Data Analysis

Strategic Management’s health care claims data analysis and review services enable health care providers to identify trends in their data, analyze claims for reimbursement and implement improved billing and coding procedures. Our experienced consultants and claims auditors are the nation’s leading experts in data analysis using RAT-STATS statistical sampling.

Health Care Claims Data Analysis

Strategic Management provides robust health care claims data analysis that goes beyond simply reviewing claims by using sampling methods, including extrapolation and RAT-STATS, data prospecting, pattern detection and using SPSS and SAS. Our experienced team examines the procedures in place and provides techniques necessary for a successful billing and coding program.

Internal Analysis

Best practice to prevent and mitigate high-risk areas in health care billing and coding is to conduct internal medical claims data analysis. Strategic Management works with health care organizations to:

  1. Reviews existing procedures;
  2. Implement billing monitoring techniques;
  3. Design metrics that flag billing and documentation risk; and
  4. Conduct mock audits that use data prospecting, overpayment extrapolation, RAT-STATS, pattern detection and other methods used by government auditors.

Government Audits

Through proactive steps, health care organizations can mitigate potential government investigations and enforcement actions. Strategic Management works with health care organizations to prepare for and to conduct mock government audits. CMS and state Medicaid agencies have increased regulatory and enforcement efforts and surveillance with the use of claims data analysis techniques and statistical auditing including extrapolation methods.