Compliance Services

Data Mining & Data Analysis (Laboratory)
In recent years, the government and third party payors have increasingly relied upon data mining technology and analysis to discover patterns, trends, ratios and aberrant claims data submitted by healthcare providers. These techniques have led to more findings of overpayments, particularly when combined with documentation inspection. Some healthcare providers have readily adopted such techniques as part of their internal audit and compliance activities. Others, many with less available resources, have not implemented data mining as part of their revenue management and compliance activities.  Instead they rely on in-house or clearinghouse claim edits and controls. Such internal controls are not a substitute for data mining.

Trusent Solutions can help. We can work with you to develop a data mining program or conduct data mining on your claims data. Our analysis relies on statistical methodologies to discern financial and operational knowledge largely unknown to hospital management. Our procedures require careful scope definitions so that our data capture is tailored to your needs. We work with your management team to define and explain the parameters of the statistical measures used in the data mining project. Our deliverables include a written report of the results for management with our recommendations.

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