Aerolib Analytics

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We specialize in running a current needs analysis of the organization and based on current regulations, help the Case Management and Utilization Review departments with formulating defensible statement letters that look at the patient globally. Our determination letters include

1. Case Summary: Includes chief complaint and summary of clinical events detailing medical necessity and severity of illness

2. Bedding status recommendation: Inpatient or Observation

3. Audit Risk Score: Calculated using proprietary Aerolib Analytics, this gives an estimate of the risk of an audit

4. At Risk Reimbursement: based on DRG, LOS and billing submissions from existing hospital data and Medicare payments for region

5. Interventions to decrease Audit Risk Score

 

The Audit Risk score a complex statistical analysis of multiple variables including the following:

Clinical severity indices

Medical Necessity of hospitalization

Documentation

Severity of Illness

Intensity of Service

Risk of mortality

The weighted means of the variables are analyzed using multiple regression analysis with a key component being clinical risk which is based on Evidenced Based Guidelines and Best Practices. Various disease specific severity indices are used from meta-analysis studies and Physicians finally combine this data to determine the Audit Risk Score

 

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