While internal monitoring and auditing is essential for identifying if a physician is coding correctly, data analytics has become pivotal in the efficient identification of where incorrect billing could exist. The industry’s heavy reliance on traditional assessment methodologies has a close resemblance to the story of an old man who lost his wallet in the dark and searched for it in the light. The old man’s idea of searching in the light easier than doing it in the dark, in fact, yields no results. The reason? The lowest common denominator in healthcare today continues to perceive analytics as an arms race, and words like ‘bigger, more complex, and more predictive’ are often used to define it. The industry expresses confidence in the typical approach of more is better—more data, more analytics, and more matrix. Evidently, in many ways, this is the story of most healthcare compliance departments today, unless they are a partner with Nektar Analytics.
“The healthcare compliance staff performing the auditing does not include data scientists or analysts. These auditors need simplified analytical and benchmarking capabilities that will allow them to do their job better. Period,” begins Jared Krawczyk, Director of Analytics, Nektar Analytics. Having worked closely with more than 25 of the nation’s largest health systems to help transition their compliance departments to Risk-based auditing, Krawczyk saw from close quarters how healthcare auditors were ‘auditing in the dark’ without knowing where their risk lies and how they can get out of it. “The challenge for a health system boils down to not having enough available resources to adequately identify and fix coding issues before CMS auditors do,” underscores Krawczyk. “For instance, most compliance departments can only audit a percentage of their total employed providers each year. However, in the wake of this under resource scenario, they better be auditing the right providers that put the organization at risk, which again cannot be determined with basic ‘10 charts in random’ to identify the outliers.”
In an ambitious bid to change this narrative, Krawczyk collaborated with the brightest minds in medical group compliance to lay the cornerstone of Nektar Analytics. The company is born with a focus on assisting healthcare compliance departments in transitioning their audit functions from the basic “10 charts in random” to a strategic risk-based approach.
The central thesis of Nektar Analytics is to guide healthcare compliance departments to better identify who is at risk, where they are at risk, and assist in resolving the associated risk factors—all in a highly simplified fashion. As Krawczyk puts it metaphorically, “Our methodology brings simplicity to benchmarking for Medicare coding risk so that health systems can instantly know where they need to focus their audits. It’s just like turning the lights on in a dark room for them. That’s the simple value proposition of our company.”
Nektar brings simplicity to benchmarking for Medicare coding risk so that health systems can instantly know where they need to focus their audits
The Road to Seamless Compliance
In the healthcare system, while there is a growing focus on the identification and prevention of overpayments and the reduction of waste, Nektar Analytics’ breakthrough suite of healthcare compliance products specializes in easily benchmarking the providers and identifying the outliers. A sense of wonderment prevails over other players in the market, puzzled about how Nektar Analytics empowers users to proactively audit doctors for recoupment. It is way beyond just passion and innovation the team displays to put its clients on the path of success, which is why it is imperative to throw light on, understand, and appreciate the unique methodologies of Nektar Analytics.
To begin with, Nektar Analytics’ team works with compliance departments of healthcare organizations to help them leverage coding utilization benchmarking within their internal audit functions. Nektar Analytics’ suite of healthcare compliance products steer the internal audit process away from random sampling to understanding where the compliance professionals should focus their audit efforts.
Nektar Analytics allows compliance professionals to specifically target who, what, and where they have the greatest audit risk exposure. From benchmarking E/M Bell Curves to reviewing surgical and imaging services, Nektar’s benchmarking software platform provides a holistic view of all aspects of a provider’s coding required for analysis. At the core, comparing the providers to their peers is essential to benchmarking and determining their audit risk exposure. With Nektar, compliance departments can access integrated peer groups among the latest in Medicare data, their own network’s data, and various other sources—all in one platform.
Nektar Analytics’ cloud-based platform is highly flexible and allows generating and customizing reports that are critical to clients’ daily operations. Unlike the traditional solutions for finding scoring matrices, the platform provides instant reports of doctors or departments at risk with basic audit plan methodologies.
With Nektar Analytics’, under-resourced compliance departments can become highly effective within a matter of minutes.
Seamless Implementation and Execution
The uniqueness of Nektar Analytics’ solution stems from the fact that the platform does not require integration with a customer’s system. Instead, all health systems need to share a provider cpt production summary files via CSV format. Secondly, the platform’s data requirements are exceedingly simple, with no inclusion of sensitive information like PHI under HIPAA. This way, the team can avoid all the technical hurdles that most competing software usually meets with during implementation, sign up, or for security evaluation. Once the client sends their data in a CSV format, Nektar Analytics can help onboard them within a day by utilizing the five data elements, that too with limited risk factors. Moreover, compared to a full-time auditor, Nektar Analytics’ solutions provide the most comprehensive and advanced risk identification and auditing at a highly affordable cost.
"The uniqueness of the Nektar Analytics’ solution stems from that we allow health system’s to pilot the solution for free prior to purchasing"
Today, Nektar Analytics works with some of the largest healthcare systems in the country including Ascension, UW Health, Houston Methodist, and Memorial Hermann. Over the years, the growth rate of Nektar Analytics has been rapid as they can quickly set up without any implementation charges. Before signing a contract, the company offers a free pilot of the software for 60 days with the customer’s data in it. Nektar Analytics’ fixed subscription pricing strategy, which is contrary to the traditional “price per doc,” making the solution very budget-friendly. In addition, Nektar Analytics’ value proposition ranges from visibility and expertise to hands-on training facilities for its clients.
Driving to Perfection, Every Day
With new features being launched every month, Nektar Analytics is currently focused on adding more innovative functionalities to their platform that will cater to the clients’ unique requirements. Instead of having several variations of a product, the company puts forth its single suite of products for every client. The company’s team gathers input from the different health systems that are using the solution and prioritizes the feature that is best for everyone before incorporating it in the solution. With this approach, Nektar Analytics aims to advance much faster as they need not manage multiple update requests. As the company already does professional billing analyses, it is now branching out to inpatient billing to foray deeper into the realm of billing. “As per client requests, we are also working to introduce a new sister product that focuses on identifying Facility Outpatient billing risk,” concludes Krawczyk.