Over $150 Million in Inaccurate Revenue Identified by Pareto Intelligence’s Data Integrity Solution

Pareto's Data Integrity solution has uncovered a multitude of data quality issues causing revenue loss, as well as overpayments due to inaccurate submissions, with total financial value of over $150 million.

CHICAGO, Ill., September 2018—Pareto Intelligence, a leading analytics solution provider for healthcare organizations, today announced successful outcomes for its Data Integrity solution for 2017. This proven solution analyzed the encounter data completeness and accuracy of over 4 million lives across all government markets (Medicare Advantage [MA], Medicaid, Affordable Care Act [ACA]) last year, including over 12% of the MA population. From this evaluation, Pareto identified several data quality issues with a total financial impact of over $150 million. With 2018 regulatory submissions for encounter data well underway in all regulated markets, health insurers should begin evaluating their end-to-end data processes now to ensure they are not experiencing issues suppressing revenues or presenting compliance risks.

Evaluate Your End-to-End Processes

"All issuers know if what they've submitted is accepted or not by the government, but many are unable to say with confidence whether or not they submitted everything completely and accurately," said Brandon Solomon, Vice President of Client Advisory and Business Development with Pareto Intelligence. "Our Data Integrity solution continues to uncover new issues throughout the end-to-end encounter process that are posing financial and compliance risk to issuers. After a very successful 2017, we have one of the most effective solutions in the market."

Pareto's Data Integrity solution works by obtaining data extracts from each point of data process from encounter through to regulatory submission. Advanced analytics are then applied to pinpoint specific areas of data degradation. Once discrepancies have been identified, Pareto's clustering algorithms determine the root cause of data quality issues, enabling focused remediation and resolution at the source. This process is built to achieve complete and accurate outcomes by improving processes and proactively identifying instances of incorrectly captured and submitted encounter information, resulting in lost revenue and/or compliance issues.

This solution enables health plans in all markets to close gaps in reported risk, ensuring that final risk scores match the acuity of the population managed.

65-80% of Data Quality Issues Occurring Prior to Submission

Plus, Pareto's experience has shown that even small data quality issues can have a material financial impact. Typically, a 1-3% data quality issue translates into $5-$15 million in premium shortfall for a 50,000-member health plan. With an average of 65-80% of data quality issues occurring prior to submission, an end-to-end assessment ensures that all information received (e.g., billing 837s, supplemental records from chart reviews, etc.) is making it through to submission and acceptance without any degradation.

"While the potential financial impact is important, CMS is ramping up audit scrutiny, particularly in the Medicaid market, and accurate encounter submissions are more important now than ever before," said Jason Montrie, President with Pareto Intelligence. "We've designed the Data Integrity solution so that it focuses on two-way evaluations to achieve accurate, compliant submissions."

Pareto's Data Integrity solution is part of the Revenue Integrity suite, which also includes risk adjustment, premium integrity, and payment integrity solutions.

About Pareto Intelligence

Pareto Intelligence is a leading healthcare technology company modernizing the way health plans and providers succeed in value-based care. We deliver analytics, technology and advisory solutions to help our clients achieve complete and accurate revenue, communicate critical patient information seamlessly, activate clinical and claims data, and make more informed strategic decisions. Our solutions are supported by proprietary algorithms, predictive models, and advanced data science that have analyzed over $150 billion in claims and medical costs and identified more than $250 million in financial improvement opportunity. Through this, Pareto demystifies complex healthcare data, and delivers actionable insights to improve outcomes.

To learn more about Pareto Intelligence, visit www.ParetoIntel.com.

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