Data-Mining Panel - Tennessee Hospital Association

levelsordData Management

Nov 20, 2013 (3 years and 4 months ago)

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THA


October 21, 2009

Data
-
Mining Panel Discussion

Talking Points


-
Data Mining Overview

-
Industry Status Post RAC demo project

-
Provider Perspective


Reasons to Proactively Mine Data at the Provider Level



RAC, ZPIC, MIC, MAC, etc.



Law Enforcement Cases Developed from Data Mining


Data Mining Tools


Commercial v. Home
-
Grown


Data Mining Challenges



Government Contractors performing Data Mining on Tennessee
Provider Claims Data (Medicare and/or Medicaid)


*
RAC


Recovery Audit Contractor


Connolly Consulting


*ZPIC


Zone Program Integrity Contractor

-
AdvanceMed


(currently a PSC


Program Safeguard Contractor)


*Medicaid Integrity Contractor

-
AdvanceMed


*Medicare Administrative Contractor

-

Cahaba Government Benefit Administrators


Select Government Programs with Contractors Performing Data Mining
on Tennessee Provider Claims Data (Medicare and/or Medicaid)


*
CERT


Comprehensive Error Rate Testing Program


Program administered by
AdvanceMed


Statistical Contractor


The
Lewin

Group


*
PERM


Payment Error Rate Measurement Program

-

Tennessee part of FY 2010 Program

-
Statistical Contractor


Livanta
, LLC


*PEPPER


Program for Evaluating Payment Patterns Electronic
Report

-

TMF Health Quality Institute


One Program Integrity


http://www.edssafeguardservices.eds
-
gov.com/onePI.asp


A 3
-
part claims analysis system for data mining by contractors
and

government employees (Medicaid, MFCU, OIG, DOJ, etc.)



1) The Portal or Gateway designed for
“collaboration”



2) Data Analysis Tools: Business Objects & Advantage Suite



3) Role
-
based access to Medicare & Medicaid Data including
Hospital, Physician, DME, Home Health, Ambulance,
Pharmacy etc. for
combined

analysis.