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Background |
Readmission Analysis Module
Health Data Desk's Readmission Analysis looks at every hospital admission for each patient in the payer's data across all providers. Claims that might be duplicates are marked, as are any readmissions within 3-days of the last discharge. Here, an analysis of all 9,000+ claims from a small payer shows that over $175,000 in payments may have been paid twice. The Readmission Analysis module identifies hospitals that have a relatively large percentage of unusual repeat admissions. The Overlapping Claims tool identifies claims with admission dates before the discharge date for that patient's previous claim. Duplicate claims are included in this category. The Transfers tool identifies those claims with an admission date equal to the patient's previous discharge date. The tool separates these transfers to those that stay within the hospital and those that move to a different facility. It also provides a tool for exploring specific hospital-to-hospital transfer paths. The Quick Returns tool identifies those claims in which the patient has been re-admitted to the hospital within a short, client-specified period of time.  Once a patient has been identified as having a possibly duplicated claim, Health Data Desk can bring up all claims for that patient to allow further investigation. Here, the third claim for Patient #18061 appears suspicious because it entirely overlaps the time of the second claim. In this case the payer may have overpaid by $2400. |
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