The claims and billing data of healthcare providers for the Medicare Program, after being kept behind closed doors for around 35 years, was recently made accessible to the public in the second week of 2014, excluding patient data due to the patients’ rights of privacy.

The big data includes care provider information, their specialties, procedures and related costs.

Due to reasons such as intrusion and misuse of privacy, many groups have protested against such  information  being made public. Patient health information is private and any potential disclosure can result in damage for both the patient and provider.

Government agencies and industry groups on the other hand have positive opinions about the release and expect to find conclusive data on reductions in cost that can be achieved through this program.

It is imperative to realize that this data is truly significant to understand the various angles of federal expense on healthcare, billing platforms of providers, and embezzlement to enhance the customer experience and make the system fool-proof.

Some of the best ways payers and providers can leverage analytics solutions to enhance customer experience includes fraud prevention, usage of doctor ratings, and potential cost-reductions.

Reports conducted by the government in 2012 revealed that the value of improper payments were around $44 billion, in the Medicare Program. Further calculations reveal that around 8% of the $555 billion total payments were improper payments, revealing an opportunity to reduce costs in the future.

The evolution of digital information analytics has brought about advanced models of estimation and/or prediction that decipher and reveal improper payments information, based on factors such as provider billing estimates, cost estimates and patient behavior.

By having access to such information, patients will have greater decision-making power. For example, if a patient wants a specific operation or surgery, he can search for providers who performed that operation or surgery and make a decision based on how many times that procedure was performed over the course of one year. This can also help in developing a rating system of doctors for specific treatments that patients can use for their benefit.

The Medicare claims data is a very useful piece of information that analysts can utilize to improve healthcare provision, optimize patient and customer experience, and reduce anomalies in billing cycles.

 

EHRs