Jared Krawczyk, CEO, Nektar Analytics
Profiling for statistical outliers is one of the greatest, yet most under-utilized assets in the healthcare compliance sector today. An effective and all-inclusive benchmarking program can serve as an advisory tool that magnifies what the compliance department knows, presents new findings, offers new perspectives, and provides new ways of gleaning actionable insights. However, the internal audit departments in the healthcare sector often fall prey to generic, random sampling of audits, which do not serve the purpose while eating into their resources.
To put this into perspective, consider a healthcare group that sought to audit all their doctors over the course of a year by looking at ten medical charts and picking samples from different areas. Even after spending a considerable amount of time in auditing, the compliance department ended up diverting resources to many areas that were never going to be targeted by governmental audit entities. Also, the under-resourced auditing department (a case with many organizations) that only could audit 400 doctors failed to serve the needs of the organization that had 1000 doctors. They just performed the audit, but couldn’t proactively identify and solve issues to help the organization implement corrective actions.
While this is the scenario with many healthcare organizations, how can internal audits be done right and add value?
Nektar Analytics has the answer.
“We specialize in profiling provider and facility coding utilization patterns and comparing them against national and state norms to pinpoint specific areas that have a higher likelihood of getting audited by either government or commercial payers,” says Jared Krawczyk, CEO of Nektar Analytics. With a keen focus on the internal audit component of the compliance arena, the firm is pushing the wave of risk-based auditing for the benefit of healthcare organizations. Risk-based auditing allows organizations to have greater visibility into the areas that are CMS coding outliers, and in turn, help them focus their resources on those areas. Nektar Analytics effectuates this by analyzing the coding pattern of each doctor with similar benchmarking techniques that are leveraged by CMS to pinpoint high value audit targets. This empowers internal audit and compliance teams to conduct an efficient and effective audit, identify the areas of risk, resolve them, and ultimately, enable organizations to stay ahead of the curve by complying with government regulations. Nektar Analytics adopts a three-pronged approach to carry out this process.
The Three-Pronged Approach
According to Krawczyk, accessibility to your doctors coding utilization data is the first and foremost element in conducting an efficient risk-based internal audit. Aligning well with this, Nektar Analytics offers its clients access to information based on all sorts of analysis—procedural analysis, modifiers, and Medicare payment analysis—on every single doctor, with few clicks of the button. Audit officers can make decisions based on this evidence, making them more efficient and enabling them to move away from the legacy “Excel” model for digging out data. For instance, consider a healthcare organization that wanted to view a doctor’s coding in the oncology services. With legacy systems, the audit team would have to seek the help of the IT department to get access to billing systems for gathering the information.
We have the capability to build customized audit plans for our clients according to their ever-evolving audit needs
This is not only complex but also time-consuming. However, with Nektar Analytics, the audit team can do this job in seconds. Auditors need to simply enter the name of the doctor to receive all information about his services in oncology, his average within their health network, and average across the country. What makes Nektar Analytics an unique solution is that it doesn’t require integration into a organizations billing systems or sensitive PHI claim data, Nektar requires only provider production summary information that typically can be generated with the standard excel reports that come out of EMR system.
As the next step toward a successful internal audit, auditors and compliance officers need to read the analytics data so that they can identify areas of risk. However, more than often, they lack the statistical expertise to interpret the analytic results properly. Unlike other benchmarking vendors who ask clients interpret what they feel is “at risk”, Nektar Analytics has built its solution with the proven outlier identification logic that pinpoints what exact areas have audit potential for the end client. “We tell our clients where the risk is; that is the biggest benefit for them,” adds Krawczyk. With the click of a button, the audit team can see doctors who are at risk across all aspects of billing, modifiers, and surgical procedures. This eases the job of auditors and helps them focus on auditing charts.
Moving towards the final step, Nektar Analytics helps the audit team—that is now equipped with the right information on areas of risks of each doctor—to operationalize those insights. “We have the capability to build customized audit plans for our clients according to their ever-evolving needs,” says Krawczyk. The audit team can seamlessly generate their audit plans with Nektar Analytics. They can then run their data to get the information of all doctors at risk, in the order of severity. “We are not only identifying outliers but also prioritizing their risk into a comprehensive audit plan that is simple to quickly add into their yearly compliance work plan,” Krawczyk adds.
While enabling audit departments to be competitive, Nektar Analytics delivers results to companies in an effective and agile fashion. The solution incorporates features like custom downloadable PDFs that allow auditors and compliance officers to present their findings along with evidence in a visual and engaging manner. This gives the management good visibility into the compliance scenario within the organization. The PDF feature also allows audit department to share information— including areas of risk, the reason for picking those areas, and severity of risk—with the doctors, which will enhance the compliance and coding relationship with physicians.
Using the solution, the audit department can also create report cards for each doctor, share it, and extend this evidence-based information throughout the organization. The reports are customizable according to the varying requirements of clients.
Nektar Analytics possesses the nimbleness and independence to develop robust solutions that are capable of bringing in a quantum change to the healthcare space. With its solutions, the company is not just giving insights to identify the risks, but also taking on the responsibility of assisting auditors and compliance officers in protecting the healthcare system. This has enabled the firm to garner a broad customer base, including the biggest healthcare systems in the country. Interestingly, most of Nektar’s clients are organizations that employ 500 or more physicians. Nektar Analytics offers its plan in three cost effective variations—small, medium, and large— that work seamlessly into the restricted budgets of compliance departments. They are provided at a fixed cost with no additional charges for implementation, adding new features, including more doctors, or post-implementation services.
"We specialize in profiling provider and facility coding patterns along with utilization patterns, and comparing them against national and state norms to pinpoint specific areas that have risk and a higher likelihood of getting audited by either government or commercial entities"
With the zeal to evolve as a one-stop-shop solution provider for the healthcare organizations in terms of compliance risk, Nektar Analytics is extending its solutions to other billing areas within the healthcare compliance space as well. In a bid to focus more on being a complete compliance-benchmarking suite, the company is rolling out an innovative product for facility outpatient billing. This first-of-its-kind facility outpatient product for compliance analyzes the facility, compares cost centers within the facility, and compares billing within the cost centers against similar ones across the country. The client-driven state-of-the-art product will add value to the healthcare auditing space as it empowers organizations to analyze their systems themselves.
Along with developing the outpatient analytics product, the firm is working on a facility inpatient tool as well. With this, the company is trying to enhance its product portfolio and become a single vendor solution by offering end-to-end benchmarking capabilities that will push innovation within the small hyper niche of analytics within internal audit.
Backed by strong leadership, value-bound innovative offerings, and customer-centric approach, Nektar Analytics is having bright plans for the future. “Our success is attributed to our approach of constantly expanding features and functionalities. This will extend the value of our products and help our clients’ audit team to make their lives and jobs easier,” concludes Krawczyk.