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Administrative Healthcare Data and SAS(R)

Course Details
Code: BHCDA94
Tuition (USD): $1,650.00 • Classroom (2 days)

This industry-specific course focuses on the payer side of the industry: the origin, content, management, and use of administrative healthcare data. During the course, students become acquainted with the providers, payers, and users of the U.S. healthcare system. This course is a hands-on programming course, but rather, it explores the business of medical claims data, health plan members, and service providers. As a supplement to this course, programmers should consider also registering for Administrative Healthcare Data and SAS(R): Hands-On Programming Workshop, a one-day course that focuses on programming methods and techniques that are useful in the healthcare industry. The two courses are offered on contiguous days.

Skills Gained

  • Recognize the different origins, content, and uses of administrative healthcare data.
  • Understand the intricacies of national claims coding structures.
  • Be aware of evolving issues that face industry payers.

Who Can Benefit

  • Analysts and programmers who need to understand and work with administrative healthcare data

Prerequisites

  • Experience with SAS software, programming, or the healthcare industry is required.

Course Details

U.S. Healthcare System

  • A "30-thousand-foot" view of the industry.
  • Payment systems, payers, and providers.

Healthcare Data Origins

  • Professional and ancillary claims (CMS-1500 claim form).
  • Facility claims (CMS-1450 claim form).
  • Prescription drug data.
  • 837 electronic claims.

Medical Claim Codes

  • Diagnosis codes.
  • Procedure codes.
  • Billing codes.
  • Drug codes.
  • Laboratory codes.
  • Others.

Post-adjudication Data

  • Administrative healthcare data.
  • Data structures, types, and organizations.
  • Data validation and accuracy issues.

The Business of Healthcare Data

  • Business rule development.
  • Available industry rules/guidelines.

Member Files

  • Complexity and use of membership information.
  • Rate setting.
  • Uses of enrollment and eligibility data.

Provider Data

  • Basic structure of provider files.
  • National Provider Registry.
  • Uses of provider data.

Evolving Industry Concepts

  • Brief overview of HIPAA.
  • National identifiers.
  • Public data sources.
  • Industry futures.

HEDIS

  • Understanding the what and why of performance measurement.
  • Overview of several measures.
  • Recommended data structures.

Fraud and Abuse

  • Understanding a major healthcare industry issue.
  • Measuring and detecting fraud.

Looking Ahead - What to Consider Next

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