4 ways analytics can help a compliance team

Published
  • February 02 2017, 4:00am EST

How analytics helps compliance team members do a better job

With acute care and ambulatory providers near universal adoption of electronic health records and physician practice management systems, the amount of billing and claims data has grown exponentially. This data can give providers new insights into regulatory and financial issues that were not previously available.

But it is not just managers and supervisors who can benefit from the analytics that all this data can support, according to Hayes Management Consulting. “In particular, use of analytics can significantly improve communication between the compliance team and other departments in the organization,” the firm notes. Here are examples of how four compliance team members can get real value from analytics.

1. Compliance officer

Analytics gives compliance officers a global view of the entire organization. The increased use of analytics gives them tools to spot and proactively address variances and shifts that may be indicative of emerging risks. Tools boost the effectiveness of the compliance program by enabling the compliance officer to access data directly, rather than relying on other groups to provide it. This greatly aids the rest of the team when they need to conduct more in-depth investigations.

An analytics program enables the compliance officer to help create dashboards that incorporate specific areas of potential risks. Dashboards provide operational and action-oriented data by providing alerts to predefined tolerance levels, opportunities for rapid drill down to pinpoint specific claims and the ability to facilitate mitigation and resolution of issues. Analytics tools and rapid access to additional data frees up the compliance officer to spend more time uncovering issues and potential risks.

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2. Auditors

The routine audit function often consists of reviewing samples of 10 or 20 cases devoid of other context, leaving the auditor with a limited view of the actual activity in a particular area. With an analytics program, the audit doesn’t have to end with a simple review of sample cases. After the review is complete, auditors can use analytics to do a deeper investigation by looking at the physician profile and reviewing activity to better understand physician billings and claims.

An in-depth review can help reveal new issues or provide evidence of existing ones. An auditor can then take this history and match it to the audit just conducted to see if they align. This type of extended review can also uncover other issues that can be brought up with the physician. This analytics-based approach makes the auditing process much more comprehensive and efficient and gives auditors a more global view of organizational activity, rather than being limited to a particular slice of time or limited sample of audited claims.

3. Trainers

Reviewing bigger picture analytics also can provide significant benefits for trainers. Using analytics, the trainer can gain a wider scope when doing ad hoc training or individual training with physicians.

Analytics data also can be helpful when training new physicians from specialty departments. Trainers are able to research the specialty beforehand, familiarize themselves with the different procedures and services involved and identify how each is billed. This information can be invaluable to trainers, providing them with a common language that will improve communication in meetings with physicians, practices or departments to begin or follow up on training sessions.

4. Investigators

Issues will inevitably arise and when they do, it will be helpful for the investigator to review the data from a global point of view. Investigators are often focused on singular events such as potential violations of laws or regulations. Reviewing data collected in an analytics program enables investigators to view individual instances within the context of the area involved or the organization as a whole.

If the Office of the Inspector General within HHS is involved, the investigator is required to conduct a thorough investigation complete with a written report of all potential violations that describes in detail the targeted conduct. Having access to detailed information as a result of a robust analytics program will help the investigator get to the heart of the issue quickly to help mitigate penalties.

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More information

Use of analytics in healthcare is proving to be significant in helping to reduce and often avoid risks. It is also becoming an important component in helping individual members of the compliance team and making the compliance program stronger and more effective. In the end, that will greatly benefit the organization as a whole.