Viewpoint: Big data, analytics can help physicians cut claim denials

Physician practices seeking to improve efficiency and accuracy of billing and collections by reducing claim denials should focus on using big data and predictive analytics, according to Karun Philip, PhD, president and co-founder of healthcare technology company Tranquilmoney.

"Big data analytics can find data patterns such as causes of insurance claim rejections, strategies to follow and so on," Dr. Philip stated. "This helps providers submit accurate claims as often as possible, allowing the reduced number of manual interventions to be more productive."

He said big data can simplify and improve accuracy in the billing process by identifying medically necessary and completed procedures.

Reducing medical errors and eliminating duplication of services reduces claim rejections and even unintentional fraud, Dr. Philip said

Additionally, value-based programs such as the Medicare Shared Savings Program can use artificial intelligence and data analytics to predict outcomes and treatment plans, he said. Data analytics also can be used in revenue cycle management and to determine margins for ancillary services and the most financially beneficial value-based contracts.


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