Claims Data Analysis

Health Care Claims Data Analysis and Review- RIAS™

Claims Data Analysis

Strategic Management’s health care claims data analysis and review services enable health care organizations to trend, analyze, and report on claims and other data that they generate on a daily basis. The Centers for Medicare & Medicaid Services (CMS) and state Medicaid agencies have increased regulatory and enforcement efforts and surveillance with the use of claims data analytics techniques and statistical auditing including extrapolation methods.  The next frontier in preventing and mitigating risks in the health care industry is to conduct internal claims data analysis reviews, design billing monitoring techniques and programs, design and apply metrics that flag billing and documentation risk before submitting that data to regulators, and prepare to respond to government audits that use data prospecting, overpayment extrapolation, RAT-STATS, SAS, pattern detection and other methods with the same heavy arsenal the government applies.  Automated and complex reviews have become the norm.  Being proactive is critical, and leveraging one’s own data and medical documentation before the government auditors and contractors do is both prudent and financially smart. Our Revenue Integrity and Audit Services (RIAS™) provide you with necessary techniques and support so health care providers and organizations can take proactive steps in mitigating any potential enforcement action that might otherwise ensue.

For more information about claims data analysis, health care revenue integrity, and the other services we provide, please contact us by calling (703) 683-9600 or filling out our online contact form.

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Health Care Claims Data Analysis and Revenue Integrity Related Resources

The following articles provide additional information regarding claims data analysis and revenue integrity:

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