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Administrative Healthcare Data by Renu Gehring, Craig Dickstein

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Chapter 10: Computing and Tracking Financial Metrics

Introduction

Case Study: Bucketing Costs

Case Study: Calculating PMPM Costs

Case Study: Creating Reports

Conclusion

Introduction

Healthcare insurance companies are interested in figuring out where and how they are spending their money. With this in mind, the Finance/Actuarial departments of most, if not all, healthcare insurance companies compute, track, and report on key financial metrics. These include but are not limited to inpatient, outpatient, and primary care costs calculated on a Per Member Per Month (PMPM) basis.

Most healthcare insurance companies also track key utilization metrics including, but not limited to, ER visits, primary care visits, specialists visits, and inpatient admits. ...

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