Services
Medical Rx Lost Charge Recovery
Medical Datalytics can help your hospital significantly improve its bottom line without any financial risk. The service is not intrusive and works offsite to prevent any lost productivity to your overworked business office. Having extensive experience in electronic billing and claim construction/adjudication our data mining algorithms efficiently and effectively identify billing outliers. These outlier claims are then reviewed by our billing analysts against a provider's formulary data and associated medical record information to provide documentation of all charge errors. These validated errors are then rebilled to their respective payers and then monitored until payment is received.
340B Ineligible Claim Audit
340B Third Party Administrators' (TPA) priority in maintaining program integrity tilt their claim processing filters and algorithms to the conservative side. This practice misclassifies a percentage of claims as Ineligible when in fact they should be classified as compliant and submitted for 340b savings. MDL's 340B audit provides the necessary insight for Covered Entities to confidently and efficiently over ride some of their TPA's findings and recover substantial revenue through the additional program savings.
Medical Rx Charge Master Reveiw
Medical Datalytics combines its industry experience with the nation’s leading Medical Rx data sources to identify line items that could affect your revenue. Specifically, we can help you:
• Identify invalid HCPCS and NDCs
• Insure the crosswalk between HCPCS and NDCs are valid.
• Ensure proper pricing margins
Even if Medical Pharmacy in your CDM is completely accurate, if your clinicians charge capture practices are not in sync with the set-up of your CDM, you are still exposed to potential revenue loss. That’s why part of the review can include a PuPit claims analysis. Our Medical Pharmacy CDM reviews provides a reliable way to identify charge master vulnerabilities.
Medical Rx Formulary Reviews
Medical Datalytics compares provider's formulary data against the nation’s leading verified Medical Pharmacy data sources to identify inaccuracies and inconsistencies.
A Provider’s formulary can be uploaded on a periodic basis and is scrubbed to find outdated and missing drug information. Regulatory and industry notification are forwarded on to the provider for just those drugs that are present in their current formulary.
For a fraction of the cost of a FTE a provider can be assured there formulary data is accurate and up to date.