How do you identify and resolve encounter data quality issues?

The complex nature of the encounter data process creates many issues for healthcare organizations, including an average 1%-3% of premium lost due to unreported risk. Gone unresolved, data quality issues can have a negative impact on performance.

Pareto’s Data Integrity solution independently analyzes data generated by providers, payers and CMS by applying detailed encounter-level analytics to uncover data quality issues suppressing risk scores, impacting quality measures (HEDIS®/Stars) and/or posing potential compliance issues.

20:1 ROI

average for clients in the MA and ACA markets

$30 TO $50

average PMPY impact for underreported risk in the MA and ACA markets

60% TO 85%

of data quality issues exist prior to submission, requiring an end-to-end evaluation of encounter data processes

100%

of Pareto’s Data Integrity evaluations lead to improved financial accuracy

Automate & Prioritize Gap Identification & Remediation

Pareto’s Data Integrity solution offers a comprehensive analysis of end-to-end encounter data accuracy to automate and prioritize gaps for remediation. We utilize proprietary algorithms to uncover the primary root causes impacting revenue and compliance, allowing you to resolve issues at the source and prevent future inaccuracies. All results of our analysis are delivered on our secure, web-based tool with configured reporting to enable speedy resolution and resubmission to CMS in advance of submission deadlines.

Through our extensive experience working with over 25 healthcare organizations, Pareto has evaluated both internal encounter processes to refine strategies and recommend efficiencies, as well as submission accuracy to the government or CMS. This includes being trusted by multiple delegated submitters to ensure the accuracy of their own processes.

Holistic Evaluation

  • Encounter-level data evaluation identifies where data quality issues exist
  • Financial exposure quantification determines the value of data discrepancies and prioritizes remediation
  • Root cause investigation allows for resolution of issues at the source
  • Web-based tool provides actionable insights into current performance and allows for additional data exploration
  • Compliance evaluation identifies potential under- and over-reported encounter submissions

Why Pareto?

Compliant

We focus on complete and accurate encounter data to mitigate compliance exposure.

Transparent

Our solution is not a “black box.” We provide transparency into the analytics and outcomes of our evaluation.

Flexible

From a one-time diagnostic assessment to full operational evaluation, we offer multiple delivery options, as well as configurable outputs to support specific needs.

See it and Believe it

Our demos say it all. Tell us about your challenges and we’ll show you how we can help you overcome them.

Schedule a Demo