There may be no other industry that is regulated as much as health care. According to Adrian Velasquez, president of Wauwatosa-based Fi-Med Management Inc., declining reimbursement rates and a tough economy have increased audits and investigations of hospital systems across the country.
To make the job of the compliance officer easier, Fi-Med has released Reveal/md, a web-based, analytical tool to help health care facilities quickly identify areas at risk for audit and possible revenue potential, regardless of the size of the facility.
“Compliance officers need help,” Velasquez said. “Hospitals are under-resourced in time, money and personnel, and compliance in today’s health care environment is an almost impossible task.”
Reveal/md allows compliance officers to discover which physicians are at risk, what they are at risk for and how they can improve the process, said Jared Krawczyk, chief product architect and the person responsible for the development of Reveal/md.
Historically, health care facilities would randomly select 10 to 20 charts per position, per year to analyze, Krawczyk said.
“They would select charts at random and search for anomalies in coding and loss of revenue,” he said. “It would take them about six months to do and they may or may not find the risks and they probably won’t know exactly what to do to mitigate the risk even if they do.”
Reveal/md can analyze every physician within a facility and discover who is at risk, based on 45 different indicators, Krawczyk said.
“And because Reveal/md can process the information so quickly, it allows for the use of other tools to track trends and improvements among physicians, and procedures on a month-to-month basis,” he said.
In a health care facility, physicians are required to fill out paperwork based on the procedures and tests they run on each patient. Procedures are labeled using codes.
Whether intentionally, to account for loss of reimbursement, or unintentionally, due to a lack of education, incorrect or under-coding accounts for a large portion of audit risks.
According to Krawczyk, user experience was important to him in developing Reveal/md. Not only can Reveal/md indicate which doctors are at risk for audit, what they are at risk for and how to fix it, it can also identify physicians who might be under-coding, which could mean additional revenue, all without a medical or mathematical background.
“We’ve designed it so the algorithms and the mathematical calculations take place behind the scenes,” Krawczyk said. “The user sees a series of easy-to-understand graphics, charts and images that are labeled with badges and other easy to understand indicators. We wanted to make the job of our clients easier, not more difficult by adding a system with an enormous learning curve. We want this to augment their day-to-day lives.”
Reveal/md is not only a way for compliance officers to police themselves, it’s also a way for them to discover and plan for continuing education among their medical staff.
Fi-Med rolled out Reveal/md in January. Their target market is acute care and outpatient facilities across the country with any number of providers, as low as 30 or as many as 1,700.
“Traditional models don’t allow for an apt behavioral change, which is what is needed in order to become compliant,” Krawczyk said. “Monthly metrics and custom reporting allows a compliance officer to see progressions and where more education or counseling needs to take place.”
Fi-Med has also started meeting with law firms and other health law organizations to work in a supportive environment for their clients, Velasquez said.
The company offers Reveal/md on a per-physician subscription basis, Krawczyk said.
“There’s nothing else like this on the market,” he said. “We even offer a proof of concept scenario where we will actually ask for their data and show them where they are at risk and where in their staff there’s additional revenue potential. The reactions so far have been incredible.”
Health care, historically, has been a very reactive industry, Velasquez said.
“Reveal/md gives them back the power to negate those risks by becoming a proactive environment,” he said. “We give them the power to fix operations before they get audited and end up needing to pay back billions of dollars.”
“Some hospitals don’t survive costly audits,” Krawczyk said. “If a hospital system gets audited and it’s discovered there’s an error in even just one particular piece of coding that pay back bill is due to the government or the insurance agency in 30 days. It upsets the normal work routine, hospitals aren’t staffed for it.”
