Once again, we are pleased to announce that CMS, the Centers for Medicare and Medicaid Services, has chosen Opera Solutions for a three-year, $28 million contract that will enable Opera Solutions to provide the operational analytics that drive the Health Insurance Marketplaces of the Affordable Care Act. In this role, Opera Solutions will continue to build on the strong foundation it has built in the first three years of this relationship, adding more advanced analytics and ensuring data integrity across the widespread, diverse data environment within CMS.
Is now the right time to add machine-learning analytics into your charge-capture management system?
ICD-10 is here and chances are, as a provider, you’re as ready for it as you can be, knowing there could be some hiccups and impact on revenues. Most predict that the impact will be confined to inpatient revenues, driven by significant adjustment issues in grouper methodologies. But what if the impact extends well beyond that, to outpatient revenues?
Edited by Yan Zhang
Healthcare fraud, waste, and abuse (FWA) are national problems that affect all of us either directly or indirectly. National estimates project that hundreds of billions of dollars are lost to healthcare FWA on an annual basis. These losses lead to increased healthcare costs and subsequently increased insurance premiums.
Switching to a new medical coding system won’t be easy, but when combined with data science and machine learning, ICD-10 presents enormous potential benefits for both the financial and the clinical sides of healthcare.
Part of why the healthcare industry is such a notorious laggard in jumping on the Big Data bandwagon is that every attempted change faces a huge domino effect, rendering many good ideas useless until everyone — and everything — is ready. One big step in the right direction, however, is an important upgrade to the computerized codes used for electronic medical records (EMR), which will take hold in the next year or two. These codes, known as ICD or International Classification of Diseases, determine what ailments patients have and how much they and their insurers should pay for a treatment. The set of codes, currently called ICD-9, is scheduled for its 10th revision this fall (but there may be a year-long delay). The new ICD-10 codes allow for much greater detail than the existing codes in describing illnesses, injuries, and treatment procedures. Through the use of data science techniques, this increased granularity is expected to allow for improved tracking of public health threats and trends as well as better analysis of treatments.
Since retail clinics started gaining popularity in 2007, healthcare professionals have been worried — for all sorts of reasons. Will patients still get the care they need? Will they visit their doctors less? How will these clinics impact patient volume in nearby emergency departments?
Predictive analytics–based staffing solutions can save hospitals millions.
While we wait to see how insuring more of the population affects healthcare costs for patients, hospital groups are also working hard to reduce the cost of healthcare. Some hospitals are reducing unnecessary department labor costs — in some cases staff hours have been reduced by up to 8% — by using solutions that analyze Big Data to predict patient inflows. With accurate patient forecasts, hospitals can optimize scheduling to better match supply (nurses) to demand (expected patients). Not only does this reduce costs, it makes their hospitals more efficient and even increases patient satisfaction.
While some users are just now getting their footing in Big Data, two — healthcare management and fraud prevention experts —are already successfully using predictive analytics to deliver unprecedented results. And so it makes sense that the Centers for Medicare and Medicaid are turning to Big Data predictive analytics solutions to prevent fraud and enhance operational controls in the new health insurance exchanges that form the centerpiece of the program.
NEW YORK, N.Y., Nov. 15, 2012 — Opera Solutions, LLC, a leading global Big Data science company, today announced that it has been selected by the Centers for Medicare & Medicaid Services (CMS) to provide advanced analytics to enhance operational controls and prevent fraud in federally funded Health Insurance Exchange Operations (“HIX”) managed by CMS’ Center for Consumer Information and Insurance Oversight (CCIIO). Opera Solutions will apply its unique healthcare claims data anomaly detection experience, in tandem with its extensive origination/eligibility and fraud detection expertise, to support CMS’ rollout of the Exchanges that begins in January 2014.
NEW YORK, N.Y., June 20, 2012 — Opera Solutions, LLC, a leading global Big Data predictive analytics company, today announced the general availability of its Revenue Cycle Management solution.
Already in use in more than 60 hospitals, the solution helps hospitals significantly increase profitability and operating efficiencies by identifying missing charges and reducing audit expenses. Based on industry profitability averages, hospitals using the solution can increase their operating income by 10 percent or more.