In today’s dynamic claims environment payers often still experience significant levels of unnecessary or inappropriate medical spend no matter how sophisticated their editing systems are. Over-billing or unnecessarily high levels of service by certain physicians; unwarranted increases in readmissions, lengths of stay and other facility claims; and outdated or missing medical policies can all contribute to overpayment that goes undetected.

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Studiomaca Benchmark Analytics™ can help you pinpoint the areas and symptoms of unnecessary or inappropriate medical spend in your organization with accuracy to help you avoid future loss, while minimizing administrative effort. This structured analytics service provides reports and analysis that compares your paid medical claims with our proprietary, recent benchmark dataset. Our aggregated claims data from more than 20 payers is up-to-date to the last quarter and represents 75 million covered lives segmented by region and service, ensuring that findings are specific and statistically accurate.

Studiomaca Benchmark Analytics™ helps you remedy inappropriate claims spend with:

  • Up-to-date and comprehensive benchmark data. Updated every quarter and HIPPA and HITECH compliant, the data includes multiple claim types (professional, outpatient and inpatient facility) and is statistically significant across all four regions of the United States as well as across Commercial, Medicare and Medicaid lines of business.
  • Support from Studiomaca healthcare analytics experts.  Analysts who understand clinical coding and healthcare claims make sense of the complexities of the data, track trends and identify relationships that help you understand the most current and relevant challenges in your organization and the marketplace as a whole.
  • Flexible and practical reports. Receive spreadsheet, PDF or dashboard driven reports and analysis from our analytics experts annually, bi-annually or quarterly depending on your licensing agreement.

Choose one or more of our outlier analytics packages:

  • Provider Outlier Analytics: Helps find known areas of waste or abuse in provider billing as compared to industry benchmark data.
  • Facility Outlier Analytics: Help find areas of waste in facility spend and includes year over year reports focused on inpatient medical spend, outpatient utilization, inpatient utilization, readmission analysis, inpatient length of stay and provider practice variation.
  • Service Outlier Analytics: Help reveal meaningful trends in provided services when comparing your organization’s procedure and diagnosis codes to the industry benchmark dataset, looking at volume as well as payment.