Revenue Enhancement and Risk Reduction

A Career Step Company

Revenue Enhancement and Risk Reduction CLAIMSauditor.com® is a web-based compliance and auditing tool that assists clinical, coding and financial professionals to uncover coding, compliance and reimbursement risks and opportunities hidden in their provider claims and other detail data.

Unlike EDI systems or “scrubbers,” CLAIMSauditor.com® allows users to apply and create rules not typically found in such systems. The system facilitates a more cost efficient and effective focused review and audit approach.

With CLAIMSauditor.com®, you will be able to: Query and select records for review Select from hundreds of rules from our library or even design your own Choose those charts or claims having the highest probability for a coding, compliance, quality or billing discrepancy Use retrospectively or concurrently with the billing process Access data and develop reports without burdening IT

CLAIMSauditor.com® uncovers: Lost revenue Under and overpayments due to coding and/or documentation RAC audit targets Medical necessity targets CERT, MIC, MAC, PSC and OIG targets MCC/CC capture rates Unbilled services (lost charges) Underbilled services Quality issues I10 coding and documentation issues

Compare our Features Panacea’s CLAIMSauditor

Multi-claim or record type capability. (Hospital, physician, freestanding imaging, free-standing surgery center, etc.).

Multi-user and multi-provider capability.

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Option to sort, filter and customize columns and further filter results instantly by patient type, payor, revenue code, rule name

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and more.

Option to include hospital itemized bills to provide line item detail

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Inclusion of payment data at patient level (e.g. 835 data).

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Web-based secure HIPPA-compliant platform.

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Retrospective daily or pre-bill interface options.

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Intuitive/user friendly rule writing engine.

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units quantity, and charges not found in detail on 837 claims.

Allows inpatient and outpatient and physician rules for audit creation.

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Ability to write complex rules with presence or absence of related procedure and diagnosis codes, and the presence or absence of zero, one or more than one CC or MCC and with gross charge

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and/or length-of-stay parameters to process simultaneously.

Option to create custom rules configurations by department and user, and to search by rule name or by rule type (e.g. RAC Region

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A, lost charge, likely underpayment, likely overpayment, etc.).

Rules engine facilitates HIM, compliance RAC, PEPPER, OIG, quality, medical necessity, lost revenue, CCI, and many other

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types of simple or complex rules.

Create rules based on chargemaster service codes that do not have a HCPCS or CPT and not found in 837/uniform bill.

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Random and seeded random sample feature for audit selection with additional option for inpatient records

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completed by coder.

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Panacea’s CLAIMSauditor

Some other vendors

Most or all other vendors

No “black box” rules library, containing 2,000+ rules.

View, copy and edit rules written by Panacea clients and consultants to customize based on your coding and billing

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practices to reduce and eliminate false positives.

Optional inpatient, outpatient and professional audit module to enter audit results, track changes and produce

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coding and financial accuracy reports.

Additional discount consulting support offered if needed for audit support, rule writing, or education during term of contract.

Option to report on one, all or customized groups of providers within health systems.

Report results to screen, and Qlik®, data analytics and visualization module and Excel.

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Qlik® Data Analytics and Visualization and ad-hoc report writer integrated to provide data warehouse at no additional cost.

Print worksheets in excel or on-screen, for auditors/ reviewers to enter code changes and notes at record and

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line item level.

Custom export/interface options from CLAIMSauditor® to other vendor system via SFTP, web service, or simple

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download/upload of CSV file.

Technical/customer support included at no additional cost.

Optional use of MS-DRG, APR-DRG, E&M and other groupers and pricers.

Vendor is both software and clinical coding and healthcare financial consulting company.

Flexible pricing and payment options (annual subscription, perpetual with zero percent financing).

Subscription/license fee includes expert consulting support at no additional cost.

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A Career Step Company

Panacea Healthcare Solutions, Inc. is a Career Step Company Career Step is an Inc. 5000 company with total revenues of $64M and over 160 employees across offices in Minnesota, New Jersey, Florida and Utah. Career Step manages Panacea Healthcare Solutions, Inc., as an independent brand and entity within the Career Step Professional Training division.

Minnesota

New Jersey

Utah

Panacea®

Panacea®

Panacea®

444 Cedar Street

595 Shewsbury Ave

2901 N Ashton Blvd

Suite 920

Suite 201

Lehi, UT 84043

St. Paul, MN 55101

Shrewsbury, NJ 07702

Ask about Panacea’s HFMA peer-reviewed solutions – Hospital Zero-Based Pricing, ComparativeHealthData.com and Unit Cost Estimator. *HFMA staff and volunteers determined that this product has met specific criteria developed under the HFMA Peer Review Process. HFMA does not endorse or guarantee the use of this product.

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