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Hi Fishes, I recently joined Pwc AC and was informed to update my checkpoint portfolio where we update all our investments. If we have some investments and if we do not declare them, will it be a problem or can I update it as Nothing to report. Recently I joined here so I'm having some confusion regarding this.
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Probably source dependent. MEDPAR is 100% of discharges but commercial / MA data sets have sampling issues from the clearinghouse / you may have to use scalers.
U find a proof point
Love that you’re using FB for an actual work question 🤓
I think I would start looking at the top: Are we double counting claims? Do we have incorrect claim codes? Are the claim codes too broad? Is it a programming / sql counting error? Does this get replicated with another disease area as well?
All claims data goes through a clearinghouse and various vendors get different proportions of the claims in the claims universe.
If a subset of hospitals sends its claims through a clearinghouse that's better represented in your vendor's data, then you may not have an equal distribution. Look for patterns in your data to see if this is true. Indeed you may need different scales.
But, like others have mentioned, there may be other reasons. Do you really need claims, or are patients the right count? If claims, are you looking at the final one? Is there a reason the smaller hospital could actually be doing more of said procedure (they have more doctors in that department, it's their specialty area, they happen to have a high volume clinician)?
Claims data is as much art as it is science. Think of it as a puzzle to solve :)
^ only MCO claims, FFS claims do not but I agree with your statements on the clearinghouse challenges