyst will take you through the process the payers use to identify high-valued targets and what you can do to both prepare for and mitigate the damage these audits can cause.
Understanding Frequency Distributions
Everyone is familiar with the term “bell curves” but few have a clear picture what that means. Understanding distributions is critical in all phases of statistical analysis and particularly important when it comes to inferential statistics. Determinations of sample size, error and precision calculations are all dependent upon distributions and in this session, Frank will show you ways to challenge government audits and ways to ensure that your internal audit results are as close to the truth as possible.
Measures of Central Tendency
I would guess that pretty much everyone knows what an average is but I would also bet that not near as many understand whether that is the correct metric to use in all situations. Besides the mean, there is the median and the mode. And when it comes to averages, there is the arithmetric, geometric, harmonic, root mean square, trimmed and other types that apply in different situations. Knowing what point estimate to use can minimize the financial damage of overpayment estimates and help you get a better understanding of where the real central tendency is within your data.
Measures of Variability: Confidence Intervals and Precision
Anyone that has ever been subject to an extrapolated overpayment estimate is familiar with the terms “confidence interval” and “precision”. But, do you really know what they represent and more importantly, how they are calculated? Understanding the basics of how variations are calculated and how they impact a compliance audit can mean the difference between a $10,000 overpayment and a $10 million overpayment. And if you are using data in other areas, like revenue cycle, physician compensation, etc., understanding variance ensures that your predictions are going to be as accurate as possible.
Check back for future events.
If you have questions regarding our Data Analytics & Business Intelligence services or our platform, the Compliance Risk Analyzer please contact us at (800) 635-4040.
Work on Real Issues Right Away
CRA creates an audit plan of the top five critical risk issues for each medical provider with a moderate to high risk.
Rather than using your limited resources to search for potential risk issues by conducting initial probe audits, direct them to validating real risk. Our audit action plan is based on a statistical review of 100% of your claims – something that’s virtually impossible any other way.
- Analyze critical risk areas
- Replace probe audits
- Assess risk accurately
- Produce drill-down reports
- Validate education efforts
- Gain insight beyond raw data
Compliance Risk Analyzer is HITRUST CSF Certified
HITRUST r2 Certified status demonstrates that CRA, hosted by Microsoft, has met key regulatory and industry-defined requirements to appropriately manage risk.
CRA: Developed by The Frank Cohen Group, a division of DoctorsManagement, LLC