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In healthcare businesses, common IT solutions like Encounter Data Processing Systems (EDPS) continuously transmits data. This data exchange helps a business make informed decisions about providing quality care and ensuring efficient operations.
However, in the current scenario, integrating these systems can be challenging due to lack of standardization, data quality issues, system complexities, and privacy concerns. These challenges can lead to inaccurate risk scores, wasted resources, and financial losses for health plans. Mirra’s encounter data processing solutions efficiently handles 837 data, ensuring it's complete and compliant before transmitting it to CMS. It also automates responses and calculates accurate risk scores to improve the financial performance of health plans.
Mirra’s encounter data processing solutions efficiently handles 837 data, ensuring it's complete and compliant before transmitting it to CMS. It also automates responses and calculates accurate risk scores to improve the financial performance of health plans.
In this blog post, we will share a comprehensive understanding of the common interoperability challenges faced by health plans when integrating EDPS and how Mirra's encounter data processing services can help. Read on for more.
What is Interoperability and Why is it Important?
In a traditional healthcare setup, a healthcare entity relies on a different system for everything – patient data (HMS), providers’ access to patient records (EHR), and premium billing. These outdated systems do not have the functional ability to work with other systems or products without extra effort from users. That's where interoperability comes to the rescue!
Interoperability streamlines the connection and communication between different systems to create a more unified database. According to the National Library of Medicine*, widespread medical device interoperability can eliminate more than $36 billion worth of waste in inpatient settings alone.
With a comprehensive view of patients' health, interoperability facilitates quicker and more precise diagnoses, reducing the need for unnecessary procedures. On the other hand, it enables automated information exchange, which helps administrative staff minimize errors in scheduling and billing tasks.
Common Interoperability Challenges
Data Standardization
In the healthcare industry, there's no universal standardization for data formats and hence there’s no one-size-fits-all data processing solutions. Different healthcare IT systems use different proprietary languages. So, when they try to exchange data, it's like trying to understand a different language without a translator. This incompatibility can lead to errors, delays, and loss of information.
Take the example of a doctor's office that uses system A to record patient visits and the health plan that utilizes system B to calculate risk. Since both sets of data are entered in different formats, any data exchange between these two systems will not be possible. Even if any attempt is made to integrate the two different sets of data, the output may run the risk of being misrepresented, inaccurate, which will in turn lead to incorrect inaccurate risk assessments.
Read More: MRA Compliance: Challenges And Opportunities
Data Quality Issues
Accuracy and inconsistency are two common problems associated with healthcare data. Manual data entry can result in missing information, incorrect coding, and duplicate entries, which eventually impacts the overall data quality.
Adding this inaccurate data to the system is like adding the wrong ingredients to a recipe. If this incorrect data goes into the system, it will miscalculate risk scores, which are used to determine reimbursements for patient care management services. This can lead to underpayment for high-risk patients, who require more resources, and overpayment for low-risk patients.
Complexity in System Integration
Imagine what will happen if you are trying to connect a USB cable to an HDMI port. It simply won't work. The same principle applies to healthcare IT systems.
Different healthcare IT systems have their own unique API (Application Programming Interface) or communication protocols. Therefore, integrating these systems for data exchange requires proper integration tools and data processing solutions.
Privacy and Security Concerns
Protecting sensitive patient data during the data exchange process is one of the most important responsibilities.
HIPAA (Health Insurance Portability and Accountability Act) mandates robust security measures to safeguard patient privacy during data transformation process. If there are any privacy concerns during the data exchange process between different systems, it can damage a health plan's reputation and result in expensive fines and legal complications.
Solutions for Seamless Data Exchange in Healthcare Interoperability
Standardize Data Formats
Adopting standardized data formats like HL7 (Health Level Seven) or FHIR (Fast Healthcare Interoperability Resources) can help healthcare businesses implement efficient data exchange and processing solutions. These standardized formats act as a common language that allows data to be understood and exchanged across various IT systems, including EDPS.
Manage Data Quality
Healthcare businesses should implement data quality management practices to ensure accurate data exchange. It refers to the process of cleaning and organizing filing cabinets before feeding information into EDPS. While data validation techniques help identify and rectify errors, data cleansing removes duplicates and inconsistencies.
Mirra's encounter data processing solution helps maintain data quality by managing and interpreting CMS error reports in real-time. Our data processing services targets high-impact issues by utilizing HCC risk prioritization. These features act as a safety net, catching and fixing errors before they affect the data exchange process.
Align Data Sources
The complex interaction between Claims, EDPS, MAO-002, and MAO-004 can create inconsistencies while integrating different systems. Our EDPS acts as a bridge to resolve differences and maintain data accuracy across platforms.
This process helps health plans ensure a smooth data transfer and avoids expensive discrepancies and delays in the decision-making process.
Take Robust Security Measures
To ensure HIPAA compliance, Mirra’s EDPS solution incorporates robust security features like encryption and access controls.
While encryption makes data unreadable during access attempts from unauthorized sources, access controls ensure that only authorized users can access patient data. These two advanced features safeguard sensitive patient data throughout the data transformation and integration process.
In addition, our EDPS solution also performs HIPAA and CMS-specific edits on encounter data before submitting to CMS.
Benefits of Using Mirra's Encounter Data Processing Solution
Improved Accuracy of Risk Scores
By ensuring accurate data exchange, Mirra's Encounter Data Processing solution provides more precise risk scores.
Clean, accurate data allows EDPS to calculate risk scores that reflect the actual health status of a plan's member population. It helps payers to allocate resources accordingly.
Increased Revenue
Accurate risk scores, paired with efficient resource allocation, can improve the financial performance of health plans. Mirra's EDPS solution ensures that health plans receive appropriate reimbursement for high-risk patients and avoids unnecessary expenses associated with inaccurate data - all of which help maximize their financial growth.
Simplified Workflow
Mirra offers advanced automated solutions for Medicare Advantage plans including claims processing, premium billing, EDPS, etc. Our EDPS system has automated features and user-friendly interface to minimize manual intervention, saving valuable time and resources. Our solution also allows health plan staff to focus on core business functions, such as member care and quality improvement initiatives.
Taking the Next Step
Seamless data exchange between different IT systems is critical for accurate risk adjustment in healthcare. If you're struggling with calculating accurate risk scores, Mirra’s encounter data processing solutions can help. Contact us to schedule a consultation with our experts and learn more about how our EDPS solution can simplify your data exchange process and improve your financial performance. Contact us to schedule a consultation with our EDPS experts.
* Data retrieved from WHY INTEROPERABILITY IS ESSENTIAL IN HEALTH CARE.
