You Can't Afford to be MIA with DIA: ANALYTICS TO ANSWERSEXECUTIVE SERIES Reducing Liability Loss with Data Integrity Audit Use
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A N A LY T I C S T O A N S W E R S E X E C U T I V E S E R I E S
You Can’t Afford to be
MIA with DIA:
Reducing Liability Loss with Data Integrity Audit Use
MARY CHMIELOWIEC, MBA
Executive Vice President
PointRight Inc.PointRight’s DIA
saved $4.7 Million
EXECUTIVE SUMMARY
To say that professional liability is a great concern for long-term care providers is a vast
understatement. If a provider isn’t aware of their residents’ areas of risk, healthcare plans can
get off track and the facility can experience loss. In today’s world of healthcare reform and
industry regulations, knowing what to do and when to do it is vital to staying compliant and
avoiding losses. The best way any provider can circumvent losses is by using a Data Integrity
Audit (DIA) with a unique database that comprises patient-level and facility-level data from
private, commercial and government sources.
This paper looks at the results of a recent study conducted by PointRight Inc. that focused on
how DIA use improved the professional liability loss experience for a long-term care provider.
Claims were considered in the year before and the year after each facility began using DIA.
Both the best and worst DIA user facilities improved their loss experiences after implementing
DIA. The average incurred loss per claim for the 31 months prior to DIA implementation was
$158,705. After utilizing DIA for 2 years, the total incurred loss across all facilities was
reduced by $4,700,000. Annual claims frequency also declined in the same time period after
DIA was implemented.
2THE OUTCOME Healthcare reform continues to impact all providers of long-term
care. Providers must be prepared to demonstrate that the MDS data they submit to CMS is
accurate in order to ensure that proper reimbursements are received.
THE EXPLANATION The current and emerging healthcare reform environment is
complex. Providers must act strategically to avoid claims that result in losses. An experienced
data analytics partner can provide a successful process that helps providers achieve the
desired outcomes they deserve.
THE CONCLUSION Quality data leads to quality clinical outcomes, and helps
prevent losses. A skilled data analytics partner can assist by expertly translating disparate
data into usable information and insight. This is done by using data analytics and Web-based
tools that measure risk, quality of care, compliance and reimbursement accuracy of the
long-term care corporation, division or facility.
100%
D ATA I N T E G R I T Y A U D I T D E F I N E D
You may have heard the term DIA, but what is it, really? It is a patented Web-based tool that
analyzes 100 percent of MDS assessments prior to CMS submission. DIA is a perfect tool for
the reform environment because it screens data in a manner similar to that used by RAC
auditors and surveyors to ensure that submitted records are accurate, and goes beyond
checks performed by MDS software systems to ensure accurate MDS-based reimbursements.
Instant feedback is provided to call out potential inconsistencies and documentation
requirements. By incorporating feedback recommendations into the MDS assessment,
facilities can ensure accurate reimbursement, maintain regulatory compliance, and reduce
risk all while improving residents’ quality of care.
3WHAT YOU DON’T KNOW, CAN HURT YOU
Makes sense, right? But not everyone uses DIA and it can have devastating financial results.
The following charts illustrate the financial losses of 300+ facilities that did not use DIA in
2007. Each subsequent year after DIA implementation decreased liability loss.
Year Total number of % of claims Loss $ per Loss reduced
qualified claims reduced occupied bed (Total)
2007 153 N/A 1,019 N/A
2008 141 7.8% 864 15.2%
2009 141 7.8% 842 17.3%
2010* 109 28% (pending) (pending)
*estimate
ACCURACY IS EVERYTHING
Accuracy and consistency of your data is a top priority for DIA. The extremely detailed
process applies 3,500 coding checks, 750 CMS consistency checks and more than 300 clini-
cal and statistical tests to every MDS assessment to ensure data integrity and assessment
validity. DIA checks for logical consistency, clinical and financial consistency, relationships
between symptoms and diseases, along with treatments and disabilities, and overall coding
of the MDS. DIA also provides multi-facility summaries, aggregate performance data and
reimbursement information including money at risk and potential money unrealized. With
confidence in your data, you’re ready to take the next step.
Don’t leave $$
on the table.
4S U M M A R Y O F R E S U LT S
The study was conducted on a group of more than 300 skilled nursing facilities that imple-
mented DIA in 2007. Facilities were put into two groups: Best and Worst based upon their
adoption of the DIA service. The following table outlines how using DIA improves the profes-
sional liability loss experience for all facilities involved, regardless of their degree of utiliza-
All Facilities Best 50 Facilities Worst 50 Facilities
% of Facilities with PL Losses
28% 16% 32%
in the Year Before DIA
% of Facilities with PL
25% 10% 26%
Losses in the Year After DIA
Average # of Claims Per
0.40 0.16 0.52
Facility Before DIA
Average # of Claims Per
0.33 0.12 0.38
Facility After DIA
No provider can afford to be MIA when it comes to DIA. Don’t you deserve accurate RUG
reimbursement, improved QMs/QIs, better care plans, fewer fines and deficiencies, huge
savings on time and money and better compliance to regulations, policies and procedures?
ABOUT POINTRIGHT
PointRight is the industry leader in providing data-driven analytics and Web-based tools that
measure risk, quality of care, rehospitalization, compliance and reimbursement accuracy in
the healthcare industry. Using some of the largest and best databases in the industry, our
nationally recognized clinical staff, researchers, and technologists expertly translate disparate
data into usable information and insight. For more information, call 781.457.5900 or visit
www.pointright.com.
© PointRight Inc. January, 2014
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