How to Use Data Analytics to Become an Authority in Medical Billing Industry

Data analytics creates a possibility to answer complicated questions that remain beyond bounds for more straightforward analysis techniques. Among the many features of data mining, the most significant are as follows:

Even though simpler data techniques and statistics analysis use data for intelligent segregation, their capabilities don’t even come close to the complex abilities of data mining. This makes the latter far superior to conventions of statistical analysis. Through the automated nature of data mining models, the dependence on manual entries is significantly reduced, and much larger amounts of data can be used.

Data Analytics Meets Medical Billing and Coding Challenges
The healthcare industry is one that deals with data in large volumes. More and more organizations are opting for healthcare analytical tools to gain insights into their workings. Data companies are now more accessible to medical billing and coding companies, with everything from servicing to IT infrastructure being outsourced. From overcoming business challenges to increasing the efficiency of everyday workings, the benefits of data mining in healthcare remain unprecedented. We conducted research on the popular benefits of data mining for the medical billing and coding industry and below are the most prominent advantages:

Controlling Costs and Expenses
Identifying Fraud
Predictive Analysis for Reimbursement Cuts
Prescriptive Analysis for Rectification
Controlling Costs and Expenses
Through healthcare data analytics, an examination of claims is a substantial way to control costs and reduce expenses. Any additional claims expenses can be easily caught through the data analytics intelligent models.

Furthermore, the process is thoroughly beneficial towards the use of identifying associations between diagnosis and treatments and for the identification of inefficiencies within the current system as it seems through the data at an automated pace, with the reduced requirement for manual intervention.

The medical billing and coding industry is one that is faced with massive chunks of data and what better way to intelligently classifying this data but using data mining in healthcare.

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The Process
Costs and expenses are reduced through the following practical methods of using data:

Exploration of data
Preparation of meaningful analysis
Modeling of data
Evaluation through automated systems
Definition of problem areas
Future outcome analysis
Deployment of segregated data

Data mining works toward finally reinventing healthcare through transformed payment schemes that prevent critical occasions of readmissions. With the ability of data mining to predict the likelihood of readmissions with a right amount of accuracy, the health system can cut costs and keep health in check by raising the radar on people who are likely to be readmitted.

Identifying Fraud
With the ongoing instances of fraud in medical billing and coding continually rising, data mining is now being looked at to address and identify frauds and thereby eliminate expensive security blunders.

Whether it is fake claims or inaccurate ones, frauds have cost the healthcare industry dearly over the years. With the intelligent capturing capability of data mining, fraud can not only be identified, but there are provisional ways to eradicate the possibility of them taking place completely.

Through certain predictive analysis, data can be accumulated to prevent fraudsters from accomplishing their goal. Within the analytics system, data mining technology is used to gather the data through expert techniques. This data is then converted into meaningful analogies, and standard measurements, which ultimately culminate into an Enterprise Data Warehouse (EDW). EDW then works as the basis through which further data investigations occur that can identify fraud.

Through this EDW, data mining identifies health care providers whose:

Coding and billing strategies and actions vary from their regular practices
Coding and billing systems that differ significantly from their competitors
The Process
This is done through the analysis of the healthcare providers:

Area of practice
Type of healthcare service offered
Frequency of billing
Size of operations
Through the above healthcare data analytics, fraudsters are identified, and due action is initiated, thereby saving expenses to an important lesson.

“In 2007, the Criminal Division of the Justice Department refocused our approach to investigating and prosecuting health care fraud cases. Our investigative approach is now data driven: put simply, our analysts and agents review Medicare billing data from across the country; identify patterns of unusual billing conduct; and then deploy our “Strike Force” teams of investigators and prosecutors to those hotspots to investigate, make arrests, and prosecute. And as criminals become more creative and sophisticated, we intend to use our most aggressive investigative techniques to be right at their heels.”

-Reported by Robert W. Liles, As Lanny A. Breuer, Assistant Attorney General of the Department of Justice’s (DOJ’s) Criminal Division.

Predictive Analysis for Reimbursement Cuts
Predictive analysis tools can go a long way to manage reimbursement cuts and control patient claims efficiently. These analytical tools will help in predicting patient behaviour and therefore increase the likelihood of efficient functioning while avoiding unnecessary financial costs. These tools also aid in identifying areas of billing errors and substantially reduce the risk of subsequent inefficiencies.

There is a noticeable increase in value that the medical billing and coding companies will notice from mining their data. The future predictions can lend coding companies to adopt strategies that will diminish the likelihood of reduced productivity and increase overall performance through intelligent evaluations. The evidence gained from predictive analysis allows medical coders and billers to incorporate strong and efficient categories into practice at an early stage.

Predictive Data Analysis uses the following information to make intelligent predictions:

A comprehensive record of bills submitted by healthcare providers
A quantum of data related to the billing and coding of each practice
Supporting documents related to a or a group of claims
An analysis of claims submitted
While it is virtually impossible to identify misdoings before they occur definitively, the use of predictive data analytics efficiently points the medical billing and coding industry in the right direction, wherein qualitative investigation can happen to minimize its susceptibility to wrongdoing.

The drastic increase in the diagnosis codes from 13,000 under ICD-9 to 68,000 under ICD-10 has made every kind of analytics and reporting results much more detailed than it used to be. Billing and coding companies that have adopted predictive analysis tools have received a considerably higher value return from mining their data.

Prescriptive Analysis for Rectification
After a predictive analysis is undertaken through data mining, the next order of business is a prescriptive analysis of the data. In layman terms, this literally means an analysis of what needs to be done about the predictions that have been made. This is a useful area and a significant component of the meaningful information that can be extracted through data mining. Considering this is a newer area of data mining, the prescriptive analysis offers actionable suggestions that work as solutions toward the predictions made by the predictive analysis feature of data mining.

Prescriptive analysis is undertaken data hk with the use of the following tools:

Business rules
Machine learning
Computational modeling
An efficiently deployed predictive analytics platform can track the current and upcoming trends, gauge its effect on cash flow, and offer solutions for rectification. For example, if a company is reimbursing claims at a higher or lower level than required, predictive analysis catches the lapse, then displays the inefficacies and offers remedial action through complex algorithms.

The Response of the Medical Billing and Coding Industry to Data Mining
Several data mining techniques are endued with the capability of collating volumes of data to create meaningful analysis and offer predictive outcomes that can assist in increasing efficiency within the medical billing and coding industry by leaps and bounds. While there is no doubt about the advantages of these processes, there is still a wide number of industry professionals who are still to adopt these data analytics techniques. This could be attributed to a certain amount of confusion among industry professionals as to the detailed capabilities of data mining and its subsequent advantages. The hesitancy also comes from the attachment to conventional methods of audit and compliance that are undertaken through mostly manual statistical collection.


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