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With increasing digital interaction and dependency, data has become the backbone of most industries, and healthcare is no exception. To make this sheer volume of data useful, it needs to be carefully stored, processed, and analyzed. Effective data collection and encounter data management can help healthcare businesses improve patient outcomes, optimize costs, and enhance decision-making. This is where Mirra Health Care’s Encounter Data Processing System (EDPS) comes into play as a reliable platform to streamline and optimize data collection and processing.
In this blog post, we will share comprehensive insights into data collection and associate challenges in healthcare, and how Mirra’s advanced EDPS solution can streamline the entire data collection process. Read on for more!
Understanding Data Collection in Healthcare
Data collection involves gathering, analyzing, and utilizing information obtained from various sources. These sources can include patient records, treatment outcomes, diagnostic results, and even patient feedback. This collected data is typically categorized into two main types: quantitative (numeric data) and qualitative (descriptive data).
Quantitative Data
This includes measurable data such as blood pressure readings, lab results, and medication dosages. It is crucial for monitoring patient health, diagnosing conditions, and determining treatment plans.
Qualitative Data
It includes patient feedback, medical history, doctor’s notes, and more. It provides context and insights that are not captured by numbers alone.
The Importance of Data Collection for Health Plans
- Improved Decision-Making: Access to accurate and comprehensive data allows health plans to make informed decisions regarding patient care, resource allocation, and operational strategies.
- Cost Optimization: By streamlining data processing, health plans generate risk scores and optimize resource allocation.
- Risk Management: Collecting and analyzing data helps health plans identify and mitigate potential risks, including financial risks, compliance risks, and patient safety risks.
- Performance Monitoring: Data collection allows health plans to monitor provider performance, track patient outcomes, and evaluate the effectiveness of various health programs and interventions.
- Better Communication: Accurate data facilitates better communication and collaboration between health plans, providers, and patients.
- Predictive Analysis: Health plans can use predictive analytics on collected data to forecast future trends, identify high-risk patients, and proactively manage potential health issues.
- Member Satisfaction: By collecting and analyzing data on member experiences and satisfaction, health plans can tailor their services to meet member needs and improve overall satisfaction.
Challenges and Considerations in Data Collection
Data Security and Privacy
Health data includes highly sensitive personal, medical, and financial information. Therefore, it is a prime target for cyber-attacks and unauthorized access.
Health plans must comply with stringent regulations such as HIPAA (Health Insurance Portability and Accountability Act), which mandates strict standards for data security and privacy. Non-compliance can result in hefty fines and legal consequences.
Data Quality
Healthcare data can be inconsistent, incomplete, or inaccurate since it comes from various sources. In addition, duplicate patient records are a common data quality issue handled by health plans.
Interoperability
Health plans collect data from a wide array of sources, including hospitals, clinics, labs, and insurance providers, each using different systems and platforms. The lack of standardized protocols and formats for data exchange makes it challenging to integrate data from disparate sources.
Read More: Data Overload
The sheer volume of data generated by healthcare activities can be overwhelming. This vast data collection makes it difficult to extract relevant data and generate actionable insights.
Besides, storing and managing large datasets requires additional resources and robust infrastructure.
How Mirra’s EDPS Solution Revolutionizes Healthcare Data Collection
1. Error Correction and Prioritization
Mirra’s EDPS solution ranks and prioritizes error correction activities by Hierarchical Condition Categories (HCC). This ensures that critical errors are addressed immediately while maintaining data accuracy and compliance.
In addition, our encounter data processing system can manage and interpret CMS data more efficiently, further enhancing the error correction process.
2. De-duplication and Data Reconciliation
Mirra's EDPS solution de-duplicates EDPS encounters, manages CMS data and defines and reconciles discrepancies. It helps health plans work with clean and accurate data.
Furthermore, the solution also includes HIPAA and CMS-specific edits to enhance data integrity.
3. Compliance and Accuracy
Our EDPS solution generates CMS-compliant 837 (v5010) format files and converts customer files into internal formats. This process ensures accurate, complete, and compliant encounter submissions using a sophisticated Rule Engine.
This compliance is crucial for health plans to meet regulatory requirements and deliver high-quality care.
4. Real-time Tracking and Dashboards
The solution offers real-time file status tracking with batch scheduling and detailed dashboards that provide insights into file status, encounter error distribution, and encounter distribution by frequency code. These features enable health plans to monitor and manage data effectively.
5. Automation and Efficiency
Mirra’s EDPS solution automates the process of receiving and analyzing CMS responses (TA1, 999, 277CA, MAO002) and applies MAO004 and invalid RSP and MAO001 responses. It also classifies encounter rejections by type and prioritizes error correction activities by risk score. We utilize automation to enhance efficiency and reduce the administrative burden on health plans.
6. Comprehensive Data Management
We ensure complete data management by reconciling source files with CMS responses, tracking diagnoses back to source files based on the MAO004 received, and managing discrepancies. Our EDPS solution also provides unique IDs for submissions, encounters, and files, enhancing data traceability and integrity.
7. User-friendly Features
Mirra’s EDPS solution offers a user-friendly and intuitive interface for individual corrections through a web portal. It allows users to upload files for processing, manage users and plan IDs, and generate ad hoc reports. These features make the solution accessible and usable for health plan administrators.
Moreover, our EDPS solution provides detailed reporting capabilities, including encounter error distribution dashboards and encounter distribution by frequency code. These reports help health plans analyze data effectively and make informed decisions.
The Bottom Line
Effective data collection is crucial for improving patient outcomes, optimizing costs, and enhancing decision-making in healthcare. Mirra Health Care’s EDPS solution offers an advanced platform to streamline and optimize data collection and support health plans in delivering high-quality care.
By leveraging Mirra’s EDPS solution, health plans can ensure data accuracy, compliance, and efficiency, ultimately leading to better patient outcomes and improved financial performance. Connect with us to schedule a no-obligation demo now!
