PDF · 3 pages
Every Risk Score. Fully Reconciled.
A concise, three-page look at how Falcon connects contract-aware risk-score calculation, payer and CMS reconciliation, recapture, and AI-supported suspect review.
View the brochureResources - Practical guidance for healthcare operators
Concise, evidence-based guides for the teams responsible for making healthcare data accurate, compliant, and actionable.
PDF · 4 pages
Targeted Outreach. Measurable Correction.
A concise four-page summary of how human-reviewed, client-sent provider outreach was followed by measurable claim corrections and promising—but exploratory—changes in future payment.
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PDF · 16 pages
Effectiveness of Targeted Provider Outreach Letters: A Retrospective Comparison of Client Test Sent Letters and Client Control Drafted-but-Unsent Letters
A 16-page retrospective study comparing sent provider outreach letters with drafted-but-unsent controls across earlier-claim reversals and subsequent payment.
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PDF · 4 pages
What “Right” Looks Like: Diagnoses & Procedure Codes for PACE Center MA Encounters
A practical, four-page guide to the procedure codes, encounter data, and documentation practices that help PACE risk-adjustment diagnoses count.
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PDF · 25 pages
From Prediction to Explainable Provider Behavior Profiles for Fraud, Waste, and Abuse Review
A practical framework for turning claims data into interpretable provider behavior profiles that help fraud, waste, and abuse teams understand what changed and where to investigate.
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PDF · 12 pages
Anomalous Urinary Catheter DME Billing Patterns in Medicare: ACO-Affiliated Beneficiaries at Disproportionate Risk
An analysis of the rapid growth in urinary catheter billing, the suppliers driving the increase, and the disproportionate financial exposure borne by ACO-affiliated beneficiaries.
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