Business Knowledge Series course

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 not 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: 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.

Learn how to

• 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 should attend

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

Formats available	Standard duration
Classroom:	2 days
Live Web Classroom:	4 half-day session(s)	System Requirements

Experience with SAS software, programming, or the healthcare industry is not required.

This course addresses Base SAS software.

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