When we realized how many mistakes payors can make in processing claims, we started auditing paid out workers compensation claims to ensure providers were collecting every dollar. Of course, there are several systems that can electronically monitor workers comp reimbursement; however, one of the challenges is with jurisdiction and the number of payment/denial codes that differ among those jurisdictions. This is the reason we use the good ol' fashion manual audit. In utilizing this method, we were able to see which carriers were making mistakes and how we could work with the providers to correct them. We started to see other issues that had to do with errors the provider made. Once we started reporting that information back to them, they were able to determine root causes and re-train specific employees when needed. Sometimes, these error are not human errors but more from chargemaster or coding errors. Fixing all the errors helps providers to gain more revenue from their work comp claims but other financial classes as well. It hit us one day - we are looking at reporting and analyzing that information in an effort to generate cash. When you combine "curo" (which is Latin for making or generating money) with analytics, you get Curoltyics!
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