BC Advantage - 2022 Issue 2

How Anomaly Detection Can Fight a Nearly $300B Healthcare Issue

In healthcare, just as in life, no one likes losing money-particularly when you don't know why it's happening.Hospital revenue cycle leaders understand how critical it is to reduce fraud, waste, and abuse as much as possible, from both an operational and financial perspective. Yet even the best-designed revenue cycle management (RCM) system will not prevent internal errors in intake, billing, and follow-up processes that can result in significant undetected losses.Healthcare organizations ultimately perform better when their processes are reviewed for vulnerabilities and random errors are corrected accordingly. Identifying systematic outliers is not only a proactive business strategy...

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