Claims data is a rich source of patient information. It helps you gauge a holistic view of the patient’s interactions with the healthcare system. Analysis of claims data is a powerful asset across the payer and provider industry for activities such as retrospective and predictive analysis, identification of potential operational problems, operational realignment, identification of potential revenue losses, and overpayment and underpayment analysis. Clearing houses can also leverage this data for cross-provider benchmarking.
As we gear up for the overhaul it is not just the compliances that Providers need to secure their processes for, you also need to tap large amount of data for data forensics. The EMR and data warehouse systems will become rich sources of information, making it important to build a holistic framework to manage clinical and financial information for effective and efficient reporting. Similarly, it is important to design processes to achieve high levels of data quality and standardization and appropriately interpret and implement evidence-based clinical guidelines.
As the industry gears up to achieve Quality Measure compliance for ACOs (Accountable Care Organization) it is imperative to consider EMR data as a rich source of information to evaluate the Quality Measure compliance.