Question

Briefly explain why claims data is the preferred resource for analytics and reporting. Include at least one example.

Answer 1

Claims data are the one which is used for reimbursement process.It is a form of obtaining patient information and the use of hospital resources for mefical conditions and procedures.It requires a series of value judgement and side in improving data quality. It should involve age,gender,total health care cost,diagnostic code ,procedure code,place of service ,employment status.It has billing codes in it.It uses a standard set of codes.A holistic relationship between patient doctor are established. The most advanced form used now is EHR

For example

If a patient has a follow-up after 6 month, meanwhile if he is sick he may meet a physician or take OCT medications ,undergo laboratory test where it cannot be recorded in EHR by the primary physician during the visit while having a follow up.