Businesses deal with increasing amounts of data available from both internal and external sources. Today’s enterprises require accurate analyses and insight to increase their decision-making capabilities.
Here at ACM Analytics, we provide custom-tailored data analytic solutions to government and commercial businesses by transforming their data into actionable insights. We apply a wide array of data analytics, such as data mining and statistical analytics, from small to big data across multiple industries:
Record Linkage – Fuzzy Matching Analysis
The healthcare industry collects vast amounts of data. The analysis of healthcare data at both the micro and macro levels can improve the quality of care, business management, and costs.
As healthcare organizations, health insurance companies, and government healthcare programs are subject to ever-changing and increasing regulations, healthcare analytics is essential. ACM Analytics provides analytical techniques to gain actionable insights:
Electronic Health Record (EHR) Analysis
Comparative Billing Analysis
Population Health Analysis
Healthcare data analytics is a powerful tool in detecting fraud, waste, and abuse (FWA) in government healthcare programs such as Medicare and Medicaid.
At ACM Analytics, we understand that although intentional acts of FWA are often targeted at Medicare and Medicaid programs, private insurers are also at risk of becoming targets. FWA, whether intentional or unintentional, ends up costing the government and private insurers money. For example, a case in 2016 involved a psychiatrist in Miami, Florida, whose false diagnoses resulted in over $50 million in fraudulent insurance claims and undeserved disability benefits being paid out to patients over a decade. (Chang, 2016)
Our data analytic techniques can detect fraudulent patterns and wasteful billing that are not otherwise readily evident, thus protecting you and your clientele from risks. Furthermore, here at ACM Analytics, we pride ourselves on being highly experienced at applying predictive analytics to detect potential FWA.
When a business needs to review its data but is constrained by limited resources —the solution is audit sampling and extrapolation. Sampling reduces costs and time spent by allowing a business to draw the same information and conclusions from a sample in a shorter time period, thus gaining an unbiased representation of the entire population in the same amount of time.
ACM Analytics provides audit sampling and extrapolation services that generate samples of items to be reviewed using a statistically valid random sampling methodology, which results in an unbiased selection and representative of the population.
Our experts have extensive experience conducting and providing statistical sampling services using simple, systematic, stratified, and cluster random sampling. We can also substantiate, in-depth, the technical steps taken in the sampling and extrapolation processes, including the provision of a sample design report.
Extrapolation and Error Rate Calculation
Streamlined analytics increases productivity, efficiency, and accuracy. We understand that data analytics follows a workflow process that includes data acquisition, preparation/validation, data analytics, and reporting.
If the type of data analytics performed is iterative or routine, then a practice can streamline the workflow process through the automation of each step in the workflow process. If data is being acquired from a plethora of sources, then an extract, transform, and load (ETL) process can be used to streamline the process.
ACM Analytics offers streamlined analytics to improve your data analytics for decision-making.
In today’s ever-changing atmosphere, many businesses have projects, programs, and policies which require impact assessment to evaluate effectiveness. New programs are often implemented as pilot programs before extending to a larger scale. All impact assessments are comparative, thus requiring data collection before and after program implementation.
ACM Analytics performs impact assessments to help select relevant outcome measures and analyze quantitative data to determine if the business is achieving its goals.
Quantitative Impact Assessment
Learning to identify and understand the impact of Medicare & Medicaid program integrity and claims on your business is a crucial component of reducing fraud, waste, and abuse (FWA).
Our consulting services assess the overall picture while providing custom-tailored solutions to help you take the next step in your business. We understand the intricacies behind program policies and regulations and how they can impact your practice or business if not compliance.
We work with your team to help you increase your efficiency and reduce waste. ACM Analytics’ team has over 13 years of knowledge/experience with:
Medicare Part A, Part B, DME, Part C, and Part D claims
Medicare & Medicaid program policies and regulations
Medicare claims processing guidelines
Medicare & Medicaid program integrity
With this knowledge, we can provide subject matter expertise in identifying FWA, erroneous claims billing, and program vulnerabilities for entities big and small.